The subject of sex can seem taboo to many women, especially when they go to see their doctors for routine exams. It may be difficult to discuss or admit that sex is painful, non-orgasmic, or not as good as it used to be.
It can be hard to say out loud that things are changing “down there” with age or after children. Some women feel that they have dried up or conversely, as someone once told me, that they have "too much cervical fluid."
Sexual issues occur at any and every age. I have discussed “how to have sex” with women of all ages, just like I have discussed “how to have an orgasm,” or “where is the clitoris,” with many of my patients, regardless of their stage in life.
I discuss sexually transmitted infection protection with my teens just as easily as I chastise my newly divorced 50-year-olds who feels their menopausal status means they don’t need condoms.
Newsflash: You need to use a condom. Menopause does not protect against chlamydia or herpes.
So how do you talk with your health care provider about sex?
It does depend somewhat on the relationship you have with your doctor. Bedside manner plays a big role in discussing the finer points of orgasm or vaginal dryness. However, everyone who's gone through advanced medical schooling such as an MD, DO, ND, NP, and PA, will have received a lot of training in gynecology.
First, write down your questions in order to have an open discussion. Try to avoid the pitfalls of the internet where “worst case scenarios” dance wildly in your head. That itchy rash might just be a yeast infection.
Be as specific as possible. Do you bleed after intercourse? Is there a new bump on your labia? Have you cheated on your partner and need testing?
Are things drier than they used to be making sex painful? Have your orgasms decreased? Are you looking to avoid pregnancy?
It does not matter how big or how small the question, add it to your list.
Next, be honest with your health care provider. Tell them you have specific questions in regards to sexual health, then ask away. If you have follow-up questions, ask those too.
Sex and sexual health are very important to both our physical and emotional well-being.
Don't hesitate to get a second opinion. If you do not feel the questions you are asking are being met appropriately or are getting brushed under the proverbial rug, inquire about seeing a different provider whose experience lies more solidly in women’s health.
Be ready for some tests. Understand that routine issues may be resolved with in-house testing to clear up infections or test for HPV.
Some women need to have their hormones tested in order to determine whether they are at appropriate levels. Others may need to see a pelvic floor physical therapist in order to evaluate their vaginal and pelvic muscles.
Sometimes you just need a little assurance or education around the entire issue of intercourse. That’s OK and completely normal.
Lastly, counseling with a qualified therapist may be in order. This may especially be true if someone is experiencing relationship issues, struggling with a difficult or traumatic past, or is finding other concerns are getting in the way of a healthy sex life.
As the overplayed song by Salt-N-Pepa states, “Everybody has sex. I mean, everybody should be makin’ love.”
Do not suppress your questions out of embarrassment. Your health care provider is there to help you find and maintain good health, and sex is a part of that.
Reviewed February 18, 2016
by Michele Blacksberg RN
Edited by Jody Smith