When it comes to sex, doctors too often have a "don't ask, don't tell"
policy. We're a country that's inundated with sex. Yet we have an
awfully tough time talking about it like grown-ups. A Consumer Reports
national poll found that 81 percent of adults ages 18 to 75 reported
avoiding or delaying sex with their partner in the past year. The most
common reasons: tiredness (53 percent), illness (49 percent), and not
being in the mood (40 percent). Fifty six percent of men reported
thinking about sex at least once daily versus only 19 percent of the
A 2007 study in the New England Journal of Medicine found that about half of men and women ages 57 to 85 had at least one bothersome sexual problem, yet only 38% of men and 22% of women over 50 discussed sex with their doctor.
Let's face it. Many people are awkward about bringing up the topic of
sex with their doctors -- or even with their partners (sometimes
especially with their partners because of the power sex has in a
relationship; sex often doesn't just mean sex). We doctors need to take
the lead in making it a normal part of the routine conversation during
an office visit. In medical school, we're taught to do a "review of
systems" -- a head to toe checklist to make sure we don't miss an
important complaint. But somehow we often skip over the subject of
sexuality. And as the New England Journal study found, if I don't bring
it up, my patient usually won't.
Doctors need to make patients feel safe discussing the most intimate
details of their personal lives. That's sometimes not easy. But I've
found that most of my patients greatly appreciate my bringing it up as
long as it's in the context of a safe, nonthreatening atmosphere. And
if I'm comfortable with the topic and with the vocabulary, they usually
follow my lead.
The most common complaint I hear is lack of desire and being out of sync
with a partner. Often -- with kids running around, schedules to juggle,
and fatigue to fight -- there's a problem just figuring out the logistics
of getting started, after which everything usually goes smoothly.
Sometimes there are problems such as erectile dysfunction or inability
to achieve orgasm that can be addressed through a combination of
treatments that may include medication and therapy.
Sexual dysfunction may be a symptom of depression; it can also be a
side-effect of antidepressants or other medications. Patients will
sometimes stop their antidepressants on their own because of sexual
side-effects such as loss of libido; but if they had just spoken to
their physician, the problem may have been greatly helped or even
totally solved with a change of medication.
The key is realizing that we're not elementary school students giggling
about a forbidden subject. We're adults addressing a crucial element of
our health -- and communication is the name of the game. Whether it's
with a partner, doctor, or trusted friend, communication helps pave the
way to a fulfilling and mature sex life.
That brings us to today's segment of "CBS DOC DOT COM."
CBS correspondent Richard Schlesigner, renowned sex therapist Miriam
Baker, and I take a field trip to a luxury lingerie and intimacy
boutique called "Kiki De Montparnasse" and ask the question, "Why do
people often get out of sync sexually, and what can they do about it?"