DR MAX PEMBERTON: Why we all need to stop being so embarrassed about talking about sex

Sex is not an easy topic to discuss, even for doctors. Asking a patient about it feels awkward, embarrassing and intrusive. The doctor is uncomfortable, the patient is writhing and everyone just wants it to be over.

It’s no real surprise, then, that research shows that the vast majority of doctors never ask their patients about their sex lives.

Doctors from all specialties struggle to broach the subject, but some of the worst offenders are GPs, with only six percent initiating these discussions.

But sex is an integral part of so many people’s lives, and medical professionals need to get better at talking about it.

Many conditions – from diabetes to depression – can affect sexual performance, so it’s an important symptom when considering a diagnosis.

In my experience, the group of people most likely to talk about sex is the same group for whom sex is often the most important topic: young men. I think part of the reluctance comes from the fact that many GPs are middle-aged women who are embarrassed to talk about such personal details with someone their son’s age – which only makes the young man feel more uncomfortable.

But doctors are failing patients by not bringing up the subject. Sex can be important to our happiness because it helps us feel connected and loved.

I have seen the consequences of this failure again and again in psychiatric outpatient clinics.

One of the main side effects of antidepressants is sexual problems. I remember a young man who was referred to me with depression. His GP had given him an SSRI, but this had not worked. He was switched to another one, but again, his symptoms persisted. He was very depressed, sometimes felt desperate and suicidal and had little pleasure in life.

He had a tendency to lock himself in and sleep for long periods of time. He lost weight because he had no appetite and fell behind in college.

Ideally, he would need a combination of therapy and medication to help him get over this, but as I was filling out the referral to the psychologists to begin therapy, it occurred to me to check that he was taking his medication.

He looked at me sheepishly and finally confided that he hadn’t taken them. “The GP was a woman,” he explained, “so I couldn’t talk to her about it.”

He said the only source of happiness in all of this was his girlfriend. But the antidepressants had caused him sexual dysfunction, so he stopped taking them. Who can blame him or anyone else in this position?

One of the things that could give them some pleasure is taken away from them and it affects their intimate relationships at a time when all their peers are getting partners.

It further increases their sense of isolation.

They quietly stop taking their pills, avoid the doctor, and their depression worsens until they end up in the psychiatric outpatient clinic.

This is such a dangerous situation and all because doctors don’t want to embarrass themselves.

But there is also another side to it. Doctors don’t always have the data and evidence to present to patients to explain the risks and benefits of medications.

This is because they cherry-pick data and bury bits they don’t like. This is especially true for sexual side effects.

After seeing this man, I now routinely ask about sexual side effects in patients taking SSRIs, and I am shocked at the number of patients who experience them. Independent studies have suggested that this may be more than 70 percent. For some it’s not a problem, but for others it can be yet another source of anxiety and worry and worsen their low mood.

But if you look at the sexual side effect data from pharmaceutical companies, it is barely mentioned. It seems that pharmaceutical companies are also reluctant to talk about sex, although not out of shame but rather, I suspect, out of concern for profits.

If doctors would work up the courage to routinely ask about sex and sexual side effects, they would see firsthand how common this is.

It might make them think twice before handing them out so freely.

Doctors campaign group, Anesthetists United, has raised more than £50,000 to take the GMC to court over Physician Associates (PAs). These are not doctors.

Its widespread use in healthcare is relatively new. They have no medical training, but instead completed a two-year postgraduate course. The original idea was that they would ‘help’ doctors, but as the NHS has come under increasing pressure they have taken on more and more clinical responsibilities.

The lawsuit against the GMC claims its plan to start regulating so-called ‘low-cost medics’ fails to set clear rules on what PAs can and cannot do. While I think PAs have their place within the NHS, I am concerned that they are too often used to plug gaps in the medical workforce, and worse yet, patients don’t even know they are not seeing a doctor. I’ve heard patients say they thought they were seeing a “doctor” because they were being seen by a PA.

There are reports that they were allowed to prescribe, diagnose and even operate on patients. A friend has been with his GP for three years and has never seen a GP because every time he was seen by a PA who he assumed was a doctor. Patients should absolutely be told who they are seeing. anything else cannot be good.

Celine’s fear for her children

Celine Dion has told how her children fear she will die as she struggles with ‘stiff person syndrome’ (SPS), a rare neurological condition that causes progressive muscle stiffness and spasms.

“My children are scared because they lost their father, and they wonder if I’m going to die. “I don’t want to die, I don’t want to lie,” she explained. Although SPS is not necessarily fatal, it is a constant concern for her family. For most of human existence, we lacked the means to diagnose disease or predict what would happen.

Yet modern medicine has produced a tremendous amount of knowledge, and we now often know if we have something serious or even fatal. Perhaps this will give us time to reflect on our lives, put our affairs in order and say goodbye. But doesn’t it also mean that we can worry about something for years and wait for progress to come, even though it may not?

Young doctors have been urged to scrap their plans for a walkout just before the election if leaders promise to make negotiations with them a priority.

The NHS Confederation accused medics of causing ‘real consternation’ with their strike plans and said the move looks more like a publicity stunt than a constructive act aimed at finding a solution to their pay dispute. I agree with that.

Dr. Max writes for… Lost boys and fairies

This miniseries on BBC iPlayer tells the story of a gay couple as they embark on the process of adopting a child in Wales. It’s a gentle and sometimes funny story about family, addiction, growing older and homophobia.

Ultimately, it is a nuanced story about our need for love. The scene with the birth mother in the last episode is extremely moving.