Let’s talk about sex! Keep open communication with your patients

By Kristen Fuller, MD | Fact-checked by Barbara Bekiesz
Published May 9, 2023

Key Takeaways

  • Many women shy away from talking about their sexual health to their physician, resulting in misunderstandings about sex and sexuality. 

  • Female sexual dysfunction and genitourinary syndrome of menopause are conditions not commonly discussed, although they can impact quality of life on par with conditions such as diabetes, arthritis, asthma, and back pain. 

  • Physicians also play a role in the silence surrounding women’s sexual health, as many do not discuss this matter with their female patients.

Sexual health goes beyond issues related to having sex—such as contraception and sexually transmitted infections—it also relates to healthy female sexual function. Unfortunately, talking about sex if you're a woman is considered taboo, particularly when sex is for pleasure rather than reproductive purposes.

Misunderstandings about sex and sexuality can contribute to women’s reluctance to talk to their doctors about their concerns, and therefore they miss out on obtaining the medical counseling or support they need. 

Why are women not talking about their sexual health?

Issues like painful sexual intercourse or lack of interest in sexual activity may be relegated to the belief that these are inevitable and uncorrectable, whereas the opposite may be the case. 

Women often feel uncertain about discussing their sexual health with their healthcare provider, as revealed by US and international surveys of women, according to an article published by the Journal of Women’s Health.[]

Some of these reasons include:

  • Discomfort or embarrassment with having the discussion

  • Previous negative experiences discussing sexual health with their healthcare provider 

  • Fear their concerns or questions will be dismissed or unheard 

  • Uncertainties about which specialty provider to discuss sexual health with, and about how to articulate symptoms and concerns 

  • Low awareness of potential conditions and the availability of effective treatments (Why would you bring something up if you don’t know it exists?)

Sexual health is relevant for women of all ages

Some cultures and societies assume that older women do not, or should not, engage in sexual activity. However, statistics say otherwise. 

Surveys indicate that sexual activity is important to women even in the postmenopausal stage.

The authors of the article in the Journal of Women’s Health report the results of several surveys on sexual health during aging:

The Survey of Midlife Development in the United States found that approximately 60% of women older than 60 years of age were sexually active. Another survey found that 22% of married women between ages 70 and 79 were sexually active. In the AARP Survey of Midlife and Older Adults, approximately 60% indicated that sex is a critical component to a good relationship. 

Among women 60 to 89 years of age who were surveyed in another study, sexual activity and functioning did decline with age.

However, sexual satisfaction and self-rated successful aging and quality of life remained unchanged across the age groups.

Genitourinary syndrome of menopause

Within mainstream society, sexual health issues associated with the menopausal transition receive much less discussion than other aspects of sexual health, such as sexually transmitted diseases, contraception, or fertility planning. Genitourinary syndrome of menopause—a collection of signs, symptoms, and disorders related to menopausal changes—can significantly interfere with a woman’s self-esteem, intimate relationships, daily living, and sexual activity.

In fact, say the authors writing in the Journal of Women’s Health, symptoms of genitourinary syndrome of menopause can impact a woman's quality of life to a similar extent as arthritis, chronic obstructive pulmonary disease, asthma, or irritable bowel syndrome.

Genitourinary syndrome of menopause is characterized as a chronic, progressive vulvovaginal, sexual, and lower urinary tract disorder, with corresponding symptoms.[]These include vulvar and vaginal atrophy and symptoms of vaginal dryness, pain during intercourse, vaginal burning and itchiness, and reduced lubrication. Lower urinary tract symptoms may include urinary frequency, urgency, and burning. 

Female sexual dysfunction 

Female sexual dysfunction is a spectrum of problems that are commonly seen in premenopausal and menopausal women and include hypoactive sexual desire disorder.[] Up to a third of adult women in the US may experience hypoactive sexual desire. 

The essential feature of female hypoactive sexual desire disorder is a deficiency, or absence, of sexual fantasies and desire for sexual activity that causes marked distress or interpersonal difficulty.

It can severely affect a woman’s quality of life, to an extent comparable to the effects of back pain or diabetes. 

Sexual health info and HIV prevention

In the American South, where sexual abstinence is taught in schools, there is a high incidence of HIV infection, including among women. Among the women affected, Black women make up 55% of cases.[]

Investigators were interested in understanding potential barriers among young Black women in the South to obtaining sexual health information and, particularly, access to HIV pre-exposure prophylaxis (PrEP). Therefore, they conducted a study among adolescent girls and young women in Alabama.

The results indicated that, at an early age, the participants wanted to learn about sexual health from trusted sources, including educators, healthcare providers, and patients.

However, most participants described a lack of providers or other advocates who could provide sexual health advice, and therefore they learned how to navigate sexual healthcare on their own.

They stated that their experience of stereotypes, stigma, racism, and sexism—and that of their peers, family members, and social media influencers—affected their willingness to seek care. Regardless, they wanted providers to discuss sexual health and HIV prevention options with them, even when they did not perceive themselves to be at risk for HIV infection. 

Are physicians impeding women’s sexual health?

The limited training in sexual health that most physicians receive during medical school and residency generally teaches them to take a sexual health history from a disease standpoint rather than a wellness standpoint. 

Of course, if a patient brings up a complaint about sexual dysfunction or has a symptom related to a sexually transmitted disease, then we, as physicians, usually address this.

The physician rarely is the first one to inquire about their female patient’s sexual health history. The article in the Journal of Women’s Health provides some answers as to why this is. The authors found, from a review of the literature on why physicians do not routinely take a sexual history, the top reasons include a lack of adequate training about sexual disorders, lack of diagnostic tools, and a belief they have limited treatment options to offer their patients. 

Time constraints also play a role, as well as considering patients’ sexual health not to be a priority. 

Physicians also cite personal discomfort in talking about sex, admitted biases about age and sexual encounters, and not wanting to offend patients. 

Some clinicians feel they do not have the resources to address concerns that are raised; others wait for the patient to raise the subject about their sexual health. Costs, coverage, and regulatory/policy issues can factor in, as well.

What this means for you

Sexual health for women can be improved by educating female patients about sexual function and sexuality, training primary care providers, and providing communication tools to healthcare professionals to facilitate effective dialogue about sex with their female patients. These measures can help empower female patients to discuss their sexual health from a wellness standpoint openly, improving their intimate relationships and overall quality of life.

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