Need sex advice? Thinking of asking your doctor? While your physician is expected to be your sex educator, counselor and number one resource, you may want to think twice before going that route.
It turns out that the average doctor has the same questions you do. Many are sexually ignorant themselves, and most lack the training to deal with your sex life adequately. And it’s causing quite a pickle for patients.
Between the media and information (including misinformation) on the Internet, patients have more sex questions than ever. Many have concerns about their sexual performance, and they see their physician as the first point of contact and referral when it comes to sex matters. But data show that many aren’t talking to their doctor about sex — and vice versa.
A 2008 survey conducted by Ipsos Public Affairs (and sponsored by Eli Lilly and Co.) found a lack of communication between patients with erectile dysfunction (ED) and their physicians. Nearly 40 percent of the approximately 3,000 men with ED surveyed had never talked to their doctor about their condition.
The survey found that patient discomfort was the number one barrier. Other major barriers included patients not knowing what to ask, and concerns about their physician’s gender. Only 36 percent thought that doctors are very comfortable having detailed discussions about ED. Of the men who spoke to their physician about it, 86 percent said that they themselves had to initiate the conversation.
So we have another piece to the puzzle of why there’s a communication breakdown between patients and physicians when it comes to sex. Earlier research findings in the Journal of American Medical Association showed that 75 percent of patients think their physicians would dismiss their sexual health concerns, with 68 percent of them believing that this would probably embarrass their doctor.
It seems they’re right.
Those who work with health professionals and those training to be physicians have found that many are burdened by sex biases, anxieties, lack of facts, misconceptions and discomfort. A number of them have an especially hard time dealing with sex matters when patients are gay/lesbian/bisexual/transgendered, elderly, physically or mentally disabled or HIV-positive.
Other issues that cause them to break a sweat include a loss of libido, vaginal dryness due to menopause, and “fringy” behaviors, like group sex. While it’s easy to blame doctors for balking when patients go to bat, the fault lies first with their training.
A huge part of the communication problem is the lack of sex education in medical schools. For decades, physicians-in-training haven’t gotten much beyond the biological basics. There are no standards when it comes to curriculum guidelines or evaluations. So if a medical school touches upon sex, this could be anything from gender disorders to sexual abuse to sex and culture.
With efforts far from comprehensive and thorough, medical students often miss out on a great deal of vital information. Research conducted by Brown Medical School in 2006 showed students identifying gaps in the curriculum in areas like sexual violence, pregnancy termination, non-heterosexual health and HIV counseling. It’s not uncommon for any of the sex education offered to be delivered over a brown bag lunch.
A 2003 study out of the Medical College of Georgia, which examined how 125 American and 16 Canadian medical schools prepare physicians to diagnose and treat sexual issues, found that most provide no more than 3 to 10 hours of sex education. Less than one-third required a course on how to take a detailed sexual history. Only 43 schools focused on treating client sexual disorders in their clinic programs.
While there is a handful of four-star sex ed programs out there, the majority of schools offering more structured classes tend to stick to a lecture format. In doing so, they ignore the need for sensitive communication training. Students are deprived of the chance to learn how to deliver information and services in a non-judgmental way.
The end result: Students who will be tomorrow’s doctors aren’t comfortable talking about sex. In assessing the instruction of human sexuality at Harvard and the University of Massachusetts medical schools, a 2001 study found that no more than 6 percent of students were “very comfortable” taking a sexual history of patients over 54 years old.
With medical schools failing to reach their sexual peak, it seems you’re the one getting screwed. The consequence of a lack of training is that a sexual history is not administered enough. The reasons doctors give for this?
— They’re worried about patient discomfort.
— They think that the chief complaint isn’t related to one’s sexuality.
— They don’t know what to do with the information once it’s collected.
— They themselves are embarrassed.
Yet between preventive medicine efforts, for example, counseling about high-risk behaviors, the impact of one’s health ailment on one’s sexual functioning, and the prevalence of sexual disorders, doctors need to be “in the know.” They need to be ready to get the full picture on what’s going on with your entire well-being. They need to impart knowledge, despite their own personal issues.
Since sexual function is a major quality-of-life factor, you need to look out for your sexual health. While you have every right to expect your doctor to be competent in communicating with you about sex, you can’t always rely on this. So you need to bring up sex issues of concern; many physicians think you’ll tell them what’s wrong.
Dr. Yvonne K. Fulbright is a sex educator, relationship expert, columnist and founder of Sexuality Source Inc. She is the author of several books including, "Touch Me There! A Hands-On Guide to Your Orgasmic Hot Spots."