In my articles, I will discuss simple communication tools and conversation starters that you can use to integrate the topic of sexuality into your everyday practice as part of normal conversation, and why this not only relieves pressure on patients, but also strengthens the doctor-patient relationship in the long term.
One colleague, a general practitioner, asked: ‘Which areas are covered by patients when it comes to sexuality? How can I incorporate empathetic questions about sex life?’ Basically, I would say that communication tools can be learned and practised through open questions about sexual medicine. But before going to all that trouble, anyone can ask this simple question: ‘How satisfied are you with your sex life?’ It's always about asking skilful, non-intrusive questions. And this is one of them. So what are some simple communication tools for starting a conversation with patients?
Let's imagine a patient who is plagued by constant stomach pains or who simply comes to the general practitioner for a check-up – this simple question would be entirely appropriate. This allows you to incorporate the question of sexuality as a matter of course. It enables the patient to say: Everything is fine. Or even: Yes, now that you mention it, it's not working for me and my husband is having difficulties – because women often speak for their husbands. Even if you ask quite openly: "Are there any difficulties in your sex life?", people have the option of saying: Yes, no, maybe. Even if a patient cannot or does not want to comment on it ad hoc, this question builds a bridge.
This signal to patients: "I can talk to my general practitioner about sexuality". Maybe next time, or two years later. Even we specialists encounter patients who say: "You asked me that four or five years ago. And now it's becoming relevant for me."
This symbolic signal is important: you can also talk to me about this topic! Another example: the family doctor is treating a patient who has had a heart attack. The patient is told that he must take it easy and pay attention to his cardiac stress. This raises the question: Can I still have sex? The patient's partner may also want to know. The bridge could be built as follows: ‘Many of my patients who have had a heart attack worry about their stress limits, for example when it comes to sexuality. Is this something that concerns you too?’ This is a conversation bridge that the patient can choose to cross or not.
Of course, empathy also has to do with yourself. How empathetic am I really, how much can I empathise with another person? This also varies among doctors. And then there is the question: How do I feel about sexuality myself? All these conversations also have a lot to do with yourself.
A colleague, also a general practitioner, writes in the comments that he always addresses sexuality when dealing with certain mental health issues, possible side effects of medication, temporary health problems and age-related sexual problems. I can only praise this colleague. That's really great. And he can certainly expand his commitment. Many antihypertensive drugs, metformin and lipid-lowering drugs, which are taken by a large number of people, also provide a wonderful opportunity to address the subject of sexuality.
In response to a comment from a gynaecologist colleague regarding further training in sexual medicine: "It does not make sense to introduce additional certification. Either you are interested in the topic or you are not." I would like to say: I fundamentally agree with him. It is also okay not to be interested in the topic – although I personally regret that. And it is not about certification, but possibly about an offer that allows further training tailored to the needs of general practitioners.
Another general practitioner commented to me: "Low-threshold offers of conversation surprisingly often lead to relieving conversations and problem solving... Simply asking about libido in addition to questions about symptoms or general well-being changes the quality of the conversation. I consider it essential to explain that some diseases and many medications can affect potency and sexual experience. The biggest problem for us doctors is that ‘there are hardly any sexual health specialists we can refer patients to." Here, too, I would like to express my sincere appreciation.
The fundamental work is to provide relief, educate, and normalise topics related to sexuality. This has a lasting effect on the relationship of trust between doctor and patient. And yes, unfortunately it is difficult to find sexual health specialists. This is a structural and also a financial problem, because it is a service that has to be paid for out of pocket. However, most people do not need to see a specialist. General practitioners with certain basic skills can do a lot themselves. The fact that there is often not enough time for this is a problem for all of us to address.
Another comment refers to the concern that ‘sex education in kindergarten’ certainly does not improve the complex topic. This is indeed a very important question. I believe that providing children with adequate education about the human body, particularly the reproductive organs, would be highly desirable. However, it is often poorly implemented. Sex education is still timidly taught by biology teachers, quickly covering the penis in the vagina, then orgasm, and then the baby. Done. This does not convey basic knowledge in this area at all. I would like to see better knowledge transfer about sexuality.
The fact that political issues are now also getting involved is additionally confusing. I am completely open-minded about gender. But I always start with the common and move on to the rare. We can twist and turn it any way we want, but most of the time it's about men and women having children. Of course, you can talk about everything else in an age-appropriate way, such as diversity. But it's better to do that once the basics have been clarified.
A colleague writes: ‘My children benefit from these topics being discussed openly, and not just at home. It's about using neutral words for body parts and being able to talk about them without shame. And it's very much about preventing abuse, which is still far too widespread.’ Yes, I also think it is very important to encourage children to defend their physical boundaries. It must be clear: I will only allow physical contact from those I want to. But in many homes, this prevention does not take place.
The constant presence of pornography on the internet adds to the complexity and confusion. There are good studies on which children are particularly attracted to pornography and which are able to deal with it more stably. In my practice, I also see young girls who are very unsure about how to deal with their boyfriend's porn consumption. I also find that porn consumption or even porn addiction is often behind loss of libido and erectile dysfunction. But that's a good topic for the next column.