Every once in a while, I like to focus on the most important thing: your sexual health. This is one of those times.
I was reading my morning newsletters and cracked up to see this subject heading.
When I was able at last to purge the image of a talking penis from my mind, I was reminded of one of my pet sexological peeves: how doctors fail patients by forgetting that the human body is an integrated system — and that the reproductive tract, inside and out, are critical to whole-body human health.
Since “the penis as canary in a coal mine” caught my attention, I hastened to Medscape.com to read and listened to a podcast featuring two doctors who agreed with me. 🙂 They talked about the reluctance of their colleagues to discuss sexual performance and reproductive diseases in straightforward terms. For example, a flagging erection could be symptomatic of a heart problem or a testosterone issue, not something you fix with a prescription for a drug that may mask symptoms of something serious.
Doctors Behaving Badly
When doctors freely prescribe Viagra or Cialis to cis-men without a thorough heart exam for potential cardiac problems, they are failing you. Although rare, this generally safe drug can suddenly turn into a life-threatening one if you have an undetected heart issue. Using the Internet, and a remote doctor to write your prescription, is dangerous.
Beyond life-threatening illnesses, far too many M.D.s do not discuss personal sexual health issues with their clients. They rarely talk about the positive role of masturbation and frequent orgasm in human health. Some of them act judgmental about the *type* of sex you enjoy and make you feel like you are to blame for catching an STD. A friend of mine with recurrent UTIs was judged and scolded by her M.D. for her poly/swing lifestyle! That’s like blaming someone for catching a cold because they shared lunch with someone they didn’t know was sick.
Know what else many family doctors either don’t know or won’t talk about? Pussies and breasts. As a proud owner of both, the only doctors who ever took interest in more than 2 standard tests (in-office pap smear and an out-sourced mammogram) were females. I finally switched to a nurse practitioner who, in true nurse style, was not squeamish about ANYTHING. She checked a lump in my labia that had been worrying me and instantly put me at ease, saying it was a common nothing and would resolve (it did). Still, in my experience, the patient may have to explicitly request a basic breast exam. They may need to ask for a smaller speculum, or a pre-warmed one, to alleviate discomfort. They may need to ask for an HPV test (which can also delay or rule out the need for a PAP smear). Sadly, patients may also need to avoid revealing their lifestyle to get nonjudgmental advice.
And forget about getting honest dialogue about transgender sexual health with most American doctors. Unless it’s their specialty (i.e., gender-affirming medicine), they tend to avoid the subject altogether.
One other big fail: while they CAN do it, very few doctors DO run hormone screens for people in their 40s. Either they leave it to urologists or endocrinologists or never mention it to their patients. A hormone panel to establish basic estrogen levels in women and testosterone levels in men should be a standard in preventive medicine for everyone over 40, as routine as checking your cholesterol levels.
The ICK Factor for Doctors
You’d think that doctors who look at blood, piss, pus, vomit, and shit would be over the “ick” factor when it comes to the penis and pudenda. But no. Many of them are just as squeamish about those organs as their patients are about asking explicit questions. They don’t want to talk about anal sex either! The big exceptions are LGBTQ doctors. If you can find one, they are usually ready to take all sexual concerns seriously.
Why are American doctors squeamish about sex? A few reasons. First, they are Americans, just as likely to be prudish and sex-negative as their pastors and priests. They avoid the topic, which makes their patients avoid the topic or feel embarrassed to raise frank sex questions.
One of my therapy patients developed Peyronie’s and was so embarrassed about it, that he stopped having sex and avoided seeing a doctor because he “didn’t want someone to see” him in that condition. He wouldn’t even let his wife see him naked! I was the only person he’d told. While I’m a sympathetic ear I couldn’t do anything to help him but calm his worst fears and convince him to see a urologist. If only a primary physician had talked to him about this common disorder and let him know that it happens, particularly in later life, and that treatment is a whole lot better than months of self-imposed chastity and shame.
Med students seldom get adequate training on how to talk about sex. Nor do they learn how to explain why sexual health is vital to whole-body health. The sad fact is that some M.D.s are stubbornly unaware of a near-universal accord that frequent orgasms are good for all of us, regardless of gender. As people of science, all doctors should be masturbation-positive and recommend it to adults as a normal part of a healthy life.
Your Doctor Should Not be Squeamish
When was the last time your M.D. calmly asked how often you were having orgasms? Does your doctor even keep up with advancements in reproductive medicine? Does your doctor prepare you for the sexual side effects of drugs for high blood pressure, diabetes, statins for heart health, and anti-depressants? Do they offer you options to mitigate those effects? Some of my patients didn’t realize the drugs they were taking could change their libido until it happened and they came to me. AGH! FAIL!
The new rule for sexual health should be: get thee to someone as comfortable examining your sex organs as they are examining your throat! Someone who knows it’s just another part of the body that deserves careful attention. Find one who asks detailed questions about your libido and performance and any changes you’ve experienced. You know, someone who lets you know it’s okay to ask questions about sex. Someone you can have an informative adult conversation with.
Find a Medical Professional Who Is Sex-Positive
Do you have genitals?
If you answered yes, that’s the most compelling reason in the world to get routine checks from specialists.
Patient after patient has told me that they can’t talk about sex with their primary care doctor. Geez Louise! Until JAMA or insurance companies prioritize sexual health, look out for yourself! Unless you can convince your primary physician to catch up with modern times, your best ally will be a sexual medicine/reproductive medicine specialist.
Urologists, gynecologists, and gender-affirming doctors are usually sex-positive. That makes them indispensable to your comprehensive health. The reproductive tract is a large and complicated system. Hundreds of different disorders and diseases can occur in our sexual anatomy. Most adults will, at some point in their lives, experience downswings in their performance or libido, have rashes, tears, growths, pains, and more that could mean nothing — but could be grave enough to require treatment. Millions of people walk around too depressed to have sex because they are hiding painful secrets in their underwear.
You need doctors who can look at your genitals, your gender identity, and your sexual behaviors without judgment.
Love That Precious Body System
Your body, exactly as it is, even if certain aspects are missing, is still an integrated system of interdependent organs. Whether you roll in a chair or walk on two feet, no matter: your brain knows you are a sexual being, even when you don’t feel sexy. Your genitals are connected to your cardiovascular system. They are part of your circulatory system. Your sexual health influences your mental health, your lungs and heart, and even your skin. That means you should take a few deep breaths and face the reality that your genitals and your reproductive tract deserve loving care — even when you aren’t using them to have partnered sex or make babies.
Thriving in the bodies we have is key to living longer, stronger lives. Learning to *choose* orgasms even when you’re not immediately aroused is a safe way to ward off a range of medical problems, from stress to strokes. Doctors should tell you that.
Like Mr. Spock, I want you to live long and prosper. Please go to doctors who can have these frank conversations. Make sexual health screening an annual event, for yourself, your elders, and your teenagers.
banner photo: Kaikara Dharma@ https://unsplash.com/photos/lGXK9renALY
