Sex talk

Nothing surprises me any more. Not a thing. Britain's general practitioners are in the front line when it comes to most aspects of healthcare, and more and more people want to discuss their sexual problems. But while such openness and trust is a remarkable honour, it isn't always easy.

The most recent issue of the British Medical Journal has confirmed that sexual problems are an increasingly common reason for consulting a GP. There are a million consultations every day with GPs in the UK, more than 300,000 of these being fundamentally about psychological and social issues, including sex.

In general practice, communication is everything. If the doctor and the patient don't understand each other, then the chance of any consultation being helpful is reduced dramatically. And when it comes to sexual health, then the opportunities for crossed wires are legion.

Many years ago, when I was working as a junior doctor in a psychiatric unit in Birmingham, I was faced with taking a detailed sexual history from a woman who had been admitted after taking an overdose. Her sex life was a somewhat unconventional mess and the source of many of her problems. I suspected that one of her many sources of difficulty, not to mention frustration, was that her husband had premature ejaculation. So I asked her about it. She clearly didn't understand any of the terms I was using, so, entirely reasonably, I asked if it took her husband long to come. "Oh no", she said. "He just gets the 1a bus from Acocks Green and he's here in half an hour."

An integral part of the training of all doctors is communication skills. Communication can be hard enough when you are trying to describe a pain. When the topic under discussion also has the potential to embarrass, it is little wonder that patients can become totally tongue-tied.

It often seems that doctors and patients use at least three different languages. There are the words doctors use when talking to doctors - the technical jargon that all professions use. There are the words that some doctors use when talking to patients, that they would not use in any other circumstance - curious words such as "pop", as in "pop up on the couch", or plurals such as "we" as in "we'll just have a look at you". And then there are words that patients use about their anatomy, health, or physical functions that they would never use when talking to doctors.

It would be so much easier if we all used the same language, but on those occasions when I have tried to help an embarrassed patient by offering an Anglo-Saxon translation, I can never be exactly sure what the reaction will be. Sometimes you sense relief, and sometimes it is shock - and it is impossible to be sure which is the most likely.

There are, of course, some patients who have no qualms about raising the most intimate of topics. For this type of patient, who is happy simply to ask about erections, or problems with orgasm, then the consultation can be as straightforward as one about a sore throat, or backache. But when the patient is too embarrassed or ashamed to talk openly, then all the skill of the general practitioner is needed to allow the topic to be raised.

Embarrassment can cause decades of unhappiness. I was recently consulted by an otherwise happily married couple who last had intercourse 18 years ago. She felt agonising pain whenever they tried and felt totally inadequate, and he was racked with guilt that it was his fault. In fact the cause was simple - hormonal - and no one's fault at all.

Embarrassment can kill. It kills when patients are too embarrassed to ask about testicular lumps, or rectal bleeding. Patients often apologise for bringing potentially embarrassing problems to the doctor - as if the doctor will be embarrassed too. There is nothing that patients can tell us that we haven't been told before. Openness and honesty are all important.

There are male patients who are embarrassed to talk to female doctors, and female patients who can only relate to female doctors, gay patients who prefer gay doctors, men who only wish to consult women, and women who only like to consult men. The vital thing is that patients should be able to find a doctor that they feel safe with, that they can be totally open and honest with, whatever their age, sexual orientation, or problem.

And if patients would realise that most doctors can understand Anglo-Saxon just as well as they do, then we all might know what we are talking about.

· David Haslam is the chairman of the Royal College of General Practitioners and a practising GP in Cambridgeshire

Thanks to guardian.co.uk who have provided this article. View the original here.