This past April, Manhattan gynecologist Susan Grant received an out of the ordinary email from an 18-year-old. "There's something wrong with me," wrote the woman, a prospective patient. "I can't orgasm and I think I need to learn how. Can you help me?"
Grant has been practicing obstetrics and gynecology for more than 20 years, but she rarely encounters such frank questions about sexuality. She's not alone. Concerns about sexual pleasure and pain are common, but conversations about them in the exam room are not.
A recent U.S. survey of 1,147 ob/gyns found that just 14 percent routinely ask patients about pleasure. Fewer than 30 percent inquire about sexual orientation, and only 40 percent ask about sexual dysfunction. The study suggests that many MDs are not doing enough to establish an environment where patients feel safe broaching the uncomfortable details of their sex lives.
When such topics are left unaddressed, serious medical conditions—sexually transmitted diseases, vulvodynia, endometriosis, or worse—can fly under the radar, cautions Vancouver-based gynecologist Trevor Cohen. He recalls one patient whose discussion of painful intercourse helped a colleague diagnose a case of early-stage ovarian cancer. "Not talking to patients about sexual issues is negligent and unethical," Cohen says. "To provide the correct treatment, you have to ask specific questions."