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Dr. Jon LaPook


Talking about Sex

Posted: 02/26/09 01:32 PM ET

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 women.

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?"