Ask Dr. Janie: How to Talk to Your Doctor About Sex Without Blushing

Dear Dr. Janie,

We’re a married couple in our 60s who’ve shared a passionate, adventurous sex life for decades. Our “sex dates” have always been a joyful part of our relationship and something we both looked forward to.

But recently, things have changed.

Valerie Vagina: I don’t understand what’s happening. Intercourse has become painful, really painful, and my body doesn’t seem to respond the way it used to. I want to feel desire, but my arousal feels like it’s gone on a permanent vacation.

Patrick Penis: And from my side, I’m still wildly attracted to my wife. But my erections? Not so reliable anymore. Sometimes I can’t get one, and when I do, it’s softer or fades too soon. It’s frustrating for both of us. We feel like we’ve lost something essential to who we are as a couple.

We’ve talked about asking our doctors, but honestly, we’re embarrassed. What if the doctor feels awkward? Or worse, dismisses us like our sex life doesn’t matter anymore?

How do we start that conversation without feeling uncomfortable or brushed off?

— Valerie Vagina and Patrick Penis

Dear Valerie and Patrick,

First of all, kudos to you for naming yourselves like comic-book superheroes of genital honesty. I love it.

You two are absolutely not alone. Many people cringe at the thought of discussing their sex lives with their doctor, even though sex is every bit as human as sleeping, eating, and complaining about the weather.

There are lots of reasons for your hesitation. We grew up at a time when sex talk was hush-hush unless you were whispering about it behind the gym or writing it on a bathroom wall. So of course, talking aloud about sex still feels awkward. Plus, we may not know exactly what words to use, or we worry we’ll sound foolish. Some people don’t know which doctor to ask. Is this a question for your primary care physician or your gynecologist or your urologist or your cardiologist? And if your doctor is the opposite sex or younger, that can add another layer of discomfort.

But think about it: you already talk to your doctor about your bowel movements, your sleep problems and that mysterious skin rash, so why should your sexual health be any more embarrassing to bring up?

You said you both feel you’ve lost something important and want to regain your intimacy. This is reason alone to push past any embarrassment, but there are other important reasons for raising sexual concerns with your doctor. Sexual changes aren’t just about pleasure and intimacy. They can also be early signs of health issues like medication side effects, diabetes or cardiovascular issues, among other conditions. So, this conversation isn’t just about sexual pleasure. It’s about health.

Talking with your doctor about sex takes some planning and preparation. Below is a guide of things to do before and during the appointment to make the conversation easier and more helpful.

How to Talk to Your Doctor About Sex Without Blushing

Accept This One Crucial Truth: YOU Have to Bring It Up

I cannot emphasize this enough: most doctors will not initiate a conversation about sex, especially with older patients.

Only 17% of older adults reported discussing sexual issues with their doctor in the last two years and in 61% of those discussions, the patient started the conversation. (Agochukwu-Mmonu, Clinical Gerontologist, 2021)

Why? Some doctors worry they’ll offend or embarrass you. Others assume older adults aren’t sexually active (they're wrong, by the way.) Younger doctors sometimes have that awkward feeling like they’re talking about sex with their parents or grandparents.

So, if you wait for your doctor to bring up sex, it will never happen.

BEFORE THE APPOINTMENT: BE PREPARED

The Boy Scout motto of Be Prepared applies to talking about sex with your doctor. Here are some things you should do before your appointment.

Make a List of Questions – Write them down or put them in your phone so you don’t forget. Once you start talking, it’s easy to get sidetracked, and later you’ll realize you didn’t ask an important question. Be like Santa: make a list and check it twice.

Practice Your Opening Line – Plan a sentence or two to start the conversation with your doctor. Choose something simple and direct. For example:

• “I have a personal health question I’d like to discuss.”

• “I’m wondering whether my medication might be affecting my sex life.”

• “I’m experiencing some sexual difficulties and want to ask you about it.”

  
  

When you talk to your doctor, this should not be the first time you are saying it out loud. Practice saying your opening line in the shower, to your dog, even in the car on the way, so it sounds natural. However, if you’re in an Uber, that might be a little awkward.

Be Ready to Describe What’s Happening – Doctors need specifics, so be prepared to describe how the sexual changes have been happening, when they started, and what exactly your symptoms are. You need to be your own historian and provide detailed information like whether the changes began after taking a new medicine, if they are consistent or infrequent, and what you’ve tried to alleviate the problem. It’s important for the doctor to know specifically how this sexual issue is affecting your quality of life. It’s one thing to say that “intercourse hurts” and another to say, “intercourse feels like sharp vaginal pain, and it’s affecting my emotional and physical intimacy.” This tells your doctor it matters and deserves attention.

DURING THE APPOINTMENT: BE DIRECT, BE HONEST, BE BRAVE

Take Notes – Trust me, you won’t remember everything. Write down what your doctor tells you. I recently didn’t and forgot whether my doctor told me to take both calcium and vitamin D or just one or neither and I swear I was paying attention. Write it down or ask to record your conversation (with the doctor’s permission) so you can listen to it later.

Use Clear, Real Words – This is not the time for “down there,” “my lady parts,” or “Mr. Happy.” Use the anatomical words: vagina, clitoris, penis, erection, orgasm. Your doctor needs clarity, not euphemisms. You’re talking to a medical professional. Precision matters.

Talk to the Nurse First – If the idea of blurting out your sexual concerns to the doctor feels like too big of a leap, start with the nurse. Say you have a sexual question you want to talk to the doctor about, but feel nervous. Nurses are a wonderful buffer and can alert the doctor that you have a sexual question. This also gives the doctor a heads up for your conversation in advance. 

Avoid the “Doorknob Effect” – Don’t wait until the doctor is literally holding the door open to ask the sexual question that was the main reason why you came. You need to raise your sexual issue early in the appointment, so you and the doctor have enough time for a real conversation.

Thank Your Doctor - Yes, really. A simple “Thanks for taking the time to talk about this” reinforces that it’s a valued and legitimate topic and encourages your doctor to follow up in future visits.

IF YOUR DOCTOR DOESN’T HELP

If They Don’t Have Answers

Not every doctor is trained (or comfortable) talking about sexual issues. If your doctor doesn’t have answers, ask for a referral to a sexual medicine specialist, pelvic health therapist, urologist, or gynecologist with expertise in sexual functioning.

If They Dismiss You

If your doctor dismisses your sexual concerns? It’s time for a new doctor. If your hairstylist or mechanic dismissed your concerns, you’d find a new one. A good and caring physician welcomes questions about any aspect of your health. Your sexual health deserves to be taken seriously and considered an important part of your overall health.

Sexual Health IS Vital Health

Your sexual health is part of your overall well-being. It’s pleasure, yes, but also identity, confidence, connection, and physical health. You don’t need to suffer in silence. Once the doctor is aware of your sexual concerns, they can offer solutions and alternative medications, treatments, and devices to improve your sexual life.

Talking to your doctor about sex should not be awkward nor inappropriate. It’s an act of self-advocacy. A declaration that you and your sexual life matter. A reminder that intimacy doesn’t retire just because your joints creak and your glasses get thicker.

Valerie and Patrick, you haven’t lost what’s essential….your intimacy and connection. You’re simply entering a new chapter and with the right support, it can be as rich, intimate, and satisfying as ever.

Dr. Janie

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Disclaimer: The advice provided in this column is for informational and entertainment purposes only. It is not intended to replace professional medical advice, diagnosis, or treatment. Always seek the guidance of a licensed medical professional for any health-related concerns or questions.