November 14, 2020

The Importance of asking patients if they have sexual concerns and why health care providers get tongue-tied

As a sexologist I often see patients who have visited two levels of providers before getting to me for help with sexual concerns.  Often they have seen a physician or nurse practitioner, and then a marriage or relationship therapist.  Sometimes, they have not been asked, nor do they bring up their sexual concerns.  

What’s going on here?

For one thing, few patients feel comfortable initiating the conversation.  In one survey of 500 adults over 25, 68% feared that raising concerns about sexual problems would embarrass their physician, and 71% believed their physician might dismiss their concerns (Marwick, 1999).

Clinicians, whether providing medical or counseling services are hesitant to ask about patient’s sexual functioning due to lack of comfort, lack of training or education, concerns about patient perception of intrusiveness or inappropriateness, time pressures, lack of familiarity with resources, and underestimation of the prevalence of sexual difficulties.

How common is sexual dysfunction?

We know from studies that at least 40% of people will be affected by sexual difficulties (Laumann, 1999; Bancroft, 2003) and that figure rises to between 52-60 %  for individuals who have been diagnosed with cancer (Fobair, 2006; Schover, 2018).

How can we improve the situation?

First:  Let the patient know it’s not taboo.

One of the easiest ways to communicate this is to ask 3 questions on your Intake form:

  1. Do you have a sexual concern?
  2. Does it relate to sexual interest, sexual functioning or pain?
  3. Would you like to discuss the problem or receive a referral?

Second:  Have a list of capable providers handy or refer the patient to the American Association of Sex Educators, Counselors and Therapists  website (  The website lists certified sexuality professionals by state.

Third:  Decide to gain some information and comfort by seeking out additional training in sexual medicine or sexuality education through several organizations or individuals who provide it.

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