“Are you enjoying your sex life?”
That’s a question sex therapist Isadora Alman would like primary healthcare providers to ask their patients, along with other basic questions often asked of people coming in for a check-up, like inquiries about smoking or drinking.
But this doesn’t happen, said Alman, who is also a California licensed marriage and family therapist, because, she believes, a satisfying sex life isn’t considered an important part of health. She addressed this topic last month during a lecture at Oakland’s Samuel Merritt University, which offers diverse programs in healthcare.
Alman started off as a volunteer about 35 years ago with San Francisco Sex Information, a phone line that anybody can call with questions about sexuality. “I found such a need for valid information that I decided to make that my life’s work,” she said. The line still exists today, and is now available online as well. She also ran her own newspaper column, “Ask Isadora,” for 25 years, and has now an online sexuality forum where people can ask questions and talk to each other.
Alman also has a private counseling practice in Alameda. Men, women, old and young, couples and single people come to her from different cities, including Oakland, to talk about their sex lives.
Sexual issues are not handled during most normal visits to a general practitioner, said Alman, because doctors “don’t have time, they don’t have the training, they don’t have the interest.” Most people “don’t talk with doctors of any nature unless the matter is urgent, rather than merely troublesome or a matter of curiosity,” Alman said. “I would say that more than fifty percent of those men and women have sexual concerns that are not being addressed.”
But she believes that general practitioners should be aware of their patients’ sexual health and concerns, and that relationships are important to consider, along with other aspects of physical and mental health. “A good health provider would take that into account and would try to discover what the issue is,” said Alman, adding: “so it’s not unusual or invasive for them to ask, ‘Who is in your life?’ ‘How’s your intimate life going?’ ‘Are you sexually active?’ ‘Is it good for you?’”
Alman believes all health care providers, for both physical and mental health, need to have “more thorough sex education, including comfort in asking probing questions.” In that case, she added, “Then questions such as ‘Are you sexually active?’ ‘Is it satisfying for you?’ ‘If not, why not?’ might be a matter of routine.”
For Alman, this is important not only because a satisfying sex life is an important part of overall health, but also because because by learning about their patient’s sex life, a doctor might discover other health problems and even cases of abuse. She also believes that information about sex should be easier for people to get, and less stigmatized.
Dr. Mike DeRosa, chair of the Physician Assistant Program at Samuel Merritt University, said that he didn’t hear Alman’s talk, but that students at that institution are trained to address sexuality issues of medical relevance. “There are good reasons” to do it, he said. Problems with sexual health could be relevant to the patient’s mental health, or related to issues such as depression and anxiety, said DeRosa, who has a family practice clinic in Berkeley.
Doctors should also pay attention to erectile dysfunction as a sign of vascular disease, said DeRosa, who added that it’s his hope that patients feel free talking to their doctor about sexual issues.
For obstetrician and gynecologist Jennifer Gunter, who directs the Pelvic Pain Clinic at Kaiser Permanente in San Francisco, “It’s really important to be aware that a lot of people aren’t going to bring up on their own problems with sexual intercourse.” So “it’s a good idea” to ask about it, whether it is through a questionnaire or directly, she said. “What each individual physician asks is different,” Gunter said, “but most screening questionnaires do have a question about intercourse.” Partner violence, family conflict, depression and anxiety can also be part of a pre-screening list of questions, Gunter said.
Whether a patient wants to disclose this kind of information or not is also going to depend on the individual. “Sometimes it takes several visits [to the doctor] for people to feel comfortable” answering intimate questions, such as if the partner is violent, Gunter said.
As a specialist, Gunter needs to ask her patients highly personal questions about their sex life–if they’re having pain with intercourse, if there’s any problem with orgasm. For some of her patients it takes four of five visits to bring these issues up, even if she has a “good relationship” with them, Gunter said. “People are very different, specially about sex,” she added.
During her 35-year career, Alman has seen how the Internet has made it easier for gay and lesbian people, as well as for people who cross-dress, to find that there are others like them. But although that’s been “a major change” over those three decades, “people are still always concerned with the same things,” Alman said: “Am I normal?” “Do other people feel this way?” And although more information is now available online, not everything out there is correct, she said. For instance, pornography is “just wrong information, harmful in many ways,” she said.
Gunter said that people email Kaiser’s physicians about sexual problems “all the time” through My Doctor Online, a website from the healthcare provider that offers health information for patients and gives them the opportunity to send their concerns. For example, under the Healthy Sexuality for Women section, patients can find information about libido, masturbation, the benefits of sex, and even how to communicate with your partner. “People need to find good sources of information and have questions,” Gunter said, adding that when people Google they can come across bad information. She said women need to be aware that “There’s no one normal for sex” and that “Sex shouldn’t be painful.”
“And I’m not sure you have to go to a sex therapist to find out what sex life is normal,” Gunter added.
To encourage doctors to talk about sex, in the past year Alman has spoken to groups in several medical settings and to therapists and prospective therapists. “I go where I am invited, do not charge a fee in such settings, and rely on recommendation from one group or hospital setting to others,” she said. The sex therapist also writes publicly on the topic “where and when” she can, in addition to maintaining her Sexuality Forum free to the public.
“I don’t think what I’m talking about is very controversial,” Alman said, adding: “But whether anybody will do anything about it, who knows?”