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Is talking about sexual difficulties still taboo?

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How often do you raise the topic of sexuality with your patients? Do you wait for your patient to be the one to bring it up?
 
Sexual problems are common, with 54% of Australian men and 66% of Australian women reporting one or more sexual issues in self-reported survey data.
 
However, research shows that patients are often reluctant to raise their concerns around having sexual difficulties due to embarrassment, shame, not feeling that it’s a valid concern or to ‘protect the doctor’ from what they believe might be a difficult conversation.
 
Similarly, GPs (and other health practitioners) have been shown to be reluctant to bring up the topic due to many of their own obstacles, including:

• the fear of ‘opening up a can of worms’
• a lack of time, resources and training
• their own personal discomfort or concern about their lack of knowledge and abilities.

This reluctance can result in patients going for many years without appropriate management – a 2019 audit of patients presenting to the Sexual Medicine and Therapy clinic, Monash Health, showed that patients had sexual difficulties for an average of 6.77 years before attending the clinic.
 
Among those who presented, 45% had the issue for 1–5 years, 26.3% had the problem for 5–9 years, and 20% for more than 10 years. Such a delay can have serious medical, personal and relationship consequences.
 
Furthermore, the length of time differed according to which problem it was.
 
People with erectile dysfunction had a relatively shorter time to seeking help, whilst 33% of those with arousal issues waited 5–10 years and another 33% waited more than 10 years.
 
Having a sexual difficulty, such as painful sex, can be caused by undiagnosed infection, vulval dermatological problems or pelvic pathology, among other causes.
 
Erectile dysfunction can be the first marker of serious underlying cardiovascular disease. Meanwhile, a loss of libido can be caused by medical, psychosexual, or relationship problems.
 
Left untreated, they can lead to worsening of health conditions, mental health issues such as depression, anxiety, low self-esteem, as well as impacting and sometimes ending relationships, or causing a reluctance to form new ones.
 
A recent study showed that a when the doctor simply asked: ‘How is your sexuality these days’, 93% of patients had either a neutral or positive feeling and 81% felt that a sexual history should be an integral part of GP consultations.
 
Currently topical discussions around sexuality are much more prevalent in the lay media, with issues around gender, sexual orientation, and pornography leading to passionate discourse.
 
However, there is very little education for GPs in these areas. GPs may feel uncomfortable, not knowing appropriate language to use with their patients and can be afraid of causing offence.
 
And although the advent of PDE5 Inhibitors has led to more open discussions around erectile dysfunction, women with sexual difficulties can feel as alone and isolated as ever.
 
Working in the clinic and seeing the enormous need has motivated me to educate health professionals, and with the support of Monash University I have been running an annual two-day, multidisciplinary short-course called ‘Let’s talk about sex: sexuality and sexual difficulties’, since 2019.
 
This year’s course will be fully online and is set to cover the need to talk about sex, address the obstacles, and will aim to empower the registrants to raise, discuss and manage topics of sexuality and sexual difficulties with their patients.
 
Given I think it is incumbent upon us as medical professionals to be comfortable having these conversations, I would encourage anyone able to attend.
 
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