Why Do Some Healthcare Professionals Medicalise Sex?

Read about the author Samantha Evans

Sexual intimacy and pleasure play a huge role in the lives of many people. When that sexual function changes as a result of the ageing process, injury, disease, disability, surgical or medical interventions, some people seek help from a healthcare professional (HCP) such as their GP.

Yet, from talking to our customers, we have found that the advice is quite varied, with patients being dismissed for wanting to enjoy a sex life due to their age or disability, misinformed about regaining their sex life or prescribed medication with no additional information.

If a man is experiencing erectile dysfunction the doctor should ascertain the reason rather than just prescribing Viagra. Often stress, anxiety, heart disease, diabetes and side effects to other medication can all impact upon sexual function.

If low libido is a problem, the man should be made aware that oral medication will only be effective if a man feels sexual desire and has some form of foreplay. He won’t get an automatic erection half an hour after popping a pill which is what the majority of men believe.

Many men benefit from taking Viagra but for some, it may not be effective.

Low testosterone can affect sexual function for men and taking testosterone supplements is big business in the US and going the same way here in the UK, being one of the top 10 most prescribed drugs which may be costing the NHS 20million a year. Often seen as a quick fix, the side effects of testosterone are still relatively unknown.

However you can increase your testosterone naturally through lifestyle changes mentioned below which improve overall sexual function. This may not work for all men but it should be recommended before prescribing a pill.

Low doses of testosterone have been found to be beneficial for women experiencing low libido.

Losing weight, taking regular exercise and eating healthily can all improve sexual function, a pathway which should be explored before prescribing medication or sex therapy.

Male sex toys can enhance male sexual function and add different sexual sensation to your sex play too.

Sex is so often medicalised by some HCPs as they cannot think beyond their training or their own sexual preferences and prejudices. Training seldom includes talking about sexual issues in depth.

A 2012 paper, “Why don’t healthcare professionals talk about sex?”, found that only 6% of practitioners initiated discussions about sexual health problems on a regular basis.

Many of those who do discuss sexual problems with their patients rarely offer simple, common sense solutions, such as prescribing a sexual lubricant or suggesting using a sex toy but refer them for sex therapy, for which there is often a long wait, or prescribe medication or some medical device that is often ineffective and patients will not use.

They also struggle with people who are not heterosexual or assume everyone is heterosexual.

Worryingly, some healthcare professionals are advising gay and bi sexual women that they do not need a smear test because they do not have sex with men. This demonstrates a lack of understanding about the Human Papillovirus and how it can be spread through mutual masturbation, oral sex and sharing sex toys.

Many people from the LGBT community often struggle to get the right advice or treatment because of the attitude of the HCP, their sexual beliefs or complete lack of knowledge.

A survey of nearly 7,000 sexually active women between the ages of 16 to 74 found that nearly one in ten British women finds sex painful published in the British Journal of Obstetrics and Gynaecology (2017)

Yet much of the medical advice given by experts in sexual health reported in the press in response to this study just said “use lubricants”. This is not good enough as many commercially available lubricants contain substances which upset the balance of vagina flora, leading to thrush and bacterial vaginosis. Much of this medical advice was also aimed at menopausal women when the study highlighted that younger women experience painful sex too.

When prescribing a sexual lubricant, HCPs need to be aware of what some of them contain, such as glycerin which promotes the growth of thrush. When advising their patient to buy a commercial lubricant they need to tell them to check the ingredients for glycerin and parabens as these both cause imbalance to the vagina flora leading to infection or irritation, exacerbating the problem further.

If your GP prescribes a sexual lubricant, ask them to check the ingredients, especially if you have sensitive skin or suffer from thrush or other vagina infections. If you experience any problems such as itching, burning or develop a vaginal discharge, stop using it and ask to be prescribed something different.

You need to take care what you are using and avoid any which may contain substances which may cause an allergic reaction.

Always choose a pH balanced lubricant to avoid upsetting the vagina flora and increasing your risk of developing thrush or bacterial vaginosis.

Many who do recommend using a vibrator don’t advise what would be suitable, what it should be made from or where to buy it. The same goes for sexual lubricants, what do they contain and are they pH balanced?

Many people are too embarrassed to buy products from high street shops, don’t shop online or even own a computer.

Talking to Healthcare Professionals about Sex

As a former nurse and the co-founder and sexual health and wellbeing expert for Jo Divine I’d love to get more HCPs talking comfortably about sex with their patients.

Having a nursing background I have written many of the sexual health and pleasure articles we have on our website, Jo Divine and for the national press and other online publications, many of which have been written in response to some of the conversations I have had with our customers about their sexual issues.

I always try to make the articles practical, offering ways in which people can still enjoy sexual intimacy and pleasure, regardless of illness or ability.

Initially I thought it was because we have many older customers, but I soon came to realise that HCPs do not talk about sex in general!

Many HCPs will admit that they find it hard to talk about sex with their patients but they really need to consider their patients, for whom it is even harder to raise their problems with their doctor for fear of being dismissed or told it is part of getting old , having a baby and they will just have to put up with it. However, some HCPs are doing an amazing job at talking about sexual issues with their patients.

Collaborating with HCPs in the NHS

At the request of Consultant Urogynaecologist, Dr Alex Slack and Women’s Health Physiotherapist, Pip Salmon, at Tunbridge Wells Hospital, we created a health brochure containing sex toys, lubricants and pelvic floor exercisers that can help with a whole range of gynaecological problems such as vaginal tightness, vaginal dryness, postoperative scarring, decreased sexual sensations and symptoms of the menopause.

Recognising the benefits of sex toys for sexual health and well-being, Dr Alex Slack says he treats many of his patients, many of whom experience painful sex so they can enjoy sex again which is such a refreshing attitude but not a commonly held view. He even struggles with the attitude of some of his colleagues about sexual issues.

I was invited to speak at the National Forum of Gynaecology Oncology Nurses Survivorship Conference for gynaecology/oncology nurses about the benefits of sex toys and finding ways in which women and their partners can enjoy sex after gynaecological cancer. Many of the delegates and charities present were interested and some were already recommending vibrators to their patients. Many HCPs were fascinated by our range of slim products and we work with several gynaecological cancer/macmillan CNS.

I also work with women’s health and men’s health physiotherapists: who are one of the most innovative, proactive group of HCPs I have ever worked with; they are brilliant. Many recommend our website as a resource for sexual health advice and products which they know help their patients who experience painful sex , vaginismus, and post childbirth pain. I have learnt so much for talking to this group which has helped me improve the content of my articles.

We work with many womens health and mens health physiotherapists, genital pain clinics and vuval dermatology clinics across the UK

I also spoke at the Mummy MOT Training Course for physiotherapists about sex after childbirth in February 2016 and to gynaecologists and obstetricians at Tunbridge Wells Hospital in July 2016.

I have also written articles for Womb Cancer Support and Chris’ Cancer Community.

Chris and I recently filmed a video about Sex and Cancer which can be found on the Jo Divine YouTube channel.

Our health brochure has been given out at the Pelvic Health Summit in Walsall 2016 and the COSRT Conference for Sex and Relationship Therapists and in menopause clinics.

I spoke at the Daisy Network conference in June 2017, an amazing charity who support young women aged 16-40, many of whom who experience an early menopause as a result of Premature Ovarian Insufficiency, impacting upon their sexual function, fertility and relationships.

I gave a talk at the Ovacome Wellbeing event to women who have had ovarian cancer.

I am also collaborating with Diane Danzebrink who set up Menopause Support.co.uk and Dr Lousie Newson, my menpausedoctor who recommend our products and articles. I recently recorded 2 vlogs with Diane about your sexual health and enjoying sexual intimacy and pleasure during and beyond menopause. Lousie Newson and myself will be recording a podcast about sex and the menopause in January 2020.

I gave a talk at the COSRT genital pain study about the health benefits of using our sex toys which can help people to enjoy sexual intimacy and pleasure and regain their sexual function.

Jane Lewis, the award winning author of Me & My Menopausal Vagina filmed this video together to discuss ways in which to remain intimate when you have vaginal atrophy.

On a fun note but practical note they were given out in goody bags at the Edinburgh Fringe this year by Gussie Grips (aka Elaine Miller, a women’s health physiotherapist) whose comedy show about the pelvic floor both educates and entertains people at the same time.

Why can’t HCPs recommend our advice?

There are so many ways in which people can enjoy sex through exploring different pathways to sexual pleasure and intimacy, yet many HCPs fail to offer this advice and don’t or won’t recommend websites like ours.

Many are just too embarrassed to talk about sex or are influenced by their own subjective experience or view.

I have found it frustrating to hear gynaecologists say they do not talk about sex to their patients including those who work in menopause care because they are too embarrassed or say it does not come up in conversation! Yet many gynaecological conditions and medical/surgical treatments including menopause symptoms such as vaginal atrophy, decreased sexual sensation and painful sex impact upon sexual function, intimacy and pleasure so this should be a priority.

The same goes for doctors and gynaecologists who refer to our sex toys as vibrating dilators, they are sex toys yet they believe that calling them dilators makes them sound medical!

I have lost count of the number of times we have been told by some HCPs that,

“We love what you’re doing but can’t recommend you!”

When I ask them what they are recommending the reply is often nothing or outdated advice and products.

Is it because it is outside the NHS and therefore not allowed, even though some HCPs working in the NHS are recommending us and our health brochure was created in the NHS? By not offering any advice to their patients, they are failing to give the best care they can, when this advice is freely available at the click of a button!

In this world of social media and the internet, patients can find so much more information online but it would be good if the information they read is well written and offers correct advice and practical tips.

Many people who experience health issues such as cancer blog about their experience which can offer valuable insight to other people going through the same experience about how they are coping and what helps their condition.

Even though we often get asked for the research about our products, especially by doctors, very little has been done. Much of the evidence is anecdotal from people who have used sex toys and have found that they help their sexual problems, in addition to making sex pleasurable again.

However the materials that our sex toys are made from have been thoroughly tested as have the ingredients in our sexual lubricants.

The sexual impact of cancer on relationships

The sexual impact of undergoing surgery or treatment for cancer, in particular prostate cancer, breast cancer or gynaecological cancer, can affect both partners, yet many couples are not offered counselling prior to surgery or treatment. By including both partners, be they heterosexual or same sex couples, in the discussion right from the start if they wish to, they can fully understand the implications that cancer and its treatment may have upon their sexual relationship.

The Royal College of General Practitioners in collaboration with Macmillan have developed a toolkit for managing the consequences of cancer treatment, including the sexual impact upon relationships and recommend couples counselling.

Sexual Health Advice for LBGT people with cancer

Often sexual advice is focused on heterosexual people with cancer, disregarding the sexual experiences of lesbian, gay, bisexual and transgender individuals, despite them experiencing the same sexual problems following cancer.

The impact on fertility may not be an issue for some lesbian or gay people but some people want to have a family and shouldn’t be dismissed by healthcare professionals.

Body image is hugely important to many people and losing your hair or being left with scars on your body can greatly affect your body confidence and relationships.

The LGBT Foundation have collaborated with Macmillan to create an informative booklet supporting Lesbian, Gay, Bisexual and Trangender People affected by Cancer.

Prostate UK have created a booklet for gay and bisexual men

By being made aware that there are ways in which you overcome some of these problems, if or when they arise, can help couples to deal with any problems, as well as involving them in the treatment process. It has also been found to speed up the rate of recovery, allowing a couple to return to enjoying sexual pleasure and intimacy, in whatever way they can or want to.

Our NHS, which gave me outstanding training all those years ago as a student nurse, is one of the best health services in the world, even during these difficult times, yet this is one area of health where we are failing patients. We work with many HCPs who are doing an amazing job at tackling this difficult subject to improve their patient care.

By recommending sex toys and alternative ways to enjoy sexual intimacy and pleasure many HCPs could reduce the amount of medication they prescribed, saving the NHS money and help their patients enjoy sex in a more pleasurable fun way too.

Better Training

There is little training about sexual issues and what is offered is very medicalised. Teaching practical solutions and ways in which people can overcome sexual issues to enjoy a more fulfilling sex life or just to return to normal after treatment isn’t rocket science.

Being able to talk about sex to your patients should be compulsory in medical/healthcare training as it is one aspect of healthcare that is often overlooked or dismissed as HCPs are too embarrassed to talk about it or are unsure what to suggest or recommend.

Change is slowly taking place but there are many people who continue to experience sexual issues that can often be easily overcome, avoidng the loss of their sex life and relationship issues. With a little thought, discussion, imagination and recommending outside resources, more HCPs can ensure that their patients enjoy good sexual intimacy and pleasure in whatever way they find pleasurable, whoever they are, whatever their age, sexual orientation, medical condition and disability too.