Talking about sex with doctors

“I don’t know if I can do it.” Jeremy seemed truly frightened. “My GP is a woman, and I can’t talk to her about my loss of sex drive.”

As a sex and relationship therapist in private practice, I’d been working with Jeremy (aged 43) and James (41) to explore their lack of sex. “It is my fault.” Jeremy had explained. “I am not that interested.”

My first task was to establish whether this was a lack of sexual desire, where the appetite for sex with a particular person is diminished? Or a lack of sexual drive (libido) where all sexual interest is reduced. Clarifying this I said, “Imagine we are talking about food. If you have lost your appetite completely, then it is drive. Whereas, if you have gone off a particular food, such as cheese, then that is desire.” I asked: “Do you masturbate? Do you ever find yourself thinking about sex? Is there anyone you fancy, maybe on TV?” If the answer to all three was no, then it was a lack of sex drive.

Jeremy said, “I used to masturbate every day, but now it’s only once a month! And no, no one really excites me.” The problem was a low sexual drive.

The next step was to eliminate physical problems. I’d asked Jeremy to see his GP for blood tests: testosterone levels (including SHBG (Sex Hormone Binding Globulin), fasting glucose (diabetes), lipid ratio (vascular disease), prolactin (brain tumour), TSH (thyroid stimulating hormone for thyroid problems), FBC (full blood count for anaemia), and PSA (prostate-specific antigen for prostate problems).

I asked, “Would it be easier with a male doctor?”

He responded, thoughtfully, “No.”

It transpired that his mother had always turned the TV off when anything sexual came on. She’d taught Jeremy that sex was a shameful subject. The idea of talking to his GP, a woman he deeply respected, filled him with horror. He decided it would help if I wrote a letter that he could give to his GP asking for the tests.

Whilst many GPs are really excellent in this regard, some find it embarrassing to talk about sexual matters. A few opt out by making an instant referral to a specialist, without asking any questions. This doesn’t always work well, as Sandra told me. “After waiting for months, I finally got to the psychosexual clinic. They said my anger at his affair was causing the sexual problem, and as a sexual clinic, they could only offer three sessions of relationship therapy. They suggested I needed long term relationship therapy. I’d wasted months waiting.”

Another client, Asif, first saw his GP for erectile dysfunction when he was 18 years old, before Viagra, Levitra or Cialis were available. “I undressed, the doctor took my penis, waggled it from side to side saying, ‘Nothing wrong with that!’ It took me nine years before I dared to go back to the GP.

This time I was told, ‘The problem is in your mind,’ and prescribed Alprostadil injections, which worked for a bit. But I became reluctant to inject myself. The third time I went to my GP I was 46 years old, and again the GP said, ‘The problem is in your head.’ But this time I plucked up the courage to ask, “So what can I do about that?”

“There are no services available on the NHS locally, but a psychosexual therapist will help you.”

He’d booked in with me. I was deeply saddened when he said, “I wish I’d had more courage. If only I’d asked the doctor twenty years ago, ‘What can I do about that?’ We wanted children. We are too old for that now.”

Asif had told me, “I was sent away to boarding school aged seven. I’ve felt like a spectator since then – always standing just behind myself, observing.” We worked therapeutically for eight months on his: low self-esteem, sexual disgust and habit of disassociation, of watching himself. Using simple mindfulness exercises, walking in nature and listening to music, Asif gradually learned to be ‘in his body’ and feel each experience. As he paid attention to his body and feelings, he discovered he could tune into his own arousal, and his partners (which he hadn’t considered before).

To support this psychological work his GP prescribed Cialis. Through positive sexual experiences, Asif regained confidence, and maintained his erection without drugs. “My life has changed. I was missing out on so much. Now it’s a surround-sound sensual experience,” he said. “Ninety percent of the time, sex works really well!”