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1. How can a person who is experiencing a low libido bring this topic up with their physician in a way that is not embarrassing or threatening?
Physicians and nurses rarely are trained to take a patient’s sexual history or address sexual concerns, so they may not ask questions that invite patients to discuss their concerns. That does not mean they are unwilling to discuss them, however. When asked, “What brought you here today?” a patient can simply add low libido to the list of concerns.
It is important for the provider to hear all of the patient’s concerns at once in order to form a complete picture of what’s going on with the patient. Often, patients wait until the provider is leaving the room to say, “Oh, there’s one other thing…” At that point, the provider may already be thinking about the next patient. Low libido is too important to treat as an afterthought, both for the sake of sexual satisfaction but also because some sexual problems may indicate underlying health conditions. The patient should bring up the libido issue again if the provider forgets to address it. If the provider does not or cannot adequately address the concern, the patient may want to seek out a certified sexuality educator, counselor or therapist at www.aasect.org.
2. How might a couple who have been rather refrained in the bedroom open up their options and introduce sex toys into their relationship?
People tend to associate sex toys with vibrators, but toys can be anything that is used to enhance the sexual experience. A couple dipping their toes into creative waters might start with a well-oiled massage followed by a shared shower. A silk scarf from an accessory drawer can become a blindfold while one partner gently strokes the other’s body with fingers, a feather, a small comb, an ice cube, etc. Once the partners can comfortably explore with items on hand, they might visit an adult shop in person or online together and discuss what’s available and what looks like fun to try. If they want to try a toy, they should opt for a mid-priced item that will operate reliably but won’t set them back too much money if it’s not to the couple’s taste.
3. How can someone’s health affect their sex life and/or their perception of their state of sexuality?
Physically healthy people may have more energy, stamina and flexibility – all factors that can enhance sexual experiences. Some physical conditions, such as respiratory problems, joint stiffness or soreness, or weight and pain issues, can interfere with sexual pleasure by limiting endurance, mobility, or comfort. This can lead to lower desire for sex, less confidence, and less ability to enjoy sex. Emotional health can also affect desire, arousal, and satisfaction, as can medications someone might take for psychological issues. This is not to say that people with physical or emotional problems cannot enjoy sex. They may have to be creative about how they adapt to physical limitations, or they may need professional help to address emotional health issues.
4. How would you educate someone who is experiencing a sexual hindrance (such as erectile dysfunction, premature ejaculation, failure to orgasm, etc) to discover the cause of these issues and then address them?
The difference between sexuality educators and sex therapists or counselors is that educators focus on building knowledge and skills, while therapists and counselors focus on assessing and addressing psychological factors. An educator would not be in a position to diagnose the causes of sexual problems and would not recommend drugs or medical devices. Once someone is diagnosed and treated by a therapist, an educator could step in. For example, if working with a man who could not attain an erection after prostate surgery, an educator might suggest ways to enjoy orgasm without an erection as well as ways to please a partner that do not rely on the thrusting of an erect penis. Education might involve the use of discussion, illustrations, books, or videos to be watched at home.
5. How can couples use their family physician (versus a sex therapist or counselor) to help address any sexual concerns they may have?
While physicians are not generally trained to assess and treat sexual issues, they have enough general knowledge about sexual anatomy and physiology to assess and treat basic concerns. In some instances, the provider may refer the patient to a specially trained gynecologist, urologist, dermatologist or endocrinologist. Physicians are often too limited by the time constraints imposed by insurance reimbursement policies to give couples adequate time to discuss relationship issues. Counselors, therapists and educators, however, do have the time and expertise to help both individuals and couples.
About Dr. Melanie Davis: HonestExchange.com, NJSexualWellness.com
Dr. Melanie Davis is the founder of Honest Exchange, LLC. Her experience as a sexuality educator began in 1984, when she volunteered as a patient educator for Planned Parenthood. She has crafted a career devoted to helping people learn about sexuality and sexual health and helping them communicate about sensitive topics with ease. She is an AASECT-Certified Sexuality Educator and consults with individuals and couples. Dr. Davis obtained her doctoral degree in Education from the Widener University Graduate Program in Human Sexuality. She delivers programs and workshops for consumers and college students; trains health care providers and other professionals; consults with schools; and develops resource materials and curricula. She is also the Director of Education Services for the New Jersey Center for Sexual Wellness Wellness and teaches Human Sexuality and Marriage & Family courses at Moravian College. Dr. Davis is the Coordinator for the Consortium on Sexuality and Aging which is a group of nationally recognized Sexuality trainers and educators. Contact them to see how they can help you or your organization.
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