SAN FRANCISCO — People with diabetes frequently experience sexual problems, but few physicians have received training in dealing with these issues, and many are reluctant to broach the subject.
However, “you don't need to be Dr. Ruth to open up these conversations,” Mitchell S. Tepper, Ph.D., said at the annual scientific sessions of the American Diabetes Association. “You don't need to be a sex therapist. It's not your job to finish or address every issue.” He offered the following tips on discussing sexual issues with patients:
▸ Your emphasis should be in talking with patients, not to them, about sexual issues. “I have an 11-year-old,” said Dr. Tepper of the Morehouse School of Medicine, Atlanta. “When I talk to him, [he doesn't respond well]. People want to be in conversation and dialogue.”
▸ Demonstrate respect. Provide privacy for the discussion. Ask permission to talk about sensitive issues. Be patient. People who feel respected will be more likely to open up.
▸ Establish rapport and build trust. Avoid judgmental or shaming remarks. Normalize and legitimize the patient's questions and concerns. For example, you could open the discussion by saying, “Many patients with diabetes report changes in their sexual function or response. What have you experienced?”
▸ Validate the patient's concerns. It's disrespectful to say things like, “Don't worry,” or “It'll take time,” or “You'll figure it out,” or “That really isn't a big problem.” Instead, say something like, “I understand this is upsetting to you. I understand that you may be worrying about how this may affect your relationships.”
▸ Capitalize on teachable moments. For example, if you notice circulation problems in a patient's foot, use that opening to explain how circulation problems can also affect sexual function.
▸ Don't overwhelm patients by trying to cover everything in one session. One way to do this is to ask, “What is your most pressing sexual question or problem?”
▸ Use open-ended questions and let the patient tell his or her story without interruption. Dr. Tepper suggested many questions that can open the door to discussion, these among them: How long have you been experiencing this problem? How much of a problem is this for you and your relationships? Do you experience the problem when you masturbate? What do you think is the cause of your problem? What have you tried on your own to solve it? What are the most important results you hope to receive from treatment?
Finally, Dr. Tepper said that it's important to be cognizant of cultural issues surrounding sexuality. “Sexuality is not only about connecting with the genitals. It's also about connecting with the mind and the soul.”