How to talk about sexual problems with your doctor

Read about the author Samantha Evans

Sex is important to many people and can have a positive impact upon sexual health and well-being. A regular, happy sex life can benefit our physical, mental, emotional and social well-being, including improving health and prolonging life.

Good sex education is vital for everyone. Many young people are confused by the often conflicting information they read online and some older people have a complete lack of sexual knowledge due to poor sex education at school.

An unhappy sex life and/or the loss of a loved one can lead to stress, depression or illness. Chronic illness or disability: can result in lack of sex and loneliness, both of which can have a negative impact throughout one’s life.

“Thinking about discussing sex is more frightening than actually doing it, and the reactions we’re fearful of very rarely occur” – Dr Daniel Atkinson GP

This quote from a GP shows the way in which many doctors feel about raising the topic of sex but it is also the way patients often feel about broaching the subject too. It is hugely beneficial to patients if healthcare professionals are willing to talk about sexuality, and where possible, be able to provide support or a referral to the appropriate service. Many sexual problems can often be resolved, either with medical intervention or counselling. Frequently, the patient is unsure about something sexually and just needs reassurance or an explanation to resolve the issue or allay their fears.

Seeking advice can also save your life if you notice abnormal symptoms which could be a life threatening disease such as cancer. from abnormal bleeding, growths and lumps to difficulty when peeing.

Having a regular smear test could save your life too as it detects abnormal changes which may be the first sign of cervical cancer. It is a few minutes of discomfort but may prevent you developing cervical cancer.

Communication is vital but both the patient and professional may hold back from initiating the conversation for a variety of reasons. Talking about sex in the work environment can feel uncomfortable. 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.

Healthcare professionals tend to hold back because of:

• Feeling embarrassed, even though they are in a professional health setting.

• Lack of time, even though many sexual health problems can be discussed in a few minutes.

• Being worried about offending the patient whereas many patients say that they would be relieved if the topic were raised.

• Feeling worried that such a conversation might be misconstrued but this can be rectified by having a chaperone present.

• Unsure that the problem can be resolved, but there are often many solutions available.

• Being uninformed – this can be resolved by referring the patient to the appropriate service, sexual health advisor or read around the subject to become more confident about discussing sexual issues.

• Thinking that if there is a problem, the patient should start the conversation.

• They consider the patient is too old or young to have sex.

• It is a problem that the patient just has to learn to live with.

Patients hold back from raising sexual health issues because of:

• Feeling embarrassed, inhibited, guilty or lack self confidence.

• Having feelings of shame at being sexual because they are female, older, feel unattractive or have religious beliefs about sex.

• Believing that they should sort out their own problems and not bother the doctor with their concerns. Many people, young and old think they should know what to do when they have sexual problems but often their sex education is poor due to the way in which it had been taught in schools.

• The healthcare professional might disapprove, esepcially if they are under age.

• Worrying about confidentiality and think that their details will be made public. Younger people may worry that their partents will be informed, especially if they are under age.

• They do not believe that there is a solution to their issue and feel that they have to just live with the problem.

• They think that they should not be having sex or enjoying sex at their age.

• They believe that the healthcare professional should start the conversation.

If a patient does not talk about their sexual problems during a consultation with their doctor, then the doctor may not be able to establish a full and clear diagnosis and offer suitable treatment, advice and support.

Better sexual health and education can lead to better sex and overall increased health and well being. Talking about sexual problems may alert the doctor to other medical conditions a patient may have. Erectile dysfunction can be a sign of heart disease and diabetes and loss of libido may be caused by depression, all of which can be treated.

Regaining a full sex life after illness can significantly speed up the recovery process. Having a healthy sex life can also prevent or reduce problems such as depression and emotional problems. Being sexually active can make people aware of their sexual health and what is normal for them and recognise signs of problems when they occur such as enlarged prostate, vaginal changes and reduced libido.

People who have a disability often complain that they are discriminated against when they discuss or try to discuss their sexual needs and problems as some healthcare professionals consider that they should not be having sex at all. Yet, by making simple changes to the way in which they have sex they can still enjoy a full sex life.

More education and training needs to take place among health care professionals to encourage them to initiate the subject, when appropriate, during consultations. Better sexual health can not only improve your sex life but may uncover any underlying medical problems that you are not aware of which can be treated, which in turn, can hopefully resolve your sexual problems.

Many young people don’t want to see their family doctor they have seen since childhood to discuss embarrassing problems as they get older as they worry their doctor will tell their parents. As all consultations are confidential, this will not happen. However, they can always ask to be seen by another doctor. Having a good relationship with your doctor can make it easier to seek medical advice in the future.

There is so much conflicting and often inaccurate information online and in social media that finding the right information can be confusing. It is important to get your information from a reliable source. Some NHS websites may contain inaccurate advice as they are not updated regularly.

Some medications have sexual side effects so talk to your doctor if you have started a new drug and have noticed any changes to your sexual function and libido.

If your doctor is unsympathetic, even if you do pluck up the courage to raise any sexual issues you may have, ask to speak to another doctor or practice nurse. Ask if they have any printed information for you to read or can recommend a website to look at or an organisation you can speak to. You will probably find that your doctor is more than willing to talk about your problems and will thank you for raising the issue with them.

Doing the work I do there are more HCPs who care about their sex lives of their patients and are happy to offer advice, support and promote products beyond their professional training to help their patients overcome sexual issues.

Talking about sex should be part of training to encourage HCPs to raise any issues with their patients, feel comfortable talking about sexual problems and are informed about what they can recommend or suggest. Doctors also need to be aware that not all products available on prescription are good for your sexual health and pleasure including sexual lubricants and moisturisers.

“I regarded my doctor in a new light when he asked about the most precious part of my life. He became a human being” – Julie