How to Talk to Your Patients About Sex

Roxanne Nelson, BSN, RN

October 15, 2015

When Patients Need to Talk About Sex

It seems that everyone is talking about sex these days, except where it may really matter most—inside the doctor's office.

Even though sex is an integral part of life, studies show that all too often doctors aren't having "the talk" with their patients. Instead, the topic is frequently glossed over or pushed by the wayside, even though it means missing an important component of the patient's overall state of health.

"The majority of patients, including seniors, would like their physicians to bring up the topic of sexuality, especially related to aging and chronic illness," says Leslie R. Schover, PhD, a professor in the Department of Behavioral Science at The University of Texas MD Anderson Cancer Center in Houston.

She notes that even though healthcare providers, including physicians and nurses, typically agree that it's a good thing to discuss sex with patients, it frequently doesn't come to pass. "Repeated surveys suggest that each professional group regards this topic as 'not my job,' and unfortunately, it's rare for patients to find someone who does regard it as their job," Dr Schover says.

Still Regarded as a Major Taboo

Although the World Health Organization has declared that sexual health is an important and integral aspect of human development and maturation throughout life,^[1] shortfalls in doctor/patient communication about sexual matters appear to be the status quo. Take a look at some of these statistics:

Only about 15% of patients reported getting counseling for sexual activity after an acute myocardial attack, and among US patients, most stated that they initiated the conversation.^[2] These were younger patients (median age, 48 years), with the majority reporting that they were sexually active before their heart attack.
In a study looking to identify and quantify the barriers that physicians encounter in discussing sexually transmitted infections with their patients, less than one half of primary care doctors (44.3%) provided some form of counseling (eg, asking about sexual history, information about safe sex,) on a regular basis.^[3]
Among a sample of more than 3000 adults aged 57 years and older, only 38% of men and 22% of women reported having discussed sexual issues with a physician after age 50 years.^[4]
A study among very long-term survivors of vaginal and cervical cancer showed that 62% had never discussed the effect of genital tract cancer on sexuality—even though three quarters of the women surveyed believed that doctors should talk about sex.^[5]
Less than two thirds of doctors and teenage patients talk about sex, sexuality, or dating during annual visits, and when these topics were mentioned, conversations lasted an average of 36 seconds.^[6] None of the teenage patients initiated the talk, and only 4% of them had prolonged conversations with their doctors.