Dr. David Fawcett

Speaking of Sex

Filed By Dr. David Fawcett | September 02, 2008 2:00 PM | comments

Filed in: Living
Tags: sex, sexual competence, sexual health, sexuality, shame

Good sex involves more than technical skills. Despite a lot of experience, many people don't feel very competent with one important component of sex: speaking up about it. Sexual competence must include the ability to be comfortable with sexuality, discussions of sex, and especially, expressing sexual needs. It is one of the great ironies of a sex-drenched culture that sex, if it is spoken of at all, is too often described with a buffer of code words and cute metaphors.

There are many situations where this can be a problem. Couples (gay or straight) often have trouble speaking frankly about their sexual needs or concerns in their relationship. Revealing serostatus to a date or sex partner is a big concern for many gay men. And others, even after seeking out a gay physician, are reluctant to talk about their sexual practices honestly with them, which jeopardizes their health. I have had clients who prefer to get tested and treated for STDs at an anonymous clinic rather than at the office of their gay doctor. This is not for insurance reasons but because they are embarrassed about their sexual behavior.

Sex still carries shame for many people. This is true of professionals, as well. I have had clients who completed inpatient substance abuse programs tell me that while in treatment they never spoke of their sexual practices, most of which were critically linked to their drug use. Why wasn't this discussed? In many cases it was because the counselor was uncomfortable speaking about sexual practices. When I train other therapists we pay close attention to their sexual competence: the ability to be comfortable speaking about sexual concerns and make it safe for their clients to do so as well.

How is your sexual competence? Here are some tips for speaking up about sex:

1. Respect yourself. Gay men and women need to work at self love even harder than society at large simply because we are consistently bombarded with negative messages, both overt and covert. You have a right to your feelings, a right to speak up and be heard, and a right to have your sexual limits honored.

2. Minimize embarrassment or shame when speaking about your sexual needs, concerns, or problems. You're not the first to have such feelings and not speaking up could have fatal consequences. That goes for discussions with your doctor, as well. I know one man who didn't want to speak to his physician about his anal warts which consequently went untreated and developed into rectal cancer.

3. Speak your truth, whether it's your HIV status, the need to use condoms, or your concern that your sex life might be a little out of control. Don't keep it to yourself. Speak up and be willing to listen to the feedback you receive.

4. Make your healthcare provider an ally. Be certain that you can frankly discuss your sexual practices and concerns in a safe, non-judgmental atmosphere. Even if you want to ask what you might think is a naive question, speak up, Believe me, they have heard it before.

Sex should be fun, but anxiety, anger, or other negative feelings resulting from unspoken concerns can quickly destroy the mood. When discussing something as important as sexual needs or sexual health, everything should be on the table. Your life depends on it.


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Hi Dr. Fawcett, thanks for a great post! I think another aspect of discussin sex includes talking to your partner(s) about what you are un/comfortable with in the bedroom. No one should have to do anything that makes them uncomfortable. And no one should be embarrassed to ask for something.

Dr. David Fawcett Dr. David Fawcett | September 3, 2008 10:47 PM

Thanks, Serena. You're absolutely right - communication and the ability to express one's needs is what it is all about.

Dr. David Fawcett Dr. David Fawcett | September 3, 2008 10:48 PM

Thanks, Anthony.

Good first post, Dr. Fawcett.

While I tend to do the anonymous HIV testing, my doctor isn't gay (that I know of). I'm not comfortable talking about sex with him; I only visit once a year for a check up and occasionally when I get ill. We don't have what I'd term a comfortable-enough relationship to discuss sex or sexuality.

Any suggestions on how to improve that? It's not as easy as finding another doctor, my insurance has assigned me to his practice. While I could see any of the three doctors in his office, he's the best fit for me. (One of the other doctors is a female from India that just seems ever-so judgmental while the other doctor is so old I just don't trust his diagnosis since he can barely see the prescription pad.)

Dr. David Fawcett Dr. David Fawcett | September 4, 2008 6:18 PM

Thanks, Bil. I’ve found that a health provider’s comfort level with sexual discussion is often more important than being gay or straight. Whether seeing your doctor a few times a year or much more frequently, I think the principles are the same: trust your instinct and advocate for yourself – don’t wait to be asked if you have a concern. Sometimes when sex comes up there’s nervous fidgeting, sweaty palms, and avoidance of eye contact (and I’m talking about the doctor!). If that’s the case you are probably better served by making a change.