Outdated sex talk puts care at risk—here's how to modernize
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"Sexual health can be connected to everything from heart disease to mental well-being, so creating a space where patients feel safe to share really matters." — Raj Dasgupta, MD, internal medicine physician and Chief Medical Officer of Sleepopolis
Most patients won’t bring up sex—so it’s on you to ask.
That’s the message from internal medicine experts at this year’s American College of Physicians annual meeting, where NYU professor Richard E. Greene, MD, urged physicians to take the lead on initiating conversations about sexual health.
Many patients struggle silently with sexual dysfunction, STI risks, or fertility concerns—and unless a clinician creates a safe space to talk about it, those issues can go undetected and untreated. “If we don’t ask, they often don’t share,” Dr. Greene said. [] []
The reality is, stigmas around sex exist for both patients and providers—with both parties at fault for allowing these important conversations to get skipped over. But today's doctors owe it to their patients to let go of outdated assumptions about what is and isn't up for discussion in the exam room.
“It's really hard because we have all the stigma around talking about sex,” Dr. Greene said. “We were raised in the same culture they were. We were told what was appropriate and not appropriate to talk about with people. And then we became doctors, and we're supposed to have these conversations.” []
Sex and stigma
Many patients may not know how to address their sexual activity during routine health exams. That's why docs should make a point to kickstart the conversation and inquire about their sexual history, their desire to have children, and their risk for STIs, Dr. Greene said.
"Anywhere between 20% to 50% of our patients have some form of sexual dysfunction, but if we don’t ask, they often don’t share that with us."
— Richard E. Greene, MD
Dr. Greene added that it’s crucial to challenge feelings of discomfort and spearhead the conversation in an open, nonjudgmental manner.
“This develops a more comfortable relationship with patient and provider,” Stanton Honig, MD, chief of sexual medicine and reproductive health for Yale School of Medicine's Department of Urology and a member of Yale Cancer Center, tells MDLinx.
Related: 6 sexual health myths bustedIt's time to modernize
These conversations may also reveal larger health issues at play. For example, men who present with erectile dysfunction (ED) may also have blood flow issues elsewhere in the body that may benefit from treatment, Dr. Honig said.
ED could also be connected to diabetes. Sexual distress may be indicative of an underlying mental health issue such as depression or anxiety, research reveals, as sexual health and quality of life are intimately linked. []
“Sexual health can be connected to everything from heart disease to mental well-being, so creating a space where patients feel safe to share really matters,” Raj Dasgupta, MD, an internal medicine physician and Chief Medical Officer of Sleepopolis, tells MDLinx.
Sexual health is a highly personal issue. People may feel embarrassed, shy, depressed, or anxious about symptoms they’ve been struggling with, says Dr. Honig.
As such, they may avoid bringing up their concerns to their physicians. In fact, he suspects that this is why online providers like hims & hers—which allow people to bypass in-person discussions—are doing so well.
Proactively addressing intimacy issues and concerns can get the conversation going, he adds. And better conversations lead to better health care.
“By having these honest conversations, we can catch issues earlier, offer better treatment options, and help patients feel more confident about their health,” says Dr. Dasgupta.
Related: How to talk to patients about their sexual history