Sex is not an easy topic to discuss, even for doctors. Asking a patient about it is uncomfortable, embarrassing and intrusive. The doctor is uncomfortable, the patient is squirming, and everyone wants this to be over and done with.
So it’s no surprise that studies show that the vast majority of doctors never ask their patients about their sex lives.
Doctors across all specialties are struggling to address the issue, but some of the worst offenders are GPs, where only six per cent initiate these discussions.
But sex is an integral part of many people’s lives, and medical professionals need to get better at talking about it.
Studies show that the vast majority of doctors never ask their patients about their sex lives.
Many diseases (from diabetes to depression) can affect sexual performance, making it an important symptom when considering a diagnosis.
In my experience, the group of people most likely to avoid talking about sex is the same one for whom sex is usually the most important topic: young men. I think part of the reluctance comes from the fact that many GPs are middle-aged women who are embarrassed to talk to someone their child’s age about such personal details, which only makes the young person more uncomfortable.
But doctors let patients down by not addressing the issue. Sex can be important to our happiness because it helps us feel connected and loved.
I have seen the results of this failure time and time again in outpatient psychiatric clinics.
One of the main side effects of antidepressants is sexual problems. I remember a young man who had been referred to me with depression. His GP had prescribed an SSRI, but this had not worked. They had changed him to another, but again his symptoms persisted. He was very depressed, felt desperate and suicidal at times and enjoyed life little.
He used to lock himself away and sleep for long periods. She lost weight because she had no appetite and fell behind in college.
Ideally, he would need a combination of therapy and medication to help him overcome this, but while I was filling out the referral to the psychologists to start therapy it occurred to me to check that he was taking his medication.
He looked at me sheepishly and finally confided that he hadn’t been taking them. “The family doctor was a woman,” he explained, “so he couldn’t talk to her about it.”
He said the only source of happiness in all of this was his girlfriend. But the antidepressants had caused sexual dysfunction, so he stopped taking them. Who could blame him or anyone else in this position?
One of the things that could give them some pleasure is taken away and affects their intimate relationships at a time when all their peers are getting partners.
This further aggravates their feeling of isolation.
They quietly stop taking their pills, avoid the doctor, and their depression gets worse and worse until they end up in an outpatient psychiatric clinic.
This is a very dangerous situation and all because doctors do not want to be embarrassed.
But this also has another side. Doctors do not always have the data and evidence to present to patients and explain the risks and benefits of medications.
This is because they cherry-pick data and bury parts they don’t like. This is particularly true in the case of sexual side effects.
After seeing this man, I now routinely ask about sexual side effects in patients taking SSRIs and am surprised how many are affected. Independent studies have suggested it may be higher than 70 percent. For some it is not a problem, but for others it can be another source of distress and worry and aggravate their bad mood.
However, if you look at the data on sexual side effects from pharmaceutical companies, they are barely mentioned. It seems that pharmaceutical companies don’t like talking about sex either, although I suspect this is not out of embarrassment but rather concerns about profits.
If doctors had the courage to routinely ask about sex and sexual side effects, they would see for themselves how common this is.
It might make them think twice before handing them out so freely.
Doctors’ campaign group Anesthetists United has raised more than £50,000 to take the GMC to court over Physician Associates (PA). These are not doctors.
Its widespread use in the health service is relatively new. They have not attended medical school and instead have two years of postgraduate training. The original idea was that they would “help” doctors, but as the NHS becomes increasingly stretched, they have begun to take on more and more clinical responsibilities.
The court case against the GMC claims its plan to start regulating so-called “cut-price doctors” does not set out clear rules about what PAs can and cannot do. While I believe PAs have their place in the NHS, my concern is that too often they are used to plug gaps in the medical workforce and, worse, patients don’t even know they are not seeing a doctor. Some patients told me they assumed they were seeing a “doctor” because they were being seen by a personal assistant.
There have been reports that they are allowed to prescribe, diagnose and even operate on patients. A friend has been with his GP for three years and never saw a GP because each time he was seen by a personal assistant who assumed he was a doctor. It is absolutely necessary to inform patients who they are seeing. anything else can’t be right.
Celine’s fear for her children
Singer Celine Dion was diagnosed with stiff person syndrome (SPS) in August 2022
Celine Dion has spoken about how her children are afraid she is going to die as she battles “stiff person syndrome” (SPS), a rare neurological condition that causes stiffness and progressive muscle spasms.
‘My children are afraid because they lost their father and they wonder if I am going to die. I don’t want to die, I don’t want to lie,’ he explained. While SPS is not necessarily fatal, it causes constant concern for your family. For most of human existence we lacked the tools to diagnose diseases or predict what would happen.
However, modern medicine has provided an enormous amount of knowledge and we now often know if we have something serious or even fatal. Perhaps this will give us time to think about our lives, put our affairs in order, and say goodbye. But doesn’t it also mean that we can spend many years worrying about something and waiting for it to progress, even though it may not?
Young doctors have been urged to abandon plans to strike just before the election if leaders promise to make negotiating with them a priority.
The NHS Confederation accused doctors of causing “real consternation” with their strike plans and said the move looked more like a publicity stunt than a constructive act aimed at finding a resolution to their pay dispute. I agree.
Dr. Max prescribes… Lost Children and Fairies
This BBC iPlayer miniseries tells the story of a gay couple who begin the process of adopting a child in Wales. It’s a gentle and sometimes funny story about family, addiction, aging, and homophobia.
Ultimately, it’s a nuanced story about our need for love. The scene with the birth mother in the last episode is extraordinarily moving.
