Sex

Open Letter to My Doctor (and Yours)

Too often, ignoring sex seems to be state-of-the-art medical care.

Posted Dec 31, 2019

Dear Doctor: You didn’t ask me or talk to me about sex. Not once.

I saw you for hip pain. Given the way that so many kinds of sex involve our hips, asking about sex would seem important. You didn’t.

Of course, you’re not alone, Doc. Last year I saw four different doctors—all highly-regarded, with long waiting lists—about my hip pain. Not one asked about sex.

Eventually, I decided on hip replacement surgery. In our pre-op meeting, you didn’t ask about sex. Later that day, I attended a mandatory two-hour class at your state-of-the-art clinic. Various professionals, all competent, experienced, and caring, talked about everything we could expect—dressing, bathing, toileting, exercising, pain management, everything.

Not one mention of sex.

After the surgery (successful, thank you), I had lots of physical and occupational therapy. Again I had the attention of intelligent, skillful professionals. They had lots of clever ideas about things like how to put on socks when I couldn’t bend. They had good questions about rugs or steps in the house.

They had no questions or clever ideas about sex.

I don’t think it’s because of their prejudice about my advanced years, either (although that would be no excuse, right?). No, silence about sex is standard in every medical practice.

Infertility docs. Internists. Gastroenterologists. Urologists. Proctologists. Yes, even gynecologists and pelvic floor specialists. I work with a lot of them. I’m a patient of some of them.

They don’t ask my patients about sex, and when I’m a patient, they don’t ask me about sex.

Dentists? The good ones will ask whether you smoke, how much alcohol you use, and whether you drink soda. But they don’t ask about sex. Not even about kissing. Wouldn’t that be relevant to your “oral hygiene”?

In the medical profession, not speaking about sex is normal. And it’s simple negligence.

Some years ago I was invited as a last-minute fill-in to speak at a conference of hand injury therapists. I had recently recovered from a fall with the help of a physical therapist, and he thought I could share some insights about physical therapy from “the psychological side” of it.

After thanking the organizers, I started by asking “Have you ever noticed how crabby hand injury patients can be?” The crowd of professionals chuckled knowingly. Yes, a lot of those patients sure are crabby.

“I really appreciate how you all talk with your patients about every aspect of daily living,” I continued. “Now how many of you talk with your hand injury patients about masturbation?”

The room was as still as if it was empty.

“Ah,” I said gently. “Why do you think hand injury patients are so crabby?”