Over the years, I have seen many clients experiencing problems relating to sexual issues or suffering from some sort of sexual dysfunction. Many turn to their GPs (general practitioners), but while going to the doctor is straightforward if you have stomach pains, seeking help with sexual problems is very embarrassing for most.
It’s therefore disappointing to hear that many of my clients feel their doctor was not helpful or found it difficult to talk about sexual issues themselves. Some issues my male clients deal with include sexual dysfunction like premature ejaculation, losing their erection or having difficulties ejaculating. In women, menopause is a big problem for those who are older, while pelvic floor issues like vaginismus affect younger women.
Online news source The Conversation published an article by Carolyn Ee, GP, and researcher at the University of Melbourne’s Department of General Practice, about making menopause a positive experience. The onset of menopause is something most women dread because, as well as physical symptoms, their sex lives can also be affected.
HRT then and now
Years ago, every woman was routinely prescribed hormone replacement therapy (HRT) as soon as she reached menopause; it was seen as the fountain of youth that would keep women healthy and sexy long after menopause. This changed in 2002 when a Women’s Health Initiative study in the US was halted when researchers found that HRT increased women’s risk of breast cancer and heart disease. This alarming finding frightened millions of women and their doctors away from HRT.
Medical professionals agreed the 2002 findings were flawed and that HRT was not as risky as believed. But there is still anxiety and confusion among women and general medical professionals. Some years ago high-profile GP Ginni Mansberg admitted she and many of her contemporaries prescribed HRT for themselves – but not for their patients out of fear of being sued.
I have spoken to many women who are too frightened to take HRT but suffer from symptoms affecting their libido and relationships with their partners. Meanwhile, testosterone therapy is being researched as a potential treatment for the loss of sex drive for some women, and an HRT drug called Tibolone, sold under the name Livial, acts as a combination of all three sex hormones (estrogen, progesterone, and testosterone). One benefit of this medication may be the prevention of osteoporosis.
Over two million women are going through menopause It’s therefore important that GPs should not talk women out of taking HRT but should explain the risks and benefits, and provide an informed choice. In a recent in-depth feature in the Women’s Weekly, experts, researchers, and women shared their views on this polarising and complex issue.
Male sexual issues
If you are a GP and a young man comes to see you complaining about often losing his erection, the first question you should ask is: does it also happen when he self-stimulates. If the answer is no, he may have acquired performance anxiety. Loss of erection only has to happen a few times for a man to feel doubt, leading to anxiety the next time. When he starts anticipating problems with his performance, it becomes a self-fulfilling fear. Prescribing young men Viagra or Cialis is not helpful – only men over 50 may need them.
To keep an erection a man must be sexually aroused. When his anxiety takes over, it inhibits the blood flow in the penis, which can result in erection difficulties. The same effect happens when a man has difficulty ejaculating or not be able to ejaculate at all – he concentrates so much on reaching orgasm that he is not sexually aroused anymore.
Premature ejaculation, PE (coming too quickly), affects about 30 per cent of the male population. These men can easily be taught how to last longer with the right psychosexual education. I don’t believe there is much difference between the medical definitions of life-long or acquired PE. When a young man has sex for the first time and comes too quickly, which can be extremely embarrassing, he soon will become anxious and worried, and the cycle will start.
It’s quite common these days for GPs to prescribe healthy young men a class of antidepressants, called selective serotonin reuptake inhibitors (SSRIs), because it’s known they can delay ejaculation. Instead, however, they should look at referring those men for sex-therapy counseling first. What about the side effects of taking daily anti-depressants when they may have a psychological problem that can be treated effectively. It’s also important to remember that the average vaginal ejaculation time is between three and seven minutes. Some men believe they have PE because they only last 10 minutes!
I have spoken to more than 160 women with a condition called vaginismus. Women who suffer from vaginismus are unable to have sexual intercourse or, if they try, it’s very painful. The condition is caused by the involuntary contraction of muscles around the entrance of the vagina.
This article explains vaginismus in detail and the sad fact is that these women are often misdiagnosed by their GPs and even by some gynecologists. It’s difficult to believe that they are not aware of the condition. And it’s even more disturbing to tell a woman who has just explained that she hasn’t been able to have intercourse for three years or more that “there is nothing wrong with you, it’s all in your head, keep trying, use an anesthetic cream or drink some alcohol to feel more relaxed”.
I’m sure it’s difficult to diagnose patients with sexual issues properly with the short appointment times doctors have these days. Therefore, referring them to a sexual health physician or sex therapist is the best outcome (not to a sexual health clinic, which only provides support, treatment, and management of STIs, HIV/AIDS, and viral hepatitis).
This post originally appeared in The Sydney Morning Herald and was published on June 28, 2016. This article is republished here with permission and updated on December 10, 2020.