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Sex is NOT a dirty word!

Let’s face it, social messaging about sex from an early age portray women as the sexual objects that exist to please men. Society assigns negative connotations to women when their sexual behavior involves “too much” sex however has more approval of a man who does the exact same thing. Some of us are trained to not talk about sex because it is not “lady-like.”

I have many women come into the office stating, “my husband wanted me to ask if there’s something I can do about my lack of libido.” Why does it tend to be just about pleasing him? Why can’t it be something in it for women too? Many women just accept the fact that their libido is lost and this a new way of life and do not bother asking about options to improve it.

But there are also women who are afraid to discuss their sex life out loud. In addition to societal pressures and things learned while growing up, there are barriers to talking about women’s sexual health at a routine gynecological visit. As a Gynecologist, I am embarrassed to admit that I used to be a part of those barriers.

When I finished residency, I was so excited about establishing relationships with my own patients who I would follow through the different stages of womanhood. But I must admit that when I started practicing 13 years ago, I would cringe when I saw “decreased libido” on a patient’s list of complaints. Before I went into the room, I would do a quick google search on “improving libido in women” then let out a big sigh and walked into the patient’s room. I tried to gather as much information as I can in this 15-minute window of time then at the end of the visit, I offered the solution of, “have more date nights.” That was it! That was all I had to offer…. which was awful!! I walked back to my desk wiping my forehead feeling glad that the visit was over but also annoyed because I felt like I should have done more.

Let me explain my apprehension early on in practicing for these types of visits and I know some of my colleagues can relate!

First, I did not feel like I had enough “tools” to address this problem. In residency, there was limited teaching or discussion about women’s libido, so I did not have much exposure to how to solve and improve this issue. Also, there were not any options like Viagra that were available for women. So, I literally felt helpless when I saw these patients as an Attending physician because I did not have any great option to offer them. And I hated this feeling.

Second, a decreased libido in women can be a complex issue to tackle and get to the heart of the problem. A 15-minute visit is just not enough time to dig deep in the subject. So often I felt like I had to rush through the interview so I would not get too far behind for other patients that were waiting.

The third reason is something that I did not have trouble with, but I know some doctors may and that is not feeling comfortable with talking with a patient about her sex life. Some doctors just do not feel comfortable talking about it, and this could be due to the lack of training and/or their own biases toward sex. So, if doctors do not feel comfortable talking about it, they are less likely to bring it up in the conversation during a patient’s visit or will rush through the visit to limit the discussion.

So, these are the barriers from the physician’s perspective to talking about women’s sexual health:

1) Lack of training or resources to provide adequate treatment and/or management options

2) Lack of time during the doctor’s visit

3) Uncomfortable with the conversation of sex

Now what about the barriers from the patient’s perspective?

Many women do not bring up their sex life during a doctor’s visit because they are embarrassed or uncomfortable about it. This especially happens if she is not comfortable with talking to her physician or don’t have a good relationship with that physician.

Some women fear that they will be blown off or not taken seriously when it comes to her sexual health issues. I remember one of my patients came to me as a new patient and informed me that she mentioned her decreased libido to her previous gynecologist, and she was told, “just fake it.”

Or women are afraid of being judged by their sexual practices, so they avoid bringing it up at doctor’s visits.

There are some women who fear they lack knowledge about their bodies or about general human anatomy, so they will not bring up the topic of sex.

So, the barriers for patients in talking about their sexual health are:

1. Embarrassment and/or uncomfortable

2. Fear of judgment or not taken seriously

3. Lack of knowledge

Today, I look forward to seeing every patient, especially the ones with “low libido” because I’ve become equipped over the years with information as well as more options to offer these women. So, I no longer cringe when I see “decreased libido” on the list of complaints, I get excited about the conversation…no pun intended! 😊 I give 2 claps when my 70-year-old patient is enjoying her sex life!

So as a Physician, I aim to break down these barriers by:

1. Try my best to make my patient feel comfortable about talking about anything with me

2. I purposely ask about a patient’s sex life (when indicated) instead of avoiding it

3. Take my time with the conversation about their sexual health

Ladies, as a patient, I encourage you to first establish a good relationship with your physician so when the time comes, you can have a conversation about your sex life. Don’t be afraid to speak up about issues in your sex life, because if you don’t speak up, your doctor may not ask about it and you may end up suffering in silence. I urge you to advocate for your sexual health because it matters. A good sex life is healthy, and you deserve it!

“Sexual health is more than freedom from sexual disease or disorders ... Sexual health is non-exploitive and respectful of self and others ... Sexual health is dependent upon an individual's well-being and sense of self-esteem.” – Eli Coleman

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