For some people, talking about sex isn’t easy — even if it’s with a trusted medical professional. When it comes to overall health, however, discussing sex with a doctor is important, reveals a report entitled What We Don’t Talk about When We Don’t Talk about Sex, published in the Journal of Sexual Medicine.
“Sexuality is a key component of a woman’s physical and psychological health,” said Stacy Tessler Lindau, MD, lead study author and associate professor of obstetrics and gynecology at the University of Chicago Medicine. “Obviously, OB-GYNs (obstetrician-gynecologist) are well positioned among all physicians to address female sexual concerns.”
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According to Lindau and University of Chicago researchers, as many as two-thirds of OB-GYNs in a national survey reported asking patients about sexual activity without inquiring about other areas of sexuality.
Only 40 percent of survey participants routinely asked questions aimed at addressing sexual dysfunction or problems. Twenty-nine percent of OB-GYNs inquired about patients’ sexual satisfaction levels, and 28 percent verified sexual orientation.
Conducting a thorough sexual history is important, say study researchers, because of a clear link between sexual health and overall wellness, and the results of the survey indicate a need for more doctor guidelines when it comes to discussing sexual activity in the office.
Because many people feel shame, embarrassment or guilt when it comes to sexual issues, they often assume if the doctor doesn’t ask about it, the topic isn’t open for discussion.
“Patients are often reluctant to bring up sexual difficulties because of fear the physician will be embarrassed or will dismiss their concerns,” said Lindau. “Doctors should be taking the lead. Sexual history taking is a fundamental part of gynecologic care. Understanding a patient’s sexual function rounds out the picture of her overall health and can reveal underlying issues that may otherwise be overlooked.”
A lack of sexual discussion in the exam room was not all the report revealed, however. Factors such as age, gender, race, immigration status, religion, type of medical practice, and medical school location were taken into account when assessing whether or not an OB-GYN initiated in-depth sexual discussions with patients.
As researchers expected, female doctors are more likely to discuss sexual activity with female patients. OB-GYNs seeing the majority of women for prenatal care were less likely to screen for sexual dysfunction than colleagues, and doctors over the age of 60 were less likely to ask about sexual orientation and sexual identity.
While questions relating to sexual orientation were lacking with more than two-thirds of OB-GYNs not even asking about it, researchers feel this particular topic requires more investigation, as there is potential for a lesbian or bisexual patient to become alienated and their symptoms misdiagnosed.
“One explanation for the findings may be a deficit in physician training about diagnosis and treatment of female sexual problems,” said Janelle Sobecki, MA, a second-year medical student at Wayne State University. “Like patients, physicians may worry that raising the topic could offend or embarrass the patient. Physicians, especially OB-GYNs, are better positioned than patients to open the door for discussion.”
Open discussion about sexual health is not just about determining overall health, but is important in finding the underlying causes of many sexual issues. Certain medications for example, like those used to treat depression, can cause sexual side-effects, and many women are unaware of those potential repercussions. Patients may be better able to tolerate sexual side effects if they know to expect them.
One such medication-related area of concern for Lindau is that of breast cancer prevention treatments, which interfere with estrogen activity, therefore lowering cancer risk. These medications, which are used increasingly by younger women, can affect a female’s sexual activity.
“Women are not being counseled on the potential sexual side effects of these treatments, and we have limited data to appropriately counsel them. For men with prostate cancer, in comparison, the impact of treatment on sexual function is typically discussed as part of deciding which therapy to try,” said Lindau.
Discussing sexual side-effects with men may be a more approachable topic than with women given the number of treatments on the market for male sexual dysfunction. Such treatments for women are limited.
Sexual activity for men, however, is just as closely linked to overall health as that of women, with issues such as obesity, diabetes, smoking, and high blood pressure contributing to poor male performance.
“It’s very appealing to say that if you don’t have those unhealthy factors in your lifestyle, then you’re less likely to develop erectile dysfunction,” said to WebMD Ira Sharlip, MD, a urologist at the University of California, San Francisco. “There are pretty strong suggestions that those things are true.”
Despite the hurdles facing women when it comes to discussing sexual health with a doctor, Lindau says more and more women are seeking information regarding personal overall and sexual health, and are often empowered by learning they are not alone through online media and reputable Internet sources.
The more empowered a woman feels, the more likely she is to initiate a sexual health conversation with her doctor.
“If you have a doctor you trust who has not brought this topic up, give it a try,” said Lindau. “If you are waiting for the doctor to start the conversation, it may never happen. Communication is key.”