SEXUAL HEALTH AND EDUCATION
A patient tells you that they have a sexual issue. Do you get queasy? We have got a special guest today who is going to help you help your patients. This is the doctor who began her career as an actress in adult films. She is fascinating and committed to making sure all of our patients needs are met even though if it will make us uncomfortable to discuss. You are listening to ReachMD XM 157, a channel for medical professionals. Welcome to clinicians roundtable. I am Dr. Michael Greenberg your host and with us today is Dr. Sharon Mitchell.
Dr. MICHAEL GREENBERG:
Welcome Dr. Mitchell.
Dr. SHARON MITCHELL:
Well, I thank you. Nice to be here.
Dr. MICHAEL GREENBERG:
Okay, you have got a Ph.D. in human sexuality and have a 2 carrier foci, a private practice and AIM foundation. Can you say just a few words about each?
Dr. SHARON MITCHELL:
Certainly, my private practice, it consists of anyone who has any type of sexual problem and by that I mean if there are sexual issues that are plaguing their private lives whether it is an STD or whether they are having sexual addictions towards content on the Internet. If they are having problems in the marriage, I work with couple. I work with menopausal women who are having problems with orgasm. I also work with erectile dysfunction issues in men and the Adult Industry Medical Health Care Foundation aka AIM. It is a nonprofit organization that I founded a decade ago for the continuing monitoring of HIV and STDs, GYN services and psychosocial issues of people working in the adult entertainment industry, and the general public that chooses to use early detection testing for HIV and STDs.
Dr. MICHAEL GREENBERG:
All right, so let us talk about doctors and patients because that is who our listeners are. Do you think the patients are comfortable with the average American doctor going and talking about sexual issues and how do we doctors usually respond when we are confronted with one of these issues?
Dr. SHARON MITCHELL:
I think there is a lot of information out there now about sex, particularly on television. People are taking about it a real lot. There is a lot of TV shows devoted to it, your know Dr. Phil your operas and people have entire episodes devoted to sexual health and sexually transmitted disease and I think the patients it takes a little bit to get there, nerve up and write down their issues and what not is, recognize that they have an STD perhaps to go online or recognize that they have an issue or talk with someone and realize well, I have got to talk to my professional about it. So, they get their nerve up and they go in and talk to the doc and a lot of times the docs get a little nervous and I think a couple of things happen at this point. I think a lot of doctors tend to may be downplay it and/or some doctors tend to deal with it or try to deal with it and really do not know where and that there are places with people such as myself that specialize in these issues.
Dr. MICHAEL GREENBERG:
Now, let us talk about some of these places then. First of all, what kind of therapists are out there for our patients and how do we find them?
Dr. SHARON MITCHELL:
Well, there are a couple of different types. There are sexual therapists and a sexual therapist is typically someone that when studying the DSM for, it is similar to a psychologist in the aspect that they are going to look for disorders, people that have sexual problems and a clinical sexologist, which is what I am, someone that is well versed in sexual help as well as sexual issues and addiction that is more of someone who is going to look at the whole picture, look at the patient's history, and really basically give the patient permission to have as healthy as a sex life as she or he wants without harming themselves or others.
Dr. MICHAEL GREENBERG:
What percentage of people if you know are having issues?
Dr. SHARON MITCHELL:
I think everybody has sexual issues.
Dr. MICHAEL GREENBERG:
Okay, so it is what I was looking for.
Dr. SHARON MITCHELL:
But I think that people try to deal with them themselves, people try to pretend if they are not there, nobody really wants to admit that there may be sexual issues happening and particularly inside their marriage. For example, I find particularly couples in my private practice and/or any couple anywhere they will be very, very intimate in many different ways. They talk about their innermost secret. They talk about 1 or 2 things they never would share with anybody from when they were kids. You know, the dark places, all kind of things what they really want, but they rarely talk about sex and I have seen a lot of married couples that have gone on for years and years and years and the wife never had sat down with him and said that "this is what makes me have an orgasm, that is what makes me cum, and I cannot tell my husband that, I do not know why, just I can tell him that. I have seen a lot of cases in particular and this is quite common and it is probably the single worse thing that a woman can do is women start out faking orgasms with their mates to make the guys feel better. So, they feel like the greatest lover in the world and they do not realize that what is happening is she is really not being satisfied. She is going in the bathroom and masturbating after they have sex. She is not satisfied. She has never told him, so he is thinking everything is fine, he is a great lover. She does not want to burst his bubble.
Dr. MICHAEL GREENBERG:
Dr. Mitchell, do you think that patients are going to just come out in our offices and discuss these things or can we as physicians handle this kind of issues. Can we train ourselves or get trained?
Dr. SHARON MITCHELL:
I think you can. There is a tremendous amount of education that goes along with this. This is not a 12-hour followup or you know a 72-hour followup continuing medical education. However, I think that a good place to start is just really going over good healthy sexual bodily functions with the patients because a lot of people do not know what is healthy and what is not. Particularly, with women with their discharges, with their different phases that they go through each month, what is helping, what is not, what is a healthy reaction, menopause, puberty, these types of things. I really think that we need to talk about these things as a regular part of a checkup and make sure that they are addressed and really probe the areas of chlamydia, gonorrhea, nongonococcal urethritis. These types of things that often are not prevalent and may be something that is bothering a patient or that they do not know they have and a lot of time you know patients walk into a doctor's office and if they are not asked about symptoms for chlamydia, they may be asymptomatic or if they are not tested for chlamydia, you know man can go on carrying that and transmit it to women for quite sometime.
Dr. MICHAEL GREENBERG:
Even moving away from STDs for a second, just talking about other sexual issues, I mean I just went and had my annual physical and filling at all the questions about, you know do you have any problems with chest pain or breathing, but there is no question on their do you have any issues with sexuality. Do you think we should start putting that on as part of our regular physical exam questionnaire that we give to patients?
Dr. SHARON MITCHELL:
Absolutely, do you have a healthy sex life? What do you consider a healthy sex life? You know a lot of people do not even want to talk about masturbation, I mean there are such lines drawn now, particularly when you know of an election year and we have got some candidates that preach abstinence to teenagers and do not want any type of sex education to be introduced. In certain states just giving people no place to go to ask, so you may as a physician or clinician, you may be there only half between a healthy human sexuality and healthy sex life or healthy sexual function and not getting any help at all. So, I would suggest probing, you know, at least a little bit for general sake that there is a healthy sex function going on with the patient and having some resources available and some therapists or clinical sexologist.
Dr. MICHAEL GREENBERG:
How do we know who is a good therapist or not. How do we find out?
Dr. SHARON MITCHELL:
I always recommend going to the website SSSS or quad-S, the society for the Scientific Study of Sexuality. Because that is going to give you a list of good accredited clinical sexologist, sex therapist, people like myself that have went to school and that have studied all about sexuality, addictions, all types of sexual specialties, and this is a great resource for doctors because they do not really have to feel alone nor do they have to feel like they really need to address such issues as a sexual addiction or you know cyber-addiction or things that are becoming more and more popular.
Dr. MICHAEL GREENBERG:
Okay. Let me play Devil's Advocate here for a second. I am board certified in Dermatology and a lot of other dermatologists are, but it does not mean that if you have passed an exam or you are certified by an organization
DICTATION ENDS ABRUPTLY
