Man with physician

I have a charming primary care physician who’s up on the latest research, and quite thorough—well, almost. She never asks about my sexual functioning.

My doctor is typical. For years, sexologists have fretted about doctors’ discomfort with sexual issues. An editorial in the British medical journal, Lancet, says “sex is a legitimate part of medicine,” but doctors have “largely kept it separate from the rest of medicine.”

Many conditions involve possible sexual dysfunction: heart disease, stroke, cancer, diabetes, depression, and chronic pain, among others. In addition, recent studies show that sex problems, particularly erection impairment, can be the first symptom of several of these conditions, notably heart disease. Doctors who are reluctant to ask about sexual difficulties or don’t follow up on them may delay or miss important diagnoses.

American culture cherishes a myth that doctors step out of Normal Rockwell paintings and have all the time in the world to chat about what’s bothering their patients. In fact, doctors are under tremendous time pressure and are less likely to chat than to reach for the prescription pad. When Viagra was released, doctors suddenly had a drug to treat erectile dysfunction (ED), so ED became a subject they would discuss—quickly while writing the prescription. The same thing happened when research showed that low-dose antidepressant medication could delay ejaculation. Suddenly, there was a medical treatment for premature ejaculation (PE) and doctors were willing to discuss it.

Unfortunately, few physicians know much about sex counseling. Several studies have shown that erection medication works best when combined with sex therapy. Studies also show that with some sex information and perhaps sex therapy, most men can cure PE without drugs. In addition, sex therapists can help treat many problems for which there are no pills—and therefore, little interest from doctors, among them: arousal problems, orgasm difficulties, desire differences in couples, and the sexual changes that begin after 40.

In all fairness, physicians are not the only ones who feel uncomfortable discussing sex. Many people cannot bring themselves to raise sexual issues with their doctors. As a result, many sex-related problems go uninvestigated and undiagnosed and cause misery much longer than they should.

Talk To Your Doctors About Sex If They Don’t Talk To You

The next time you visit your physician:

• Mention your sexual functioning. You don’t have to have a problem. Just check in with your doctor about your sexuality, even if you say that all’s well. The idea is to put sexuality on the medical agenda, so that both of you become more comfortable discussing it.

• If you have a sex problem, mention it and urge your doctor to refer you to a colleague who specializes in sexual medicine, a small but growing medical specialty. If your doctor knows a sexual medicine specialist, great. If not, you might mention the Sexual Medicine Society of North America. You might also contact SMSNA yourself to find a sexual medicine specialist near you.

• When medical conditions affect sexual function, the best approach usually involves combining medical treatment with sex therapy. To find a sex therapist near you visit the American Association of Sex Educators, Counselors, and Therapists.

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