published in HealthSpeak magazine, Summer 2014, Issue 6, p24
(a publication of North Coast NSW Medicare Local for health professionals)
Doctors, do you routinely ask patients about their sexual function?
Research suggests most patients won’t tell you about their sexual problems unless you ask.
Doctors are often the first point of contact when a patient has a sexual concern. However many people do not feel comfortable talking about their sexual function unless their doctor is comfortable discussing sexual matters and invites them to speak openly.
In Australia, research indicates:
- 56% of people are dissatisfied with their sex life
- 22% of men over 40 in monogamous relationships report no sexual activity in the past year
- 30% of men experience erectile dysfunction (impotence)
- 25% of men report lack of sexual desire (libido)
- 24% of men report ejaculating too quickly
- 16% of men & 17% of women report performance anxiety
- 55% of women report lack of sexual desire (versus 30% in USA)
- 30% of women report difficulty reaching orgasm (versus 7% in Denmark)
- 27% of women report little or no sexual pleasure
What this means is that many Australians are struggling with sex. Much of this is due to poor sex education, poor understanding of their bodies, and people’s unrealistic expectations of their partners.
And we are an ageing society, where:
- 70% of women over 60 and
- 92.7% of men over 60 are sexually active
The majority of people with concerns about their sexual function are not seeking treatment. And when they do, they are often not referred to a sexual health physician or sex therapist.
In a US study of 1,682 people conducted in 2004, 15% of respondents reported they sought treatment for problems related to sexual functioning from their personal physician, while only 7% sought treatment from a psychologist or sex therapist. Across all age brackets, men are more likely than women to report having sought treatment from their personal physician or a specialist physician for their sexual functioning-related problems.
In my own practice, I am often hearing anecdotal stories about the range of responses given by GPs to patients’ sexual concerns. To give you some examples –
- The inexperienced 18 year old man who was so keen to make his girlfriend’s first experience perfect that he consulted his male GP about his inability to achieve an erection ‘on demand’. He was prescribed Cialis, but was not educated about how it works and when to take it. The result was a high level of distress when his penis didn’t perform.
- The medical practice waiting room with prominently displayed signs saying ‘this practice does not prescribe contraception or give referrals for terminations’.
- The 24 year old man who ceased having erections, even during his sleep, and was told ‘it’s all in your head, go talk to someone’ but was not given a referral.
- The 50 year old man who tentatively raised the subject of his low libido with his young female GP and was hurriedly prescribed Viagra without any further discussion or a medical history being taken.
And on a more positive note-
- The young female GP who openly enquires about her patient’s sex lives while performing routine pap smears, giving them permission to speak freely.
One obvious reason why GPs don’t invite discussion of a patient’s sexual function is the time limitation of a standard consultation. Many GPs feel they’ll be opening ‘a can of worms’ that will lead to a time blowout they can’t afford in an already busy day. Many also report inadequate training when it comes to sexual functioning since the majority of medical degrees devote very little time to the understanding of sexual function.
GPs cannot afford to ignore or dismiss sexual concerns. Evidence shows that sexual dysfunction is often an early indicator of many serious health conditions, cardiovascular disease being the most common.
If you have patients with any of these conditions, they probably also have sexual issues they need help with:
- Anxiety / depression
- Cardiovascular disease
- Chronic pain
- Spinal injuries
- Prostate or gynaecological problems
- Recent childbirth
Likewise, patients taking a variety of medications suffer sexual side effects. The most common of these are SSRI anti-depressants, anti-anxiety and anti-psychotic medications. New research also indicates that sudden cessation of SSRI medications can permanently remove sexual desire and the ability to orgasm.
To find a sex therapist to refer to in your area, go to The Society of Australian Sexologists (http://assertnational.org.au/) for more information. Sex therapists have extensive sexual health training and come from a variety of fields, including doctors, nurses, psychologists and counsellors.
Alison Rahn is a sex therapist based in Mullumbimby. She has a Master of Health Science (Sexual Health) and is a member of SAS (Society of Australian Sexologists). Alison is the only sex therapist practising between Coffs Harbour and the Gold Coast. For more information, contact Alison on 0432 599 812 or go to www.alisonrahn.com.au
AARP (2004) Sexuality at Midlife and Beyond: 2004 Update of Attitudes and Behaviors. http://assets.aarp.org/rgcenter/general/2004_sexuality.pdf
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Laumann E et al (2005) Sexual problems among women and men aged 40–80 y: prevalence and correlates identified in the Global Study of Sexual Attitudes and Behaviors. International Journal of Impotence Research 17, 39–57
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