Doctors and sex

Medical Matters: I have been reminded recently by a number of readers of topics that they would like to see covered in this column: one is dental science and the other is matters of a sexual nature.

Having resisted the fleeting temptation to devote this week's offering to oral sex, thereby discharging my responsibilities in one go, let me assure those with an interest in teeth and gums that their needs are currently being looked into. In the meantime, here are some thoughts on medical aspects of sex.

Despite the advent of Viagra and similar drugs, sexually transmitted disease remains the prime concern of doctors in the area of sexual medicine. But before launching into the latest on syphilis, gonorrhoea and their microbiological bedfellows, a few words about what can be a difficult consultation for both doctors and patients.

Dr Mary Favier, a Cork GP and a tutor in the Continuing Medical Education (CME) programme run by the Irish College of General Practitioners and the Post Graduate Medical and Dental Board, has written about the barriers to discussing sexual matters in a traditional 10-minute consultation. Apart from the obvious lack of time, there is the fear on the doctor's part of being intrusive.

The age and sex of both the GP and the patient are important factors; a young female doctor, for example, may find it easier to broach the issue with a young woman. Doctors may fear their own inadequacy and perceived lack of knowledge of sexual matters.

Cultural differences, such as a person's ethnicity and their sexual orientation, can be a significant barrier.

And some doctors may not be open to the wide range of sexual behaviours that exist, thus causing them to "close off" the opportunity to discuss sexual issues in a consultation.

For patients, sexual matters can also be a challenge. Paradoxically, the better they know the doctor, the more difficult it can be to discuss the issue.

There may also be a concern, especially for teenagers, that the details of the consultation may be shared with parents by the doctor.

The most recent edition of the Medical Council's ethical guide to professional behaviour included a paragraph on the issue of chaperones which should make the sexual consultation a little easier.

"The patient, irrespective of age or gender, should be offered a chaperone," the new guide states. It should make it easier for male patients to request a chaperone when being examined by a female doctor; something which until now, may only have been offered when the sex of the doctor and patient was reversed.

In fact, it is a good idea for the patient to prepare for the consultation.

Address your worries before you attend: would you like to bring a friend to give you support and to act as a chaperone? Ask for reassurance regarding confidentiality, if that is a concern. If you need to go for tests, would you prefer to attend a hospital in another town or a different part of the city?

If you are diagnosed with a sexually transmitted infection (STI), the following questions are likely to be important to you.

How did I get the infection? Can I pass it on? Will it return after treatment? Do I have to tell my partner and should he/she come in to be treated also?

At any time, about 3 per cent of the sexually active population have an STI, so the problem is relatively common, and the incidence of certain infections is on the rise. Syphilis is becoming increasingly common, especially in the gay community. Both it and gonorrhoea are treated and followed up in the genitourinary medicine clinics of the major hospitals.

Genital warts are the most commonly diagnosed STI in the Republic. There has been a 25 per cent increase in cases in the last 10 years. Caused by a virus, they are treated by the application of creams and by freezing treatment (cryotherapy).

The commonest treatable bacterial STI here is Chlamydia. A typically silent infection, it may cause a vaginal discharge in women or a urethral discharge in men.

Unfortunately, infection with Chlamydia leads to infertility in women and a high risk of ectopic pregnancy, both of which can be prevented by early treatment with an antibiotic called Vibromycin.

The partner of the person infected must be treated, otherwise reinfection rates are high.

Just like other areas of medicine, prevention is the best approach to sexually transmitted disease. Abstinence is the only sure way of avoidance while using condoms diminishes the risk significantly. But there is now a welcome trend towards secondary prevention, in which young people with a number of sexual partners realise the importance of a regular check-up.

They appreciate that by the time a vaginal or penile discharge occurs, significant disease may be present. And so the concept of having an STI check-up, where an individual is screened for the common infections, is gaining currency.

While the management of STI has become increasingly specialised, and the number of genitourinary medicine specialists around the country continues to increase, the family doctor remains the first port of call for many.

Thanks to Dr Favier and her fellow tutors, most doctors are now trained to handle the particular challenges posed by the person who comes to the surgery with a sexually transmitted disease.

Dr Muiris Houston is pleased to hear from readers at mhouston@irish-times.ie - he regrets he cannot answer individual medical queries.