How to Talk to a Doctor About a Sexual Concern

Picture Malik in an exam room in Columbus, paper gown crinkling, the appointment almost over. He came in because erections have been unreliable for four months. The doctor asks, "Anything else?" and Malik hears himself say, "No, that's it," and goes home with a flu shot. This illustrative visit is how many sexual health problems go untreated: not because no help exists, but because the question never gets asked out loud.

Sexual concerns are medical concerns. Pain, erectile changes, low desire that bothers you, trouble reaching orgasm, bleeding after sex, and side effects from medicine are all things clinicians are trained to address. The hardest part is usually the first sentence. This guide is about making that sentence easier and making the visit useful.

Most clinicians will not bring it up first

You might assume that if something mattered, your doctor would ask. Often they do not. In a 2007 national study of older U.S. adults published in the New England Journal of Medicine, Stacy Tessler Lindau and colleagues found that only 38 percent of men and 22 percent of women said they had discussed sex with a physician since age 50. Time pressure, embarrassment on both sides, and assumptions about age, gender, or relationship status all play a part.

The practical takeaway is simple. If you want to talk about it, plan to raise it yourself, and raise it early.

Say it at the start of the visit

Clinicians plan the appointment around the reason you give at the beginning. A concern mentioned with a hand on the doorknob gets a rushed answer or a "let's book another visit." If you can, put it in the reason for the appointment when you book, even in plain terms like "sexual health question" or "pain during sex." Then lead with it:

"Before anything else, I want to talk about a sexual health concern. It has been bothering me for a few months."

That one sentence does most of the work. It tells the clinician what to prioritize, and it is very hard to back out of once said.

If saying it aloud feels impossible, write it on a card or in your phone and hand it over. Many patient portals also allow a message before the visit. Clinicians see these concerns every week. You will not be the first.

Bring the details that actually help

A sexual health problem is easier to sort out when you bring a short history. Before the visit, jot down:

• What changed and when. "Pain with penetration since about March" is more useful than "sex hurts."
• The pattern. Is it every time or some times? With a partner, alone, or both? At the start, during, or after?
• What you have tried. Lubricant, a different position, rest, an over the counter product.
• Every medicine and supplement. Some antidepressants, blood pressure medicines, hormonal treatments, and other drugs can affect desire, arousal, or orgasm. Include doses.
• Related symptoms. Bleeding, discharge, urinary changes, fatigue, low mood, new stress, sleep problems.
• What you want. Relief from pain, more reliable erections, help with desire, reassurance that something is normal, or a referral. Saying the goal helps the clinician choose the next step.

You do not need medical vocabulary. Plain words are fine and often clearer.

Questions worth asking

Once the concern is on the table, these questions keep the conversation useful:

• "What are the likely causes in my situation?"
• "Could any of my current medicines be contributing?"
• "Do I need an exam or tests, and what will they check?"
• "What are the treatment options, including ones that are not medicines?"
• "What should I watch for, and when should I come back?"
• "Is there a specialist who focuses on this?"

If your clinician dismisses the concern, or says it is simply age or stress without looking further, it is fair to ask, "What would make you look into this more?" or to request a referral.

Knowing who to see

Your primary care clinician is a good first stop for most concerns, and some issues need a specialist. Depending on the problem, that might be:

• A gynecologist for pain with sex, bleeding, dryness, contraception, or menopause symptoms
• A urologist for erectile changes, ejaculation problems, or pain in the penis or testicles
• A pelvic floor physical therapist for pain or tightness in the pelvic muscles, which our pelvic floor guide explains
• A sex therapist for concerns about desire, anxiety, or communication. In the U.S., AASECT, the American Association of Sexuality Educators, Counselors and Therapists, maintains a directory of certified professionals.
• A mental health clinician when depression, anxiety, or trauma is part of the picture

Many concerns involve more than one of these at once. That is normal, not a sign that the first visit failed.

What an exam may involve

Depending on the concern, a clinician may ask detailed questions, check blood pressure, order blood tests, or suggest a genital or pelvic exam. You can ask what each step is for before it happens. You can ask for a chaperone. You can ask to pause or stop at any point. If you have a history of sexual trauma, you can share as much or as little as you choose, and saying "I need this to go slowly" is enough.

For people who have had a bad experience, it can help to start with a phone or video visit. Many sexual health conversations can begin there, with an exam scheduled later if needed.

Bringing a partner, or not

Some people find it easier to bring a partner. A partner can fill in details or help remember what was said. Others want privacy, especially if the concern involves the relationship itself. Either is fine. Even if your partner comes, you can ask for a few minutes alone with the clinician. Good clinicians often offer that anyway, partly to ask safety questions privately.

After the visit

Write down the plan before you leave the building. If a medicine is prescribed, ask how long before you should expect a change and what side effects to report. If nothing helps after the agreed time, go back. Sexual health treatment is often a few rounds of adjust and try again, not one perfect answer.

For routine screening that does not need a symptom to justify it, our sexual health basics and STI testing guide cover what to ask about at a regular check-up.

Questions about talking to a doctor

Will my doctor judge me? A professional should not, and most do not. If one does, you are allowed to find another clinician.

Is this too minor to bring up? If it bothers you, it is worth raising. Sexual changes can also be early signs of other health problems, such as diabetes or heart disease.

What if I do not know the right words? Use your own. Describe what happens and how it affects you. The clinician can translate.

Where these ideas come from

Stacy Tessler Lindau and colleagues, "A Study of Sexuality and Health among Older Adults in the United States," New England Journal of Medicine (2007), reported how rarely older adults had discussed sex with a physician. The American Association of Sexuality Educators, Counselors and Therapists (AASECT) certifies sex therapists and maintains a public referral directory.

Sexual health education for adults, not medical advice. If you have sudden severe pain, heavy bleeding, or an erection lasting more than four hours, seek urgent care. More limits are on the disclaimer.