New Study: Docs Don’t Talk about Sex

When was the last time your doctor asked you how your sex life was going?

I thought so.

In a new study, a team from the University of Chicago surveyed over a thousand OB/GYNs about whether they talk with their patients about sex. The results may not surprise you, but they won’t reassure you, either.

  • 63 percent routinely ask whether their patient is sexually active. (Good, but fairly superficial.)
  • 40 percent routinely ask if the patient is having any problems regarding sex. (Which means that 60 percent don’t ask about sexual problems.)
  • 28.5 percent ask about sexual satisfaction. (Which means that two out of three doctors don’t ask.)
  • 28 percent ask about sexual orientation or identity. (Yikes! Two out of three don’t even know if their patient is gay or bisexual.)
  • 13.8 percent ask about sexual pleasure. (Which means that 86 percent don’t ask whether the patient enjoys having sex.)

Even more distressing was that 25 percent of OB/GYNs reported expressing disapproval of a patient’s sexual practices. Foreign doctors, older doctors, and very religious doctors were more likely either not to address the issue of sex or to express disapproval. Female doctors and those whose practice focuses on gynecology rather than on delivering babies were more likely to do some sexual assessment, although it was often insufficient.

Dr. Stacy Tessler Lindau, a practicing OB/GYN and lead researcher in the study, points out that OB/GYNs are the most appropriate health care provider to be asking these questions, and if they aren’t, it’s unlikely that anyone else is. Which means, as we have found repeatedly, that women tend not to mention sexual problems, to assume that a doctor can’t help anyway, and to suffer with or adapt to sexual problems on their own.

Doctors should be talking about sex with their patients because

  • Sex is an intimately linked to overall quality of life and the quality of one’s relationship.
  • One-third of younger women and one-half of older women report having some sexual issues, from lack of desire to painful intercourse
  • A change in sexual patterns can indicate an underlying health problem, such as depression or thyroid problems.
  • Women with ongoing sexual issues are more likely to feel self-conscious, isolated, embarrassed, ashamed, or guilty.
  • Assuming that a patient has a heterosexual orientation is alienating to patients who are lesbian or bisexual and can result in miscommunication and misdiagnosis.
  • Common medications, such as those for depression and breast cancer, for example, can cause sexual problems, such as low libido. Women are often not told about sexual side effects of medications and are therefore unprepared to cope with them.

The researchers hypothesize that doctors don’t talk about sex because, like everyone else, they’re embarrassed or they may worry about embarrassing their patients. Talking about sex isn’t part of their medical training, and although they may treat a woman’s sexual organs, they aren’t equipped to assess and treat her sexual problems. So what’s a frustrated patient to do?

Take the initiative, counsels Dr. Lindau. If you trust your doctor, but he or she hasn’t asked about your sex life, you can, and should, begin the conversation.

  • Formulate your questions ahead of time. What, exactly, do you want to ask your doctor about sex? Do you have specific issues, such as painful intercourse or low libido? Are you anxious about entering menopause and need information about what to expect? Write down your questions and be as specific as possible.
  • Acknowledge your discomfort, advises Dr. Michelle Curtis. It clears the air. “I know this is a little embarrassing, but I have some questions about sex I’d like to discuss.” Don’t worry about embarrassing the doctor, says Dr. Curtis. It’s his or her job to answer your questions.
  • Empower yourself. The medical profession will change as women take responsibility for their own sexual health and begin asking questions and expecting thoughtful answers. You can ground yourself in basic information with websites like this one or others backed by solid medical organizations, such as the Cleveland Clinic or Mayo Clinic. Then you can approach your doctor with good, informed questions.
And if your doctor doesn’t respond in kind, avoids your questions, or seems uninformed, you can consider finding another doctor. We’ll discuss that process in a future post.
June 27, 2011

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conditions ›   health care ›   intimacy ›  


Having “The Talk”—with Your Doctor

Just when you thought you were home free—the kids are grown, and you’ve somehow gotten through multiple birds-and-bees talks. But now you find the shoe is on the other foot, and you’re the one needing information about sex. Maybe a health issue is affecting your sex life, or maybe your body is responding differently, or maybe you’re just not as responsive as you used to be. Where do you go for straight talk about these nitty-gritty topics?

According to a presentation I heard at the International Society for the Study of Women’s Sexual Health (ISSWSH) conference “physicians often do not talk to their patients about sex.” It occurred to me that the effect of this oversight is similar to neglecting the “talk” with our kids, i.e. you end up muddling along with misinformation, rumors, or half-truths.

Oddly, doctors cite similar reasons (excuses?) as the rest of us for avoiding the “talk” with their patients: They don’t have time; they don’t feel comfortable; they don’t know enough about this medical subspecialty to feel competent and helpful.

To be honest, doctors do operate under very tight time constraints in the course of a normal day. Also, sometimes, after talking about health and body parts for years, we forget how uncomfortable it might be for you to bring up what you consider an embarrassing problem. Rest assured, however, that we’ve probably discussed that problem before with someone.

None of this lets anyone off the hook. Sex is an important component to physical and mental health and well-being, and if you have questions or problems, who better to discuss them with than your doctor? If your doctor isn’t taking the initiative, here are some ways to help get the conversation started.

  • Write down your questions. This exercise may help you clarify what you want to talk about, and it will definitely help you to remember everything.
  • Prime the pump. At the beginning of your appointment, mention that you’d like to discuss some sexual issue that you’ve been experiencing. Or, get more specific—that you’d like to explore your options for vaginal lubricants or whether your medication might be diminishing your sexual interest.
  • Be clear, specific, and thorough. Don’t leave something out because it’s too embarrassing or doesn’t seem pertinent. You wouldn’t neglect to mention to your mechanic the little whirring noise in the rear axle when you turn left. Why would you omit an itch or pain or change you experience in your body?
Once you get over the initial hurdle of actually saying the S-word in front of your doctor, you may find it much easier to talk about sex the future. After all, as you told your children all those years ago, sex is just a natural part of life.
April 13, 2011

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health care ›   pelvic tone ›  


Q: Will Kegel exercises help me recover from pelvic floor damage from trauma?

It sounds like you could benefit from a really good pelvic floor physical therapist. While many physical therapists have some training with the pelvic floor, there are only a few with that specialty. Find out who that person is in your community and ask for a referral to him or her.

Physical therapists will have tools that help them determine the strength of the muscles, which helps them make an informed plan for properly improving the tone; Kegel exercises are just one tool in that process. Sometimes after a trauma there is muscle spasm; part of the therapy may be training certain muscles to relax.

It's a good approach to see how far you can get with exercise and therapy before you consider reconstructive surgery. Good luck with your continued recovery from your accident!

April 28, 2010

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health care ›   learning ›  


A Menopause Care Provider? Really?

It took a very long time for the medical community to to take the physical and psychological changes that come with the menopause seriously at all. And it took still longer before we began developing supportive products and discovering treatments that help ease this transition. View full article →