- A lack of desire/desire discrepancy between partners;
- Difficulty with arousal—lack of wetness; how to get in the mood; difficulty getting/maintaining erections; taking a long time to ejaculate/reach orgasm;
- Genito-pelvic pain and penetration disorders—dyspareunia due to atrophy; vaginismus (overtight vaginal muscle); overactive pelvic floor (can cause muscle spasm); vestibulodynia;
- Lack of pleasure from sex—primary or secondary anorgasmia vs. situational anorgasmia;
- Their physical appearance and how they appear to their partner and to others;
- Their feelings about sex and how their partner feels about sex;
- The kind of sex life they have or think they should have; and
- The frequency of sex in their relationship and whether it’s right for their partner.4
3. Understand sexual orientation and gender identity terms. Sexual orientation encompasses a wide range of sexual and/or romantic attractions (or lack thereof). Some people may be heterosexual, while others are lesbian, gay, bisexual, transgender, queer or other (LGBTQ+).
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Explore This IssueMay 2021
Gender identity is simply someone’s gender, which is based on how they feel and not on physical characteristics. How they share their gender with the outside world, through how they dress and act, contributes to their gender expression. Research conducted in recent years has led to a better understanding of gender. For example, the use of “they’ has become more common as a pronoun for an individual.
Those who don’t identify as cisgender (i.e., the gender assigned at birth) or who use different pronouns in their identity will understand if you misstate their gender pronouns. The best way to react to a correction is to apologize, correct yourself and move on.5
Adding a question to the patient intake form about what pronoun they prefer is one way to ensure you are addressing your patient the way they want to be addressed.
4. Provide patient education.
- Be prepared with recommended reading, websites, organizations and sexual health experts;
- Suggest website searches for “sexual health and …” rather than “sex and …”;
- Explain the importance of self-care and stress management;
- Talk about the importance of physical touch in maintaining intimacy and strengthening the bond between individuals;
- Suggest that understanding one’s own body through self-touch can improve one’s sex life;
- Encourage partners to share any concerns about sex and intimacy during the office visit and offer evidence-based suggestions they can try at home;
- Nobody wants to be seen as dumb about sex, so be respectful when providing information: “Perhaps you already know …”; and
- Remind patients that orgasm can be a successful pain relief strategy.
5. Have the “safe sex” talk. Perhaps nothing is as imperative as talking to sexually active patients about safe sex. This discussion will enable your patients to prepare for sexual contact ahead of time.
The American Sexual Health Association’s sexual health toolkit is an excellent resource to give to patients. It discusses the importance of knowing one’s personal boundaries, and offers pro and con lists for latex condoms, internal (i.e., pouch) condoms, lubricants and barrier methods used during oral sex, and has a section on sex toys.6
6. Don’t be afraid to refer out. Many different healthcare clinicians are trained to address sexual rehabilitation and other sexual health-related issues.