Talking about Sex
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?"
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It's easy to talk about sex. Operators are standing breathlessly by awaiting to hear you talk about this very subject. Just dial 1-900-XXX-XXXX. Caution. If you use your credit card. This could be your credit card company's justification to jack-up your rates.
I must have the sex drive of a one year old cat. What is wrong with all those women? I am so turned on by my husband, I just want to be wrapped around him. If he touches me, I am immediately thinking.. Ohhhhh YEAH.. then reality hits. My husband has diabetes, high bp, hypoactive thyroid, and NO TESTOSTERONE even with the cream. He goes to a friend of his for medical care. AND DO YOU THINK HE WILL DISCUSS his lack of sex drive? Heck no! I've begged, cried, screamed, slammed doors.. listened in understanding, ignored my needs, stopped reaching for him and been derned angry that I am the one who is considered aberant because I have a drive. So, I look in the mirror every day and say, "Something will change, please dear God... make it change." And I love him anyway.
Where are my batteries and phone?
I am right there with you. Same problem for me, except my husband sees a doctor who is just his doctor. He also has HBP, hypothyroid, overweight, no testerone and is probably on his way to diabetes. I think the movie "He's Just Not That In To You" applies to us. How can a man who loves his wife allow this to happen? I take bio-identical hormones and look 15 years younger than I am through dedication to taking care of myself. For what? To be ignored by my husband. It's been this way for 7 years. Nothing. Yep, I'm angry too.
I've just finished a book about sexual and pelvic pain and its effect on relationships with a gynecologist and pelvic pain specialist, coming out in May (www.secretsuffering.com). Chronic pelvic pain affects 20-25% of reproductive-aged women sometime in their lives, with close to 90% experiencing sexual pain.
To answer the question about what to do when you are out of sync sexually, from my interviews with patients and experts in the field, the first thing is to know that sexual pain is very real, even if there is no clear organic cause. Talk to your partner when it hurts. Don't have sex through the pain. You must communicate, despite the embarrassment, if you hope to find other ways to have sex or intimacy that don’t hurt.
There are treatments. Search for a doctor who believes you and is knowledgeable if your current doctor insists there is nothing wrong with you. Ask for a culture if you are told you have an infection to verify.
Communication, despite embarrassment, is the only way the medical community will take notice. And by speaking out, women (and men who also have such problems as interstitial cystitis) will find comfort in knowing they aren't alone.
Being “heard” and validated by doctors was the one factor across the board that made patients feel better, even if their physical condition wasn’t yet improved. And feeling safe to talk about the problem is one major key to getting back in sync with one's partner.
Could the main reason why Americans have such a hard time with talking about sex could be the FACT that their religion makes them feel that sex is a sin most of the time?
Yes! If Americans weren't such religious prudes, it would be OK to talk about it. And there just might be a lot fewer unwanted pregnancies and abortions along the way. But no, we'd rather not talk about it, consequences be dam ned.
Oh, and if we talked about it, we'd be considered liberal and open-minded, which doesn't allow us to sit in judgment nearly as much, which we Americans love to do.
Very good post, we are a nation of prudes, hyper about sexuality but afraid to actually talk about it. Most men would not now the first thing about the joys of a prostate orgasm or have a conversation with a friend about the best lube on the market. And heaven forbid they tell anyone they fantasize about anything other than the standard accepted seen at the movies heterosexual roles.
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Just a quick note to say how much I appreciate your taking the time to read my blog and see the video. And I love the discussion. Please let me know what other topics you'd like us to cover on www.cbsdoc.com, or if you have any suggestions about the segment about sex that launched today. Next week's segment will be on medical marijuana. We're shooting a discussion on the subject tomorrow. What questions or comments do you have that you'd like me to bring up?
Thanks,
Jon
I use marijuana for libido. I started using it while on anti depressants and have never looked back. Sex was so frustrating for us and it usually ended with hot tears streaming down my cheeks feeling like a complete failure.
I was told by my doctor( psychiatrist) to just be happy I was not depressed and that sex was over rated. My husband and I were forty at the time. I tried controlled breathing, meditation, Tantra, and many herbal remedies on the market all to no avail. I hope marijuana will be legalized one day. Either way I am very happy and sexually active every day. I wonder if I am alone.
It's hard from the other end of the office too. When I try to bring sex up with patients, it can be awkward, and lead to reticence, or worse, the lady patients trying to pick me up. Thankfully as I get older and uglier, that happens less and less.
Sometimes it's better to be very vague at the beginning:
"So how are things at home? With your spouse? Is the relationship happy? Are you all having any problems?"
If you try to be honest and matter of fact, people generally relax and offer info. And then the specifics come up. Sometimes after 20 minutes of talking about everything else, an embarassed patient will finally ask as they are actually at the door, leaving. It's useful to pay attention especially at the very end of the visit.
Really? I must live in a different country from y'all.
First of all, I am a woman who thinks about sex usually more than twice daily.
Second of all, when I go for a checkup, the doctor usually asks whether I'm sexually active, and if I'm protected, do I have any issues, etc. If I'm there for a sore throat or something, it doesn't really come up but during the annual checkups, yeah.
If you think it is awkward being a Heterosexual talking about Sex, it is even more awarkward being Gay talking about Sex with a Heterosexual Healthcare Provider. My Dr. is aware I am Gay, I told her, yet it seems salacious to talk about Sex, even to talk about my Prostate. I am 58 years old and Type 2 . Even talking about Body Functions like ejaculations or bowl movements seem to be address in terms of a Third Party. I goggle often to get that information on line to give me the Peace of mind so I am aware of what transitions are taking place being on the other side of the Mountain. BTW my PSA is .57, we have gotten beyond that point.
In the recent past there was a Report released about Men over 50 masturbating to keep their Prostate Healthy- i.e getting rid of toxins. I can discuss this with my partner but other Heterosexual men would give me the impression that I am coming on to them. Do Heterosexual men talk about their body functions with other Heterosexual Men? Just wondering.
Most Americans can't talk about anything like adults. Why would sex be different?
American culture is stuck in a permanent state of adolescence. Physically sort of mature but unable to handle anything responsibly on an consistent basis.
If I were the rest of the world, I wouldn't trust America any more than you can trust a 16-year-old. That is, sometimes America will do good things, but you can't rely on it for anything grown-up.
Sure, we elected Obama as president this time. But how long before we elect another m o r o n like bush?
It was all downhill after our first child was born. After ten years it was just going through the motions, and even that was difficult and less and less frequent.
At the 15 year mark it was as exciting as changing the lawnmower oil and even less frequent.
At around 20 years it ended and I don't even miss it.
Life itself became so boring I wish I could go back to Vietnam for a couple of tours.
Your life will only have the meaning that you bring to it. Why not go back to Vietnam? I'm sure there are some needy kids there who could use a man to show them how to change the lawnmower oil, or its equivalent. Find a passion in life, and you just mind rekindle a passion in the bedroom. You don't need a war to be a warrior in the name of something noble and good.
I'm sure you'll excoriate me now, but your post has a pathos that I bet is familiar to a lot of Americans. It's never too late.
I agree this hesitation to address sex like adults in harmful (and uniquely American, it seems to me).
And I would say that doctors should probably take the lead in opening up the discussion. Such a central part of a person's hierarchy of needs is ignored at a detriment to that person's overall health.
Reminds me of a SaltNPepa song...
http://TheSnarkingLot.blogspot.com
It's scary that even in colleges, people get uncomfortable if you even mention the word. You get people chuckling nervously and moving on quickly. This is important, especially when schools hand out free condoms (the first week of the new semester for me was National Health Week, and the school does that every year), but don't give out any more information about safe sex, or some of the downfalls of not practicing it.
Despite the data I reject the premise.
With erectile dysfunction ads flooding the airways and in a post Dr. Ruth era I think sex is out of the closet!
Let me tell what's still very much IN the closet between Docs and patients- Emotional distress.
When was the last time your doctor asked you my "two questions that could revolutionize medicine"
- How are things at home?
- How are things at work? Or school?
Dr. Rick Lippin
Southampton,Pa
Thank you, Dr. Lippin.
Despite the data I reject the premise.
With erectile dysfunction ads flooding the airways and in a post Dr. Ruth era I think sex is out of the closet!
Let me tell what's still very much still IN the closet between Docs and patients- Emotional distress
When was the last time your doctor asked you my "two questions that could revolutionize medicine"
- How are things at home?
- How are things at work? Or school?
Dr. Rick Lippin
Southampton,Pa
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