Discussing Sexual Health With Partners and Doctors

"Connection and affection equal the safety to feel desire and wanting," said Devèze (pronouns they/them). "It's just one of those things where people don't really get turned on unless they feel comfortable.

"There are plenty of ways to experience pleasure and climactic experiences which don't have to involve penetration," they continued. "It doesn't even have to involve touch."

Sex isn't synonymous with the same actions for everyone. The act is often fluid, even in relationships. A number of factors, both mental and physical, could shape the kind of sex that is best for you.

"Sexuality is very tied into our self-expression, our self-worth," Devèze said. "Different pleasure doesn't mean less pleasurable, it just means different."

However, your partner won't know how you feel, what you enjoy or any concerns you face in your life without communication. Still, it can be hard to communicate, especially if you've had a negative sexual experience or feel anxious about sex.

According to Devèze, if you're having sex and it isn't going well for you, a good place to start is to simply check in with questions like:

• "How could you enjoy this more?"
• "Hey, could we pause for a minute?"
• "I need to tweak this situation to be more comfortable."
• "I'm a little uncomfortable receiving right now, can I offer you pleasure instead?"
• "I'm really anxious right now. Could I cuddle next to you while you self-pleasure?"

Having these conversations with an intimate partner creates more pleasure for both of you.

"You're going to associate sex with something pleasurable but also safe, and that can help overcome many barriers," Devèze explained.

Sometimes it's good to have a conversation before reaching the point of sex. Susie Gronski, a licensed doctor of physical therapy, an AASECT-certified sex educator and a medical advisor for Aeroflow Urology in North Carolina, shared her best tips on starting a conversation about sex and sexual health with your partner:

• Schedule time to have a conversation with your partner without distraction.
• Give your partner a heads-up about what you would like to talk about so the conversation doesn't throw them off-guard.
• Even if you're nervous or uncomfortable talking to your partner about sex, let them know how you feel. Be open and honest with your feelings.
• Communicate clearly but respectfully. Understand your partner has their own fears, vulnerabilities, thoughts and experiences around sex and their sexual health.
• Explain, don't blame. Help your partner understand your concerns; remember, they cannot read your mind. Make statements that start with "I" instead of "You" as they sound less critical and are less likely to elicit a defensive response from your partner.
• Give appreciation when it's due. Acknowledge your partner's willingness and courage to engage in sexual dialogue.
• Share reciprocity. Give your partner space and attention to share their perspective. Be open and flexible when listening to their response and let them know that you heard and understood them.
• Let your partner know how they can best support you during the conversation and afterward. Allow them to share what support they'd like from you as well.

When it comes to mental health problems and sex, communication can be more challenging but more necessary.

Devèze explained that mental health concerns are difficult with regards to sex because you lose connection to your physiological responses. You may not get as wet or as hard as you once did. There's also the psychological-emotional disconnection that comes from diminished enjoyment.

"You have less life pleasure," Devèze said. "Food doesn't taste as good. Music doesn't sound as good, touch doesn't feel as good. The same applies to sex, and it can be really disappointing. It's difficult to overcome that."

Then there's feeling guilt or shame for not wanting sex.

"Our brain is wired around wanting," Devèze explained. "The longer we struggle with mental health and don't address it, [the more] we lose the wiring in our brain around sexuality. And that can contribute to even more of a loss of libido and more of a loss of arousal, sensitivity and pleasure."

You need to communicate and connect with yourself again before you can connect and feel safe with others.

"Start with learning to touch yourself, just slow touch, in a really soft, slow, safe way," Devèze recommended. "Then the brain begins to connect and likes to touch again."

From there, you can build on communication and the sexual relationship you have with your partner. You might feel too disconnected to have someone touch you at first, but offering a partner pleasure with your hands can start to lay a positive foundation.

"Sex doesn't have to be an exchange," Devèze emphasized. "It doesn't have to end in orgasms. It doesn't have to have genitals involved. It's about discussion and communicating as well."

Talking with your partner about sex and sexual health isn't the only conversation you may need.

"Communicating your needs with your healthcare provider can feel nerve-wracking, especially when you're worried about tarnishing your relationship with them," Gronski said.

"There's a certain level of risk when you choose to lean into a vulnerable situation," she continued. "As uncomfortable as it may feel, leaning on vulnerability actually builds connection and strengthens your relationships."

John Gottman, an American clinical psychologist and researcher, said, "94 percent of the time, the way a discussion starts determines the way it will end." Here are tips from his famed relationship institute to help you effectively communicate with your healthcare provider:

• Think before you speak. Think about what needs to be said and how you want the other person to receive your communication, both verbal and nonverbal. It's helpful to write your thoughts down and play out the interaction in your mind ahead of time. Remember, intent plus impact equals effective communication.
• Begin the conversation by gently naming your concerns in a respectful and nonjudgmental way. Stick with only what's relevant to the conversation.
• Talk clearly about what you want in positive terms. Tell your healthcare provider what you hope for or what you want instead of what you don't want. Your provider isn't a mind reader, so express what you want openly.
• Share reciprocity. Give your provider space and attention to share their perspective. Be open and flexible when listening to their response and let them know you heard and understood them.
• Give appreciation. You and your provider are a supportive partnership where you both want to feel appreciated for your contributions and values.
• Negotiate a plan. Discuss what changes you both want to see and implement them into practice. This includes each of you taking responsibility for your respective parts in this therapeutic relationship.

Devèze's top tip is to find a person you feel more comfortable with than you do with other staff members.

"There's always a person at your doctor's surgery, hospital or clinic that you think is easier to speak to and understands," they said. "You can just say something like, 'Look, I've got some concerns of a really private nature. Do you know who the best person is to speak to? I'm pretty embarrassed about this.' Even just that is enough to start the conversation."

Another piece of advice from Devèze is to use the word "intimacy" rather than "sex." Or use phrases like, "I've got some really personal questions I'd like to ask. Is there a private space we can go to?" or "Who is the best person to talk to about bedroom-related concerns?" The word sex can be quite scary to say, but there are many ways around saying the word specifically that people will understand.

"If you feel shamed or get a negative response from a healthcare worker, that's most likely their stuff coming out," they added. "And it's really important that you try again with someone else."

Erica Montes, M.D., a board-certified OB-GYN in Arizona, founder of the Modern Mujer health blog and a spokesperson for the women's health website Organon, discussed the importance of people bringing their sexual health problems and symptoms to their physician.

"If you feel like you're not being heard, keep seeking answers," she said. "We want to make sure that we can tackle any conditions or sexual health problems early to have better success with treatment and outcomes."

Gronski identified a series of red flags prevalent in the medical community. If you feel your relationship with your healthcare provider is along the lines of the following points, it might be time for a second opinion:

• You don't feel heard and understood.
• You don't feel validated.
• They don't take your concerns seriously.
• The therapeutic relationship is "power over" rather than "power with."
• You feel like you don't have a voice in your plan of care.
• The doctor seems defensive or impatient when you ask questions related to your health and/or a particular treatment offered to you.
• You feel like your doctor is not listening to you and interrupts you when you're trying to share your story.
• The doctor is condescending or demeaning.
• They don't make eye contact; they're glued to their screen or focused on writing notes rather than making a heart-to-heart connection with you.
• They demonstrate a lack of empathy and compassion.
• You don't feel like you can trust them or be honest with them.
• They don't return your calls or messages.
• They are not up to date on current care guidelines related to your particular issue or situation.
• You feel shamed or blamed by them.
• They don't approach your concerns or situation from a "whole person" perspective.

If you're struggling to speak to your healthcare provider about your sexual health or don't feel confident in looking for another clinician on your own, it might help to have someone advocate for you.

Achieving good sexual health can be hard if you don't feel you're being listened to or you don't feel able to speak out in the first place.

An advocate can be a friend, a relative or a professional. Their primary job should be to help you talk to your healthcare provider to ensure your concerns are heard. The most important aspects are that you feel comfortable talking to your advocate, they understand your situation and they can help you explore options and make an informed decision.

Montes said a parent could be a good advocate for young people if they feel comfortable having a parent in the room with them. If you don't feel relaxed opening up to a parent, perhaps a trusted friend would work.

"You can always ask someone to come with you to your medical appointment," she said. "Feeling supported, whether it be through a friend or a family member, can make your journey a lot easier."