Ignorance Is Not Bliss: The Sad State of Sexual Medicine

Not long ago, I discussed the discomfort physicians too often feel while discussing sexual issues with their patients. This discomfort is rooted in broader anti-sex attitudes in America - and no, the ubiquity of sex in the media does not mean that America celebrates sex, only that we commodify it. The result is that patients often don't get even very basic medical advice that could help them ameliorate sexual dysfunction.

But I totally overlooked a second problem: plain old ignorance! I just read an insider's perspective from Dr. John P. Mulhall, MD, director of the Male Sexual and Reproductive Medicine Program at Memorial Sloan-Kettering Cancer Center in New York City, and author of Saving Your Sex Life: A Guide for Men with Prostate Cancer (Hilton Publishing Company, Chicago, 2008). In an interview published last week in Renal and Urology News, Dr. Mulhall said:

There's a famous slide I often use during talks—it shows a patient on a bed beside the doctor and both have “thought bubbles” that say, “I hope he brings up the topic of erection problems.” So it's usually on people's minds but rarely discussed. In addition, we only get one or two hours of sex medicine information in medical school. There's more time spent on tropical medicine.

So I was half right in blaming doctor's comfort level - or lack thereof. But only half.

I'm shocked, honestly, that doctors get only an hour or two of formal training in sexual medicine. Then again ... if they know more about malaria than about sexual dysfunction, it explains a whole lot.

• No wonder people are often prescribed anti-depressants without sufficient information on their sexual side effects.
• No wonder prostatectomies are frequently performed without full discussion of what the patient should expect (some men are not informed that they won't ejaculate afterward, for instance!) and without followup aimed at restoring sexual function.
• No wonder doctors often don't screen women for sexual problems after childbirth and menopause, waiting instead for women to bring mention them.

Shame and ignorance make a perfect couple, don't they? Each reinforces the other. It's as if medicine were cousin to the abstinence-only movement, where shame and ignorance are wedded for life in one of those really lousy marriages that makes everyone miserable.