When To Talk to Your Doctor About Sex

April 25, 2019

Ashley Fuller, MD, Swedish Gynecology

When something isn’t going right in the bedroom, it’s hard to talk about right? It’s hard enough to talk to your partner but what about bringing up in the doctor’s office? The truth is sexual issues are hard to bring up for everyone! These are absolutely things you should bring up with your medical provider. As a gynecologist, this is something I want patients to bring up, so much so, I actually ask them about their sex lives, and I listen to what they say! Unfortunately, sexual problems weren’t a big part of our residency education and a lot of us have sort of had to learn on our own. Previously, my best pieces of advice were lubricant and “sex dates.” I found I was frustrated that I wasn’t able to help women more when they brought up sexual issues in the office, so I’ve decided to make women’s sexual health a focal point of my practice in hopes that I will be able to help more women. I want to encourage you to bring up your sexual concerns with your provider during your appointments. We want to know! There are things that can make a huge difference for you. Here are some things you should definitely bring up with your provider….

If sex is painful. Up to 75% of women will experience sexual pain during their lives. Some of them will only experience this for a short period of time or just occasionally, but some women will have this haunt them throughout their sexual lives. No one wants to willingly do something that is painful, so this can also lead to low libido or lack of sex and these things can be detrimental to women and to their relationships. There are many reasons why women can have pain with sex and a good physical exam by a knowledgeable provider can be the first step to getting help for this problem. One of the first things I discuss with women with sexual pain is lubrication. Often it is more complex than this, but good lubricant and good foreplay are never a bad place to start. Sex generally doesn’t feel good if you aren’t lubricated and aroused. Please bring up this issue with your provider as there a lot of different things that can cause pain and being evaluated is important.

If you don’t want to have sex anymore. Low libido or lack of desire is a very common complaint in women, especially women going through transitions in their lives like after recently having a baby or going through menopause. As women, our desire for sex can be complex. In fact, it is quite different from men’s sex drive which is why there is no Viagra for women. One of the big differences between men and women is the difference between spontaneous and responsive desire. Most women don’t sit at work and think about how they can’t wait to go home and have sex with their partners, especially when in a long-term relationship. Some women do and that’s a wonderful thing, but most women do not. Many women, when in a situation with their partner that is loving, or sparks excitement and arousal, will want to have sex. This is called responsive desire. It is very normal to have mostly responsive desire and if you’re a woman that has a lot going on in her life with kids, work, and family that you don’t think about sex every hour, you are normal. If during an appropriate time, your partner initiates something that causes you to get excited and leads to an enjoyable sexual experience, this is normal. Imagine instead of wanting to have sex, we are talking about wanting to work out. Most of us don’t wake up in the morning and think about how we can’t wait to go to the gym today. But because we prioritize it and we plan for it, we go. Once we get there and start working out, get a little sweaty, get our heartrates up, we often start to think, “wow, this actually feels pretty good! I don’t know why I was dreading this all day! This feels great!” By the time we are done working out and our exercise endorphins are peaking in our brain we start to wonder why we dreaded doing this and think, “gosh, I should do this more often.” It’s similar with sex. The idea of spontaneous versus responsive desire is always one of the things I talk through with patients because expectations, both of yourself and your partner, are key. There, of course, is often much more to low desire than just this. The question is often complex, as is the answer. There are very helpful sex therapists that can sometimes make a big difference. Also, there are a few medications recently approved by the FDA or in the drug pipeline, which might be helpful to certain women. Talking to your provider about your situation and your goals is an important first step.

Inability or difficulty with orgasm. Some women find achieving orgasm to be difficult, and for some impossible. Generally, I recommend spending some time getting to know yourself… if you know what I mean. You need to know how to achieve orgasm on your own before you can expect a partner to be able to help you. There are different kinds of orgasms depending on where they originate. A minority of women, or less than 30% of women, can reliably orgasm from vaginal stimulation. This means that most women will not achieve orgasm from intercourse! Did you hear that? Most women need clitoral stimulation for orgasm. It’s not always about penetration! Remember that all orgasms are good, no matter where they come from. If despite some alone time and other valiant efforts from a partner, you are still unable to achieve orgasm, please seek out help from a medical provider.

Abuse. If you are being physically or sexually abused please notify someone as soon as possible. Domestic abuse hotline is https://www.thehotline.org/ or 1-800-799-7233. Physical, sexual, or emotional abuse is not okay and if you are in his situation, please reach out for help. You can also call our office at 206-215-6300.

While you can definitely bring these issues up at your well women or annual exam, unfortunately we have little time to address these important issues at these visits. These issues deserve more time than a quick recommendation. If you have a sexual concern, please call and make an appointment for that specific concern so we can have adequate time to address this important issue. If it feels weird to call and talk about your sex life to the scheduler on the phone, just say you are making an appointment for a sexual problem. No need to go into detail on the phone. We will figure it all out at your visit! Remember, we want to know and we want to help you!

Ashley Fuller, MD, is a Swedish gynecologist. Dr. Fuller has a special interest in women’s sexual health, and her goal as a physician is to partner with women to help them decide on a course of action that will help them achieve their health and wellness goals.