How Often Are Patients in Germany Asked About Their Sexual History?

A Population-Representative Survey

Sexual dysfunction is common amongst both men and women (1). Population-representative surveys in Germany report a prevalence of one or more sexual problems in 33.4% of men and in 45.7% of women. Sexual dysfunction causing marked distress, according to the ICD-11 guidelines, was reported by 13.3% of sexually active men and by 17.5% of sexually active women (2). Sexual problems or dysfunctions can occur as a result of physical or mental illness, hormonal changes, the effects of medication or stressful life events, such as the birth of a child, stress at work or in a relationship, or the death of a relative (1). Despite their high clinical relevance, talking about sexual dysfunctions is often embarrassing, and it is not easy to introduce the topic in everyday clinical practice due to a lack of time and uncertainty about possible treatment options. There is, however, a growing consensus that taking a sexual health history should be an integral part of medical care. The aim of our study, therefore, was to assess on a population-representative basis for Germany the frequency of specific questions brought up in the past in the form of a sexual history and offers of counselling on sexual problems from the patient’s perspective.

Methods

The present study was conducted on a new sample using a strictly standardized random-route procedure as a nationwide representative survey in cooperation with Jena University Hospital, the Medical Faculty of the University of Leipzig, and the Market and Social Research Institute USUMA. There were around 34.4% dropouts amongst 5093 households due to, amongst other reasons, absence, illness, lack of interest, or holiday. 15.8% refused to be interviewed. Sociodemographic data was asked face-to-face, the other items were answered in writing and handed over in a sealed envelope.

A total of 2531 individuals (44.6% male, 55.4% female) were asked whether their doctor had in the past taken a sexual history or offered counselling.

Their average age was 48.6 years, ranging from 14 to 93. Healthcare experiences were mapped using specific items. Firstly, a record was made of whether individual aspects of sexuality (e.g., time of sexual maturity, questions about contraceptives, possible problems during sexual intercourse) had ever been asked and, if so, by which type of specialist.

The survey also asked whether a primary care physician or a specialist had ever offered to talk about sexuality or sexual problems when needed.

Results

With regard to the care situation, 91.8% of the women (N = 1286; 95% confidence interval: [90.2; 93.3]) reported that they had not yet been asked any questions relating to their sexual health history. 6.5% of the women reported that a sexual history had been taken by a gynecologist and 0.5% each by a primary care physician or a psychotherapist. 96.2% (N = 1087; [95.1; 97.3]) of the men stated that they had never had their sexual history taken. 1.2% of the men had had their sexual history taken by a general practitioner and 1.3% by a urologist. The survey also asked whether patients had ever been given the opportunity to talk about sexuality or sexual problems when needed. Only just under ten percent (N = 139; [8.7; 11.8]) of the women and 6.5% (N = 74; [5.2; 8.2]) of the men reported such an offer to talk.

Discussion

Despite the high prevalence of sexual dysfunction, it was found that too little is actually spoken about sexual problems during medical care. Even though the data are deemed to be patient-reported and the limitations of a possible bias due to social desirability or lack of memory ought to be mentioned, the results should nevertheless give us grounds for concern. Given the high prevalence numbers, it may be assumed that many of those affected will remain untreated. The results concerning the taking of sexual histories are consistent with those found in the literature, with practitioners rarely addressing the topic of sexuality. Reasons given for this include embarrassment, insufficient further training in the topic, the assumption that sexual history is not relevant to the main complaint, and limited time (3). However, sexual health histories are essential to ensure appropriate diagnosis and treatment. The responsibility for discussing sexual problems should not rest solely on the shoulders of the patients. They are often unaware that sexual dysfunctions can also be indicators of chronic diseases or can develop as a result of side effects to their medication. Equally, it is also possible that medication adherence suffers and important drugs are discontinued without prior consultation when their side effects adversely affect sexual function. It is therefore crucial in medical care to create a supportive and trusting environment and to encourage patients to openly address their sexual problems and questions or to specifically ask patients about them in a suitable setting. Such a conversation would appear appropriate, especially with regard to chronic diseases and their medication when associated with sexual dysfunction, as sometimes encountered with cardiovascular, neurological or metabolic disorders, for example. The questions can be directly included when gathering information about symptoms of illnesses or the side effects of medications: “You mentioned palpitations and dizziness – have you also noticed any interference with your sex life?”, or: “Sexual problems can arise from chronic diseases or certain medications. You can discuss the matter with me any time”. Most patients want to talk about sexual problems regardless of their age but would prefer healthcare professionals to raise the issue (4, 5).

Katja Brenk-Franz, Elmar Brähler, Madita Hoy, Nico Schneider, Bernhard Strauss

Institute of Psychosocial Medicine, Psychotherapy and Psychooncology, Jena University Hospital, Friedrich-Schiller-University Jena, Germany

(Brenk-Franz, Hoy, Schneider, Strauss) [e-mail]

Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University of Mainz, Germany (Brähler)

Integrated Research and Treatment Center for Obesity Diseases,
Behavioral Medicine Research Unit, Department of Psychosomatic Medicine and
Psychotherapy, Leipzig University Medical Center, Germany (Brähler)

Conflict of interest statement
The authors declare that no conflict of interests exists.

Manuscript received on 06 June 2023,
revised version accepted on 23 August 2023

Translated from the original German by Grahame Larkin M.D.

Cite this as:
Brenk-Franz K, Brähler E, Hoy M, Schneider N, Strauss B: How often are patients in Germany asked about their sexual history? A population-representative survey. Dtsch Arztebl Int 2023; 120: 811–2. DOI: 10.3238/arztebl.m2023.0204

References

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