I hesitated as I looked over a new patient’s medical chart. Her health history was incredibly complicated with cystic fibrosis, diabetes, a lung transplant, laser treatment for cervical and vaginal dysplasia, and recent leg amputation.
She was only in her 30s.
Most women agree that pelvic exams, especially the stirrups, can be uncomfortable — an understatement, if anything. With this patient, I anticipated the appointment would be challenging for both of us.
Entering the exam room, I quickly realized my preconceptions were wrong — on so many levels.
She was already undressed, had positioned herself on the exam table and greeted me with a cheerful hello. She answered all of my questions without hesitation — except for one.
“Are you sexually active?”
And there it was. It was subtle; it was short — only a two-second delay in her response and a brief lapse in her cheerful facade. There was a nearly imperceptible moment when her smile did not quite reach her eyes. She said she was married, and they were sexually active. I held back and did not probe deeper — at least not at that exact moment.
I finished my routine questions. Then I paused, leaned in and asked her if she had any other concerns or questions before the exam. This time there was no hesitation, and she started to share.
“Sex has been less frequent. It’s been too painful, especially since the vaginal laser treatment. It seems to be getting worse,” she explained. “My husband is supportive and loving. He is patient and doesn’t pressure me. Our relationship is good … but could be better. I miss him. Since nobody has asked about my sexual concerns in 3 1/2 years, I figured there was no hope.”
I let her talk. I finished the exam, and then we chatted some more. I didn’t have an immediate solution, but we had a plan.
When we parted, she was cheerful, extremely thankful — and best of all — she had a new twinkle in her eye. I would like to believe it was a glimmer of hope.
Silence around sexual function
Unsurprisingly, sexual dysfunction can significantly impact your quality of life for the worse. Doctors and patients both need to be aware: Sexual quality of life is important.
This brings up several questions:
- Why aren’t more women receiving help?
- Why are providers not offering help?
- Why aren’t women seeking help?
- Why the silence?
Unfortunately, miscommunication is a two-way street:
- You may feel that if sexual health was important, your provider would mention the topic during the appointment.
- At the same time, providers feel that if it was important to you, you would bring it up.
- A “stalemate” results as each side waits for the other. Ultimately nobody brings it up, resulting in “an awkward silence.”
There are many reasons you may not feel comfortable bringing up your sexual concerns. Perhaps you are not sure what words to use or worry you will sound “stupid.” Maybe you’re not sure which doctor to talk to. Is this a question for your primary care physician or your gynecologist? You may not want to address questions to a male doctor, or perhaps there simply isn’t enough time in the appointment. If you are lesbian or bisexual, you may wonder if your doctor is equipped to answer your questions. Sex may be considered a taboo subject in your culture, or perhaps you are just simply embarrassed.
Breaking the silence
Even so, if your doctor doesn’t ask you about sexual concerns, it’s worth bringing them up yourself. Sexual quality of life can:
- Decrease chronic illness
- Influence hormones, improve emotional closeness and boost immunity
- Lower the risk of cardiovascular disease
- Decrease rates of both prostate and breast cancers
And without intervention, sexual problems tend to persist and result in long-term sexual distress, with a potential for negative consequences for your individual and relationship well-being.
At your next appointment, try saying to your doctor: “I wanted to make sure we save time to discuss my sexual health.” You can bring this up with your primary care doctor, a gynecologist or even an oncologist — the doctor will refer you to another professional if needed.
As sexual health is a very private topic for many people, it’s good to prepare the information you want to get across. Think through the following questions and topics.
- Are you currently sexually active? With men, women or both? Do you want to be more sexually active?
- Do you have current symptoms interfering with your sexual health? If so, list them and how long they have been present. Also include what you’ve tried to improve symptoms and what has and hasn’t worked.
- Of course, anytime your partner is hurting you or engaging in sex with you in a way that makes you scared or uncomfortable, your doctor is a safe person to bring that to.
It may feel scary to talk about, but you deserve to have your questions about sex and sexual function answered. Remember, your doctor can’t help you with an issue he or she doesn’t know about. Questions about sexual function are common, and there are treatments that may help.
Relevant reading
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