Imagine this: You’re at the doctor’s office, getting your annual exam. Blood pressure, heartbeat – everything is fine. But these last couple of months you’ve been having trouble maintaining an erection. You want to tell your doctor about it, but you don’t feel like you can. You’ve never discussed your sex life with him before. So you don’t mention it… and the problem continues.
Or: You’re being examined by your gynecologist. Since the recent onset of menopause, your sex drive has disappeared. The problem is driving a wedge between you and your husband, but you don’t think that it’s appropriate to discuss something this personal with your doctor.
Scenarios like these happen all the time: Most men and women have trouble discussing sexual matters with their personal physician.
According to a recent telephone survey in which 500 men and women (over age 25) were polled regarding their attitudes toward sexual issues, 68 percent said that they would not feel at ease discussing sexual matters with their physician. Many said that their hesitation stemmed from the belief that such talk would make their doctor uncomfortable.
In fact, experts say, some doctors do find it difficult to talk about sex with their patients. “Speaking about intimate matters is a delicate issue that requires skill and a certain level of comfort,” says Marianne J. Legato, M.D., professor of clinical medicine at Columbia University College of Physicians and Surgeons, and director of the Partnership for Women’s Health, which sponsored the survey.
But according to Legato, relatively few physicians have a strong expertise regarding sexual dysfunction and other sexual issues. “This is something that should be taught in medical schools,” so that doctors are equipped to comfortably deal with whatever concerns their patients may have.
And sometimes, of course, it is the patient who is uneasy. Older men and women in particular, notes Legato, find the topic embarrassing and are likely to avoid it – for various reasons.
Special Problems for Older Patients
The “too close for comfort” problem. Many people in middle age or beyond have been seeing the same doctor for years. It may seem as if a long-standing relationship would ease the discussion of intimate topics, but actually the opposite is frequently true. “People often find it easier to tell a stranger about their sex life than someone they know well,” says Dagmar O’Connor, Ph.D., a New York City psychologist and author of How to Make Love to the Same Person the Rest of Your Life and Still Love It!
The age gap. It is not uncommon for people over 50 to have a physician who is a generation younger. “The age differential can create unease,” says Robert Birch, Ph.D., a psychologist in Columbus, Ohio. “For many adults, it would be like talking about sex with their son or daughter.”
Long-held inhibitions. “A lot of older people were brought up not to mention sex,” says Birch. “It wasn’t discussed when they were young, in the media or elsewhere.” Even though today there is more general openness about sexual issues, including problems like erectile dysfunction and sexual side effects of medications, long-standing inhibitions can create a barrier between the patient and his or her physician.
“Older people aren’t supposed to have sex.” Despite evidence to the contrary, such as a recent AARP-sponsored survey showing that most adults over 45 are sexually active, society still sends the message that older folks aren’t having sex – or shouldn’t be. As a result, some people feel as if they’ll be dismissed, or even ridiculed, if they reveal their private concerns. “In our society an older man with a healthy sexual appetite is still referred to as a ‘dirty old man,'” says O’Connor. “And a lot of people don’t want to think of, say, a 75-year-old grandmother having a sex life.”
Approaching the Topic
Some physicians, like Legato, do ask questions about sexual functioning as part of their regular check-ups. But if your doctor does not, it’s important for you to introduce the topic. For instance, you should always report symptoms such as painful intercourse, difficult or burning urination, genital discharge, or a rash in the genital area. These can be a sign of sexually transmitted disease or some other health problem.
You should also make your doctor aware of any ongoing sexual difficulties like erectile dysfunction, lack of orgasm or decreased desire. There are two reasons for this: 1) There may be an underlying medical condition that is causing the problem, like diabetes or a hormonal imbalance. 2) If no medical factor is found, your doctor can refer you to a sex therapist.
So, how does one broach the topic? It’s best to be succinct and direct: for instance, “‘I have a sexual concern I would like to discuss with you – if you are comfortable with that.” Chances are, the physician will be receptive, says Birch.
If, for whatever reason, he or she is uncomfortable or otherwise unhelpful, “the patient should be able to say, ‘Can you be able to refer me to someone who deals with this kind of thing?'”
Patients should keep in mind that it’s not a physician’s place to offer sexual counseling. Although “more primary care doctors are showing an interest in working with sexual concerns,” notes Birch, these are not the professionals to see for actual sex therapy. If a patient is having relationship difficulties, loss of desire without any medical cause, or other psychologically complex problems, he or she should asked to be referred to a certified sex therapist or a psychologist with expertise in sexual issues.
There are two appropriate times for a patient to bring up concerns about sex: Either at the beginning of the visit, when the doctor is asking about overall health, or during the physical examination. The exam, in which the patient is partly unclothed and being touched by the doctor, can create an avenue of intimacy that makes it easier to introduce sexual concerns. For instance, a woman who is receiving a pelvic exam can take the opportunity to say something like, “It doesn’t hurt when you examine me, but it does hurt when I have sex with my husband. What do you think the problem might be?”
The time not to bring up sexual concerns is at the end of a visit. Birch calls this “the hand on the doorknob question.” Asking an important personal question as the doctor is leaving, getting ready for the next appointment, is counterproductive and will leave you feeling frustrated.
Finally, keep in mind that anything becomes easier when you have the right attitude. “Maintain your self-respect and you shouldn’t have a problem,” says O’Connor. “Your sexuality is nothing to feel ashamed about, and your attitude should reflect that.”