You and Your Doctor

This article has been excerpted from Joan Price's book, The Ultimate Guide to Sex After 50: How to Maintain–or Regain!–a Spicy, Satisfying Sex Life (2015, Cleis Press).

 

 

 

By Joan Price

About half of all sexually active men and women aged fifty-seven to eighty-five in the United States report at least one bothersome sexual problem; one third report at least two. Yet doctors rarely address sexual concerns in older adults, particularly in women. (Lindau, S.T. and Gavrilova, N. 2010.)

And—

A total of 38 percent of men and 22 percent of women reported having discussed sex with a physician since the age of fifty years. (Lindau, S.T., et al. 2007.)

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Getting older isn’t in itself the problem—it’s the array of medical conditions and treatments that wallop our sexuality. Chronic pain, movement limitations, medications, surgeries, reduced blood flow, fatigue—all these and more can leave our sexuality behind, physically and emotionally.

In my ideal world, we’d say to our doctor, “This [insert medical issue] is causing [insert sexual limitation symptom]. Let’s fix it, because my sexuality is a vital part of my quality of life.”

In reality, though, when we need medical help for sexual problems at our age, we encounter an array of obstacles. The first and most obvious is that the doctor doesn’t ask how we’re doing sexually and we don’t bring up the subject. We’re too embarrassed, or we don’t think a doctor can help us, or our medical appointments are too rushed to let us edge our way gingerly into a sexual question. If the doctor doesn’t bring up sexuality, the topic usually stays under the covers.

A survey of 1,154 gynecologists revealed that only 40 percent ask their women patients whether they are experiencing sexual problems and only 28.5 percent routinely ask about their sexual pleasure (Sobecki, J. et al. 2012)—and that’s across all ages. I’d make an educated guess that the numbers are much lower when the patient is our age. Even more cringe-worthy: “A quarter of ob/gyns reported they had expressed disapproval of patients’ sexual practices (Sobecki, J. et al. 2012).”  Oh, great. How will that encourage us to bring up the subject? But bring it up, we must. As sex therapist Marty Klein, PhD, says, “Let the docs deal with their discomfort. They’re getting paid, and it’ll benefit their personal lives (Klein, M. 2012).”

If you’re a doctor reading this and wondering how to bring up the subject of sex with your older patients, here’s a question guaranteed to get results: “How has sex changed for you lately?”

A doctor who is considerably younger may not view us as sexual beings and is likely to assume that we don’t have a sex life, or care about it. The doctor won’t think to ask us about sex, concentrating on helping us treat our ailments. It’s up to us to start the conversation.

We can overcome our own reluctance by preparing ahead what we want to say. Writing down our questions is a good strategy. Then we need to assert ourselves. When another issue is the reason for the appointment, a good plan is to say at the beginning, “I have something else I want to discuss with you. Let’s leave time for that.” Now you can’t back out.

We must commit to bringing up our sexual issues assertively and unapologetically. Only this way can we help ourselves, help our doctors know what we need (and want!), and—ultimately–help our generation and those that follow.

Even then we may run into what seems to be a dead end: our doctor may not know how to help us with a sexual issue. Again, it’s in our court. Please practice this statement: If you can’t help me, please refer me to someone who can.

I’m a doctor’s daughter and a doctor’s sister, and doctors have literally saved my life. I believe that most doctors are doing their best to help their patients heal what ails them and enjoy the best quality of life. They’re well educated, they are constantly updating their learning as the world of medicine changes, and they care about their patients.

However, the lack of sexuality education in medical training is appalling—and little or none of it specifically addresses sex and aging.

That’s where the problem starts, but we can make sure that the story doesn’t end there. We need to talk out loud about our sexual needs and problems that might have a medical solution, and not go away defeated. We can’t let embarrassment stop us from describing vaginal pain or erectile problems, even if our doctor looks like he’s barely shaving.

We also have to take responsibility for reporting to our doctors when we’re having trouble with function or libido, because sexual problems can be the first warning sign of a serious underlying illness that can and needs to be treated—for example: diabetes, heart disease, an infection, urogenital tract conditions, and cancer (Lindau, S.T., et al. 2007).  Other health conditions that cause sexual problems are high blood pressure, underactive or overactive thyroid, lung disease, depression, kidney disease, chronic alcoholism, multiple sclerosis, atherosclerosis, and more (Davis, M.W. 2008). 

The point is this: If there’s any change in your libido, arousal, or sexual functioning, please consult your doctor.

When Meds Are the Culprit

Medications themselves may cause sexual problems. Most of us are taking medications regularly these days—people over sixty are likely to be on three different meds Siegwl, R. 2015).

Never just stop the medication that is causing the unwanted sexual side effect. You can worsen the original medical condition that warranted this medication. “Do not stop taking any prescribed medicine without your doctor’s advice,” advises pharmacist Paul Roberts. “If you suspect your medication is interfering with your sex life, it’s time to have a conversation with your doctor. Often lowering the dose may be possible, and the side effects will lessen. More likely is your provider can change you to something else that won’t have that side effect. Rarely do you just have to live with it.”

Ask your doctor or pharmacist about the best time to take your medications so that they affect sexual response or sexual function less. “Sometimes timing can make all the difference in preventing side effects from interfering with your sex life or daily life,” says Roberts.

Level with your doctor about the sexual side effects and that you value your sex life. Be clear and determined, and not confrontational. Assume that your doctor is willing and able to assist you and just needs to understand what the problem is and how important it is to you.


Joan Price calls herself an advocate for ageless sexuality. She is the author of the new Ultimate Guide to Sex After 50: How to Maintain–or Regain!–a Spicy, Satisfying Sex Life; the award-winning self-help book, Naked at Our Age: Talking Out Loud about Senior Sex; and the sexy memoir, Better Than I Ever Expected: Straight Talk about Sex After Sixty. Visit Joan’s blog, “Naked at Our Age,” and her Facebook page for ongoing news and views about senior sexuality.

This article was brought to you by ASA’s LGBT Aging Issues Network

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References

Davis, M.W. 2008. The Sex-Starved Wife: What to Do When He’s Lost DesireSimon & Schuster.

Klein, M. 2012. Sexual Intelligence: What We Really Want from Sex and How to Get It. HarperOne, 2012.

Lindau, S.T. and Gavrilova, N. 2010. “Sex, Health, and Years of Sexually Active Life Gained Due to Good Health: Evidence from Two U.S. Population Based Cross Sectional Surveys of Ageing.” BMJ 340: c810.

Lindau, S.T., et al. 2007. “A Study of Sexuality and Health Among Older Adults in the United States.” New England Journal of Medicine 357:762-774.

Siegwl, R. 2013. “Sexual Pharmacology,” presentation AASECT.

Sobecki, J. et al. 2012. “What We Don’t Talk about When We Don’t Talk about Sex: Results of a National Survey of U.S. Obstetrician/Gynecologists." Journal of Sexual Medicine 9:1285–1294.