What should I do if I'm worried about my sexual health?

What to Do If You're Worried About Sexual Health

Schedule an appointment with your primary care provider to discuss your sexual health concerns directly—most patients prefer that physicians initiate these conversations, but the majority of discussions are actually started by patients themselves, so don't wait for your doctor to bring it up. 1, 2

Why Sexual Health Matters

Sexual health is fundamentally connected to your overall physical and emotional well-being, not just the absence of dysfunction. 3, 4 Sexual concerns can reveal undiagnosed medical conditions including:

• Cardiovascular disease and related risk factors (hypertension, diabetes, high cholesterol) 4
• Depression and other mental health conditions 5, 4
• Hormonal imbalances (low testosterone, low estrogen, hyperprolactinemia) 4
• Relationship problems that affect quality of life 6, 4

How to Approach Your Healthcare Provider

Initiating the Conversation

• Bring up your concerns directly at your next appointment—don't assume your doctor will ask, as only 17.3% of older adults report discussing sexual health with providers in the past two years. 2
• Request a provider of your preferred gender if that makes you more comfortable, as patients find it easier to discuss sexual concerns with same-gender physicians. 1
• Establish continuity with one provider rather than seeing different doctors, as familiarity facilitates these sensitive discussions. 1

What Your Provider Should Do

Your healthcare provider should use structured approaches like the BETTER model 5:

1. Bring up the topic of sexuality
2. Explain concerns about how your health may impact quality of life
3. Tell you about available resources
4. Consider Timing—reassure you that concerns can be discussed anytime
5. Educate about potential effects of conditions/treatments on sexual function
6. Record the assessment and interventions

Comprehensive Sexual Health Assessment

Your provider should assess multiple dimensions 5:

• Practices: Types of sexual activity you engage in
• Partners: Number, gender, and relationship dynamics 5
• Pregnancy prevention: Current and desired contraceptive methods (if applicable) 5
• Protection from STDs: Condom use and safer sex practices 5
• Past STD history: Your history and partners' histories 5
• Sexual function concerns: Desire, arousal, orgasm, pain, satisfaction 5, 7
• Psychological factors: Depression, anxiety, fear, relationship satisfaction 5

When Relationship Issues Are the Primary Concern

If your sexual health worries stem from relationship conflict or partner dynamics, couples-based psychosexual counseling should be your first-line treatment. 6 This approach directly addresses:

• Communication problems about sexual concerns 6
• Partner over-protectiveness or fear 6
• Performance anxiety 6
• Need to redefine intimacy beyond intercourse 6

Both partners should attend counseling sessions when relationship factors drive sexual concerns, as this multidisciplinary approach yields better outcomes. 5, 6

Treatment and Referral Pathways

Office-Based Management

Your primary care provider can address many sexual health concerns through:

• Education and reassurance about normal sexual function 5
• Medication review to identify drugs affecting sexual function 5
• Treatment of underlying conditions (cardiovascular disease, diabetes, depression) 4
• Cognitive-behavioral strategies and social support 5

When to Seek Specialized Care

Request referral to a sex therapist or specialized counselor when 5, 6:

• Initial office-based counseling is insufficient
• You have longstanding or complex sexual problems
• Depression or anxiety disorders require formal treatment
• Relationship dynamics require specialized intervention

For women with specific concerns, referral to reproductive endocrinology may be appropriate for infertility evaluation. 5

Common Pitfalls to Avoid

• Don't let embarrassment stop you—embarrassment is the most common barrier patients report, but providers expect these discussions as part of comprehensive care. 1
• Don't assume age makes sexual health irrelevant—50.9% of men and 30.8% of women aged 65-80 remain sexually active, and interest in sex persists across the lifespan. 2
• Don't address sexual concerns in isolation if relationship factors are evident—partner involvement is essential for success when relationship issues contribute to sexual problems. 6
• Don't ignore medication side effects—many cardiovascular and psychiatric medications affect sexual function and may need adjustment. 5

Special Considerations for Cardiac Patients

If you have cardiovascular disease, specific counseling should address 5:

• Safety of resuming sexual activity after cardiac events
• Medication interactions, particularly the dangerous combination of PDE-5 inhibitors (like sildenafil) with nitrates 5, 8
• Positioning and energy conservation strategies 5
• Reassurance that the risk of MI during sexual activity is low 5

Documentation and Follow-Up

Your provider should document the sexual health assessment and create a follow-up plan. 5 Sexual counseling is most effective when provided through several meetings rather than a single session, allowing time to address concerns progressively and adjust strategies. 5