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

Sex isn’t an easy topic to discuss, even for doctors. Asking a patient about it feels awkward, embarrassing and intrusive. The doctor feels uncomfortable, the patient is squirming, and everyone just wants it over and done with.

It’s no real surprise, therefore, that studies show that the vast majority of doctors never ask their patients about their sex lives.

Doctors from every specialty struggle to broach the subject but some of the worst offenders are GPs, where just six per cent initiate these discussions.

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

Studies show that the vast majority of doctors never ask their patients about their sex lives

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

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

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

I’ve seen time and time again in psychiatric outpatient clinics the results of this failure.

One of the main side-effects of antidepressants are sexual problems. I remember one young man who had been referred to me with depression. His GP had started him on an SSRI but this hadn’t worked. He’d been switched to another one, but again, his symptoms remained. He was very low, felt desperate and suicidal at times and had little enjoyment in life.

He tended to shut himself away and sleep for long periods. He lost weight as he had no appetite and fell behind at university.

Ideally, he needed a combination of therapy and medication to help him get over this, but while I was filling out the referral to the psychologists to start therapy, it occurred to me to check he was taking his medication.

He looked at me sheepishly and eventually confided that he hadn’t been taking them. ‘The GP was a woman’ he explained ‘so I couldn’t talk to her about it’.

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

One of the things that might 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 compounds their sense of isolation.

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

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

But there’s another side to this too. Doctors don’t always have the data and evidence to present to patients to explain the risk and benefits of medication.

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

After seeing this man, I now routinely ask about sexual side effects in patients on SSRIs and I’m shocked by how many are affected. Independent studies have suggested it can be over 70 per cent. For some it’s not a problem, but for others it can be yet another source of distress and worry and compound their low mood.

Yet, if you look at the data on sexual side-effects from drug companies, it hardly gets a mention. It seems drug companies don’t like talking about sex, either, although this isn’t out of embarrassment but rather, I suspect, because of concerns about profits.

If doctors plucked up the courage to ask routinely about sex and sexual side-effects, they’d see for themselves how common this is.

It might make them think twice before they dished them out so freely.

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

Their widespread use in the health service is relatively new. They have not gone to medical school and instead have two years post-graduate training. The original idea was that they would ‘assist’ doctors, yet with the NHS being increasingly stretched, they have started taking on more and more clinical responsibilities. 

The court case against the GMC claims that its plan to start regulating the so-called ‘cut-price medics’ fails to set out clear rules over what PAs can and cannot do. While I do think PAs have their place in the NHS, my concern is that too often they are being used to plug gaps in the medical workforce and worse, patients don’t even know they are not seeing a doctor. I’ve had patients tell me that they assumed they were seeing a ‘physician’ because they were being seen by a PA. 

There have been reports of them being allowed to prescribe, diagnose and even operate on patients. One friend has been with his GP surgery for three years and never once seen a GP because he was being seen each time by a PA he assumed to be a doctor. Patients absolutely must be told who they are seeing. anything else cannot be right.

Celine's fear for her children

Singer Celine Dion was diagnosed with stiff person syndrome’ (SPS) in August 2022

Celine Dion has spoken of how her children are frightened she is going to die as she battles with ‘stiff person syndrome’ (SPS), a rare neurological condition that causes progressive muscle stiffness and spasms.

‘My kids are scared because they lost their dad, and they’re wondering if I’m going to die. I don’t want to die, I don’t want to lie,’ she explained. While SPS is not necessarily fatal, it causes her family constant worry. For most of human existence we lacked the tools to diagnose illness or predict what would happen.

Yet, modern medicine has delivered a huge amount of knowledge, and we now often know if we have something serious or even fatal. Perhaps this gives us time to think about our lives, put our affairs in order and say our goodbyes. But doesn’t it also mean that we can spend many years worrying about something and waiting for it to progress, even though it might not?

Junior doctors have been urged to scrap their plans for a walk out just before the election if leaders promise to make negotiating with them a priority. 

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

Dr Max prescribes... Lost Boys And Fairies

This mini-series on BBC iPlayer tells the story of a gay couple starting out on the process of adopting a child in Wales. It’s a gentle and at times funny story about family, addiction, ageing and homophobia.

It’s ultimately a nuanced story about our need for love. The scene with the birth mother in the last episode is extraordinarily moving.