A series of blogs about sex and chronic health conditions, on the lack of good evidence for treatments, challenges around talking about sex, and on what can be done to change things for the better.
Blog last updated 30 January 2023.
We have a problem with sex. Lots of problems, actually. It’s easy to think that sex is everywhere in the media. Sex sells, right? But I get the impression that there’s very little discussion about the sexual problems (let’s not talk in general terms about ‘dysfunction’ – a terribly clinical word with a whiff of judgement about it) experienced by many, many people, associated with long-term health conditions and treatments.
What do we hear about sex and cancer, diabetes or mental health problems? When does the person attending an appointment to discuss their medication or latest test results get to talk about sex, which might be uppermost on their mind but the thing they feel least able to mention? If they do, will their health professional be ready for that conversation, or even initiate it? Where might that discussion go? Are there evidence-based treatments that could be considered?
At Cochrane UK, we started talking about all this when we saw the Cochrane Review Interventions for sexual dysfunction in people with chronic obstructive pulmonary disease (COPD) (published September 2015). The authors found just two relevant studies, involving 48 men suffering from erectile problems. They highlighted two very important things in summing up this work. Firstly, that there isn’t any reliable evidence to tell us what might help improve sex for people with COPD, and what might make things worse. Secondly, at the moment, help for such patients can only rely “on clinical trials which have not involved people with COPD” and “on expert opinion”. This needs to change. This review did involve patients, and they made it clear that sex matters. There are helpful suggestions for what future research needs to address, a wish list that provides a stark contrast to what’s available now.
Since then, we’ve seen Cochrane Reviews published on other health conditions, and it’s the same old story. They have shown up huge gaps in the evidence on treatments for sexual problems and a failure to address things that matter to people. Some of these are addressed in the blogs.
Asthma UK’s Andy Whittamore explores how talking about sex and asthma could result in better asthma self-care in his blog Sex and asthma: could patients’ love lives hold the key to better asthma outcomes?
Sex and chronic pelvic pain was one of the things people talked about at a workshop to discuss which treatment outcomes mattered to them, to inform future research. Sally Crowe tells the story in Let’s talk about sex and chronic pelvic pain: it matters!
Also looking to improve the evidence base for treatments for people with vaginismus , Cochrane review author Tamara Melnik and psychotherapist Oswaldo M. Rodrigues Jnr look at the problems vaginismus can cause and what needs to change in research and in clinical practice in their blog Vaginismus is ruining sex. Research must move beyond penetration
In a powerful blog, Vaginal dilator therapy: vibrate, dilate, or wait? nurse and researcher Tracie Miles blogs about Cochrane evidence on vaginal dilator therapy after pelvic radiotherapy, and about what happens when science listens to women.
In Still being sexual in chronic illness, GP Lynda Ware uses fictional patient stories to illustrate the impact of chronic illness on sexual health, the importance of enabling discussion about it and how can be helpful. She also invites Prof Cynthia Graham to give her view on current research.
Physiotherapist and comedian Elaine Miller agrees that Asking about your sex life isn’t vulgar, it’s vital, in her blog on talking about sex with your partner and health professional, and what can help.
Five doctors working in different specialities take up this theme and share their experiences in Talking with patients about sex: asking, listening, learning and you can read some highlights of a tweetchat on Sex and sexuality in healthcare: a multidisciplinary discussion.
More information and resources
A special series on the menopause, introduced in Making sense of the menopause: evidence, experience and you, which includes pelvic physiotherapist Elaine Miller’s blog No sex please, we’re menopausal!
Evidently Cochrane blogs – Prostate cancer: to treat or not to treat? and Erections after prostatectomy surgery: does Viagra still work?
Cancer Research UK How cancer can affect your sexuality and sex life
Macmillan Sex and cancer
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Sarah Chapman has nothing to disclose.