Doctors too shy to talk about sex - study
Many feel they are untrained and ill-prepared, but they're missing a huge opportunity, say experts
Do you ever talk about sex with your general practitioner and, more importantly, does she or he ever ask you about it?
For most people, the answer is a definite no – but this marks a major lost opportunity since sexual concerns are so common.
One of the biggest studies on this issue, collated by the University of Chicago in 2006, involved more than 27,000 patients from around the world and the results were startling: more than half of the participants had one or more sexual concern or problem but only 19% had sought medical care for it.
Worse yet, only 9% had been asked about their sexual health by their doctor over the three years prior to the study.
For Anthony Smith, a Cape Town doctor who gave a presentation at the General Practitioners Conference 2019 hosted by the University of Cape Town last week, asking patients about sex should be seen as a golden opportunity and not as an unusual practice.
“As GPs, we are in the perfect position to discuss sexual issues with patients, and such issues have a high prevalence in primary health,” he says.
Yet, doctors and patients alike shy away from such topics.
For general practitioners, there are often barriers to talking about sex with their patients. These, said Smith, include GPs “feeling untrained and ill-prepared” to talk about sex. They might also feel they are “opening a floodgate and then not knowing what to do with it”.
He said doctors might not consider it a priority, or mistakenly see sexology as not being relevant – especially when looking after groups mistakenly perceived to be “asexual” such as the aged, the chronically ill or the physically or mentally handicapped.
Good sexual health has a strong correlation with good physical and mental health, said Smith, and a visit to the GP offers patients “a unique opportunity”, especially when they have few other sources of help on the sexual front.
While many patients would not tackle it directly, they were “happy to have it addressed” by their doctor.
There are also gender differences to note when it comes to sexology and your GP. Smith said: “Men are particularly challenging. They are generally reluctant health seekers as it is.”
But starting a conversation with them about sexual health could highlight important markers for comorbidity relating, for example, to neurovascular issues, depression or anxiety, diabetes, hypertension and pathology of the prostate.
With women, said Smith, sexual concerns are common as they move through life, and practitioners are well placed to be a first port of call to be “educators, advocates and risk managers”.
So what is the best way to equip doctors to venture onto the ground of sexual data with their patients and to ask the right questions?
Dr Richard Gunderman, a professor of medicine at Indiana University in the US, has been grappling with the same questions as Smith, and says training medical students is of primary importance.
“One challenge for physicians in addressing sex is the paucity of attention paid to sexuality in most medical school curricula,” he wrote in The Conversation.
A 2013 survey showed that “essentially every medical school covers topics such as reproductive physiology, contraception and sexually transmitted infections, yet many schools devote little or no attention to such topics as sexual function and dysfunction and sexual minority groups”.
Smith said it was difficult for doctors to speak about sexual health because it sometimes challenged their own “expertise, norms and intrinsic biases”. But they should be aware of those biases and remember that sex is something patients want to ask and talk about.