Sexual health and the elderly: how can GPs improve their patients' quality of life?

Sex and sexual disorders are often difficult for patients to discuss. But older patients find them particularly hard to address with GPs. Can we change this?

Overcoming barriers in discussions about sexual dysfunction

Sexuality: a shame-ridden topic

Very few people like to talk about sexuality and possible physical symptoms that restrict their sex life. The disorders are often assigned significantly less relevance than is the case for other physical symptoms. Older people in particular are often ashamed to talk to their physician about their intimate life, often for fear of being ridiculed or being considered too old for sex. Yet physical intimacy plays an important role in the quality of life of almost all elderly adults.

Breaking down barriers and supporting patients

There are many reasons for limitations in sex life. From menopause to surgery, to the side effects of medication. Mental illnesses such as depression can also play a role. It is therefore important that physicians seek an open dialogue with their patients. A good explanation of possible side effects of medication that affect sexual life is a first step.

Normalising symptoms also helps many people. For example, some people do not realise that the vaginal dryness associated with the menopause is completely normal and can be easily treated.

Open communication with those affected is therefore important in order to establish where the problems are coming from, and how they can be addressed.

Open and respectful communication: how do you start the conversation?

It can be very helpful for the physician to actively address the topic in an appreciative and inclusive manner. Generic questions such as: 'I see a lot of patients with reduced libido. Have you ever experienced this? 

More direct questions such as: 'This medication can lead to erectile dysfunction. Is this an issue for you?' can be a good way to start the conversation.

It is important to recognise the symptom as a health problem. It is just as much a part of an illness or a specific therapy as high blood pressure, for example.

Key take-away: Silence is not always golden...

Sexuality is an essential part of life, and that also applies to the elderly. It is therefore important to create a climate of inclusion and to address the topic openly and respectfully. Sexuality disorders are often a side effect of therapies or a symptom of other illnesses and should therefore be addressed as a medical problem. Most importantly, treatment is often possible.

Source
  1. BMJ 2023;380:e072388