Talking to a clinician about sex

The single largest barrier to sexual healthcare is not access or cost in most countries — it is the conversation, and it is a barrier on both sides of the desk.

What clinicians are actually thinking

Worth knowing, because the imagined judgement is generally absent.

They are working through a differential diagnosis, which means the questions about practices, partners and protection are the same as questions about smoking or exercise: information that changes what tests to order and what to consider.

They have heard everything, repeatedly, and the thing you are dreading saying is likely to be the third instance that week.

They are frequently as awkward as you are, since training in taking a sexual history is patchy and many clinicians avoid the topic for their own reasons.

Which means that if you raise it directly, you have solved the problem for both of you.

What to say and how

Lead with it rather than saving it for the end, since appointments run out of time and the door-handle disclosure gets the worst version of the consultation.

Be specific about what has changed and when, since "things aren't right" requires a great deal of extraction.

Say what you actually want from the appointment: a test, an explanation, a referral, or reassurance — clinicians are frequently guessing at this.

Use whatever words you have, since precision matters more than terminology and nobody expects anatomical vocabulary.

And answer the history questions accurately rather than in the version that sounds better, since an inaccurate history produces the wrong tests.

The questions worth asking

What could be causing this?

What are we ruling out?

Is anything I am taking contributing to it?

What are the options, including doing nothing?

How long before I should expect a change, and what should I do if there isn't one?

Is there someone who specialises in this?

That last one matters, because general practice covers an enormous range and specialist sexual health, menopause, pelvic health physiotherapy and psychosexual services exist in most systems.

Preparing

The things that improve any appointment.

Write down the two or three things you most need addressed, in order, since people reliably forget the important one.

Bring a list of current medications including anything bought over the counter or online.

Bring dates: when it started, what else changed around then.

Bring a symptom record if the problem is intermittent, since a diary is far more informative than recall.

And consider asking for a longer appointment when booking, which is available in many systems and which nobody thinks to request.

Being taken seriously

An issue with documented patterns worth naming.

Research has repeatedly found delays in diagnosis of conditions including endometriosis, and evidence of pain being underestimated in women and in some ethnic groups.

Practical responses: describe impact rather than only sensation — what you can no longer do — since function is harder to discount than pain scores.

Ask directly what the plan is if the current treatment does not work.

Ask for the reasoning to be recorded, which is a reasonable request and which changes the tone of a consultation.

Bring someone with you if you find it difficult to advocate for yourself.

And seek a second opinion, which is a normal part of medicine and is not an insult to the first clinician.

Confidentiality

Specialist sexual health services in many countries operate under enhanced confidentiality and will not routinely inform a general practitioner without consent.

Interpreters can be provided and should be professional rather than a family member, particularly for this subject.

Chaperones are available for any intimate examination and can be requested.

And any examination can be stopped at any point, which is worth knowing in advance rather than discovering mid-way.

If you are the partner

A note that applies frequently.

Attending together is helpful for many sexual problems, since they are rarely one person's alone, and psychosexual services frequently prefer it.

Being present also means the explanation is heard directly rather than relayed through someone who is embarrassed.

The thing that gets people through the door

For most people it is realising that the alternative is years of a treatable problem.

Median delays before seeking help for erectile difficulty, painful sex, incontinence and low desire are all measured in years, and in almost every case the treatment was available the whole time.

Fifteen minutes of embarrassment against several years of the problem is an unusually favourable trade.

General information only, not medical advice. Consult a qualified clinician or sexual health service about your own circumstances.