Talking About Sex



alking about sex is taboo in many circles. While it may be awkward or uncomfortable for some to talk about, sex is an integral part to everyone’s health and should be easily discussed at it can affect quality of life.

Defining the optimal sexual health each person should have is a difficult task given the various variables that come into play. Personal sexual preferences, cultural and religious standards, as well as individual health issues, can affect sexual health.

Sexual health encompasses a complex set of physical, emotional, mental and social attributes, and just like with any health concern, professionals have to consider these complex characteristics when individuals come to them seeking help. According to the American Sexual Health Association, sexual health is the ability to embrace and enjoy our sexuality throughout our lives. “It is an important part of our physical and emotional health.”

A range of public health and clinical issues are related to sexual health, according to ASHA board member and professor of pediatrics at Indiana University School of Medicine Dr. J. Dennis Fortenberry. Risks associated with sex, such as sexually transmitted diseases, should be considered, but recognizing the “pervasive importance of sex in our lives” is important.

The World Health Organization points out that “sexual health is a state of physical, emotional, mental and social well-being in relation to sexuality; it is not merely the absence of disease, dysfunction or infirmity. Sexual health requires a positive and respectful approach to sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination and violence.”

Wife and husband, University of Arkansas for Medical Sciences Drs. Gloria Richard-Davis and Rodney Davis specialize in issues related to sexual health. Both agree that improving sexual vitality can’t be achieved with a one-size-fits-all approach. Their goal is to restore the sexual quality of life that patients desire which can vary from person to person. The doctors note some patients don’t have a sex drive, for example, and are perfectly content with that notion. However, measures are taken to ensure a more serious concern that could be debilitating to the patient’s health isn’t an underlying issue.

Richard-Davis specializes in women’s sexual function as the director of reproductive endocrinology and infertility at UAMS. Age is a major factor when considering women’s sexual health, she said. Regarding the top issues her patients face, she noted, “it depends on which age group we’re talking about.”

In post-menopausal women, the main issue is vaginal dryness due to decreased estrogen. This dryness can make sexual intercourse painful, resulting in reduced libido or desire to have sex. “These are typically easy fixes with the use of vaginal estrogen moisturizers or other lubricants.” Richard-Davis said.

Pre-menopausal women are a bit more challenging, Richard-Davis said. They could be dealing with a number of issues, such as endometriosis, which can cause painful intercourse. “When they complain of painful intercourse and/or loss of interest, we have to work through different components.”

She also studies young woman’s biology as well as psychosocial truths. “A physical exam indicates where sexual intercourse hurts, and we look at whether or not they have relationship issues or a history of abuse or trauma,” Richard-Davis said. “These domains are often difficult to tease apart, so it’s important to uncover each patient’s comprehensive history and determine what else might be going on.”

Many people think targeting sexual health concerns is simple, but “it’s not as simple as you think,” Richard-Davis said, noting it’s important to understand the physiological changes your body is designed to and needs to undergo in preparation for sexual intercourse.

Hormonal changes, such as the aforementioned estrogen deficiency, can decrease a woman’s sexual desire. “We’re seeing some younger women who are hypo-sexual, meaning they’re not interested at all. And for other women, their body responds as it’s designed to leading up to intercourse, but their mind does not.”

If the physical exam and biological tests come back normal, Richard-Davis considers referring patients to counselors to uncover the underlying issues affecting their sexual health, she said.

The important thing to remember when treating sexual concerns is it has to be a problem for the patient and not just the patient’s partner, Richard-Davis said. She spoke of the value in treating sexual health concerns as a couple, especially if infertility is an issue, but stressed it’s about the patient first. “If it’s bothersome to her, and not just her partner, then I suggest seeking professional help. But it has to be an issue for the patient first and foremost.”

Another tip, she encouraged, is for patients to ask questions. “Patients have to be their own advocates and ask their doctor about concerns they’re dealing with. We all know doctors are on tight schedules, so the sooner patients bring up those concerns, the sooner their doctor can begin addressing them. And if you’re not happy with your doctor’s attention to your concerns, remember you can always go somewhere else for medical help.”

Some people might think sexual-related health issues regarding men are more simplistic than those affecting women. Davis, chair of the department of urology at UAMS, says this is a myth. The most common talked-about problem affecting men is erectile dysfunction, but that just may be the “tip of the iceberg” of what else is going on in men, he said.

“It’s a complex system. It’s the nervous system married with the vascular system married to the psychological system,” Davis said.

The top issues affecting men include disorders related to libido, arousal and ejaculation, Davis said, noting that about half of men ages 40-70 experience erectile dysfunction, commonly referred to as “ED.”

Intimacy, such as hugging and kissing, is typically something more associated with women needs, Davis said, but it can affect men just as well. “A lot of things go into creating an intimate moment. It’s the expectation of the height of the event that is created in the prelude, or foreplay, so I first ask patients if they’re participating in those things.”

The main causes of sexual issues in men are hyperlipidemia, diabetes and hypertension, Davis said. All of these concerns can affect the vascular system, which is also responsible for erections.

As for most health concerns, prevention is key. Common ways to prevent those issues, which can affect sexual desire and performance, are eating a healthy diet, exercise and keeping blood pressure in check, Davis said.

Like women, Davis advises men seek professional help when their level of sexual health bothers them. Including their partners in addressing such concerns helps both patients. Identifying sources of arousal is also important.

“I know that people’s sex lives can be complex, and I am not here to judge,” Davis said, adding medical professionals are privy to information that is very personal to the patient. “What my patients do to enjoy their lives is strictly their business. My job is to help patients manage their desires so that they satisfy them in the most healthy and safe way.”

The bottom line, both doctors agree, is to try and lead a healthy lifestyle, which contributes to a healthy sexual life. Keep in mind individual desires vary and that is OK. Seek professional help when you don’t feel right about your sexual health and never be ashamed or embarrassed to ask questions related to your sexuality.

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By Jillian Mcgehee

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