Have you ever asked a patient, “How’s your sex life?”
If your answer is “No,” you’re not alone.
The Centers for Disease Control and Prevention (CDC) finds healthcare providers don’t talk about sex with their patients for a variety of reasons:
- They feel uncomfortable discussing sex and sexuality with patients;
- They believe discussing sex will take a lot of time;
- They believe their patients are uncomfortable discussing sex;
- They’re worried about cultural differences or saying the “wrong thing”; and
- They don’t think older (age 60+) patients are having sex.1
An article titled, “‘Opening a Can of Worms’: GP and Practice Nurse Barriers to Talking about Sexual Health in Primary Care,”2 seems indicative of the situation.
Patients, meanwhile, don’t seem to be bringing up the topic, either: “Talking to the doctor about sexual health” yields a mere 100 results in PubMed.
It makes sense that any illness or disability will have an impact upon sexual health. After all, in the circle of the holistic self, sexual health has the same importance as psychological health, social health, physical health and spiritual health. Asking about sexual health concerns in the field of rheumatology, where so many patients are living with chronic pain, joint complications and other debilitating physical symptoms, is crucial. Patients may find it hard to feel intimate when they feel, or think they look, different or project their partner perceives them differently.
I believe healthcare providers have a responsibility to help patients gain a better understanding of how health complications can affect sex and intimacy, as well as offer support and suggestions. Making ourselves open to talking about sex and trying to answer questions can help our patients regain intimate relationships. Such conversations help strengthen and improve the relationship between provider and patient.
You needn’t be a sex-pert to talk about sexual health with your patients. They don’t expect you to have all the answers. It’s far more important you show you’re ready to listen.
Sexual Health Issues
Following are examples of sexual health encounters from my experience and that of physical therapist Katie Gilin, DPT:
Patient 1: Edger, age 56, with ankylosing spondylitis (AS), confided he had been experiencing impotence. I explained that, because the spinal nerves innervate the penis and help with its functioning, anything affecting the spinal nerves, like AS, can cause problems related to impotence.
We discussed the use of sildenafil, the importance of taking the medication exactly as prescribed and the need for manual stimulation to prime the body to achieve the desired result.
He really wanted to surprise his wife with his new ability to get a sustained erection, until I stressed that she, too, needed to be prepared for intercourse.
Patient 2: Tina, age 35, with Sjögren’s syndrome (SS), told me she hadn’t been intimate with her husband for the past two years, because she is no longer able to have orgasms and intercourse is very uncomfortable for her.
We talked about clitoral neuropathy and vaginal dryness, which can be associated with SS, and that additional lubrication and stimulation would be essential for her sexual enjoyment. We also talked about her joint pain, and how her husband no longer wanted to touch her for fear of hurting her.
On Tina’s next visit, her husband came with her. He said, “I wanted to meet the woman who gave me back my wife.” He said Tina’s fatigue and joint pain were improved and that having her back to her old self made him feel better too. He added, “We’re taking things slowly, but we hug, kiss and hold hands a lot, and I’m not afraid to touch her anymore.”
Patient 3: Lynda, age 31, with Ehlers-Danlos syndrome, was experiencing stress urinary incontinence, bladder prolapse (cystocele) and urinary frequency with incomplete emptying. She had undergone a surgical hysterectomy five years before, which she believed had worsened her prolapse and urinary symptoms. She also described pelvic pain with any vaginal penetration. After 10 visits for pelvic floor physical therapy, she was able to demonstrate improvements in all of her symptoms; she also reported improved intimacy with her husband, including enjoying intercourse without any pain.
Patient 4: DeeDee, age 61, came to see me for a routine checkup for her AS, which had progressed to the point that she was using a wheelchair or walker due to pain and mobility options. She explained that she was having difficulty opening her legs open wide enough to have sex with her wife. This complication was due to the fusion of DeeDee’s sacroiliac joints.
I contacted a osteopathic medicine (DO) resident I had worked with before. After two months of intensive orthopedic manual physical therapy (PT), DeeDee had regained enough mobility to allow for more satisfying intimacy.
At her next visit, I asked DeeDee how she was doing. “As soon as I stopped the home PT exercises and took a break from seeing the DO, my hips started to stiffen up again, and intimacy became difficult again,” she confessed.
I replied, “Then you’ll just have to keep yourself mobile in order to maintain your sex life.” Compliance to therapy is as important to sexual health as it is in other treatment areas.
