Most health care providers in a urologic practice are well aware that urologic conditions and sexual issues often go hand in hand. Conditions such as urologic cancers and lower urinary tract symptoms can impact a person’s sexual function, sexual desire, and ability to enjoy sex. Even so, a recent study of urologic oncologists revealed that 75% of the providers surveyed did not routinely address their patients’ sexual function during visits.
Although a sexual function assessment might be omitted from a urologic consult for a number of reasons including lack of time, the prioritization of other medical problems, and a patient’s possible reluctance to discuss their sexuality, sometimes providers simply feel ill-equipped to help patients with their sexual concerns due to a lack of training on the subject.
Daniela Wittmann, PhD, MSW, a psychotherapist, researcher, and Clinical Associate Professor of Urology at the University of Michigan, said, “I think clinicians typically worry that they’re going to open a ‘Pandora’s Box’ [by asking about sexual health] and that they’re not going to know how to answer questions or how to help, and they don’t have associated specialists in their back pocket.”
Nevertheless, sexual well-being is often an important component of a person’s overall quality of life that can have a big impact on their mental health and relationship (if they have a partner). As such, Dr. Wittmann and other sexual medicine experts strongly believe that urologists should routinely bring up sexual health with their patients with urologic problems and, when they do not, patients should bring it up with their providers.
“It is important for patients to be aware that they are entitled to ask for help with sexual problems associated with urologic problems because it is a completely normal aspect of assessing urologic problems,” said Dr. Wittmann.
Of course, providers who have not been trained in sexual medicine may not have all the answers. Therefore, it is important for these providers to have access to sexual medicine resources and specialists to whom they can refer patients. “If every doctor had a sex therapist or nurse trained in sexual health associated with them, either in their own practice or even just in their community, they would feel much more comfortable addressing [sexual health] because then they wouldn’t have to feel like they had to solve the problem,” said Dr. Wittmann.
Fortunately, there are many treatment options for sexual problems associated with urologic conditions including pelvic floor therapy, erectile aids for men (e.g., oral medications, vacuum erection devices, and penile implants), treatments to improve vaginal comfort for women, and sex therapy for couples and individuals. A sexual medicine specialist may be able to provide patients with devices, medications, and/or therapies that mitigate some sexual problems. Sex therapy can help patients and their partners address the feelings, communication, and sexual interactions associated with changes in sexual function and determine how to be intimate moving forward.
Bringing up sexual health with a health care professional may be the first step toward finding the answers to a patient’s sexual problems. “If you’re having sexual problems because you have an enlarged prostate or you have interstitial cystitis or you have lower urinary tract problems and you’re uncomfortable with sex, you’re not alone,” said Dr. Wittmann. “This is a very common problem and patients don’t often get asked about it, so you should know that you’re not alone and you can ask a provider to help you with it.”
Additional Resources for Patients:
- The American Association of Sex Therapy Educators, Counselors and Therapists (aasect.org)
- Society for Sex Therapy and Research (sstar.org)
Wittmann, D., & Bober, S.L. (2021). Incorporating the Principles of Sex Therapy into Urologic Care. Urol Clin N Am 48, 425–436. DOI: https://doi.org/10.1016/j.ucl.2021.06.003