During another day in GP Land, my coffee mug was sitting comfortably in front of me on the desk, filled to the top courtesy of the lovely ladies at reception. It was time to see the next patient. The wonderful thing about GP – you never know what’s about to come through that door.
On this day in particular, a sweet old lady walked through that door with a warm smile on her face. You know the next 10 minutes are probably going to be better than the last – a smile like this one inevitably brings a smile to your own face. The lady was well kempt, nice clothes, slight hunch to the back – but that’s OK at her age. This day, however, the reason for her presentation was unanticipated.
I started by greeting her as I do with most of my patients:
“Hi I’m Doctor Corns, pleased to meet you”.
A cordial handshake. Professional, almost too professional, especially as you go to shake that frail, osteoporotic elderly hand, afraid to apply any pressure with the fear that even the slightest excess of strength would cause a fracture. The hand is slightly cool – surprising, as almost any hand is warmer than mine.
“Ohhh nice to meet you Doctor!” she pleasantly replied.
“So what’s brought you in today?”
Her smile changes – the ‘welcome smile’ that was on her face when she entered the door has been transformed into a sort of sheepish smile. Not literally like a sheep, of course, but like a 12 year old girl upon receiving an invitation to her first ever school dance. The degree of curvature of the smile reduces, almost pulling itself inwards, the head tilts slightly towards the floor, the hands come to lay over one another, resting on her lap. She sits as upright as her kyphotic spine allows.
“Well, Doctor, you see, the thing is, is that…when I have sex….”
“…..with my husband….”
“..it sort of…hurts…each time we do it.”
OH MY. Ummm…not really ever talked to an elderly woman about her sex life before. Don’t remember being prepared for this conversation in medical school. We did learn about what happens when the vagina dries up when it’s old. ‘The Change of Life’ and all.
Lacking any other sinister symptoms in an old lady who is implicitly telling me she’s got a dry vagina, I think we can make a diagnosis. It’s what I call Old Vagina Syndrome, or, as most medical professionals call it, Vaginal Atrophy.
“Right…OK…are you using anything to help out?”
“Yes doctor, this lubrication I buy, you sort of shove it up – ”
“Yes yes! I know how it works!”
Fewf. Cut her off just in time to spare the details.
“And you’re not on any estrogen creams are you?”
Well that answers that.
“It’s a cream we prescribe sometimes…for the symptoms of dry vagina…in postmenopausal women…are you postmenopausal?”
“Haha! Oh of course doctor! Have been for many years!”
Well at least I managed to get some sort of silly joke in there. I think I do it to make things a little more comfortable, not only for myself, but for the patient as well. Comedy can sometimes be the best of coping mechanisms.
“So….how many times are you…sexually active…each week?”
How many times are you sexually active? Each week? Why would I even assume its weekly. Gosh. And why couldn’t I have just said ‘How frequently are you sexually active?’… as though the term ‘sexually active’ sort of dulls down the… ‘act’. And why was I so interested in the details?
“Well, you see doctor, I’ve been going through quite a bit of lubricant in the past couple weeks.”
Gone through quite a bit!? In a couple weeks! Holy guacamole! And you’re… OLD! Wowzers! Bravo!
Of course – all these thoughts were just zipping through my head. I somehow managed to cut off that connection between my brain and my mouth to prevent myself from actually blurting out any of those words.
The most difficult part, however, is using every single facial muscle you possess to restrict that inevitably huge smile that one would naturally exhibit after hearing such a statement. After all, how do you stop a reflex? No worries for me though – ever since the age of 3 I’ve loved doing ‘funny faces’ – this means I have an ability to pull a straight face on demand, and control all those facial muscles (that I forget the names of)…even in the midst of a vivacious elderly woman. And one rather ‘sexually active’ vivacious woman.
“Right, so, its rather frequent then.”
Rather frequent? What. Am. I. Saying.
“But…it seems to be working for you…the lubricant?”
“Oh yes! Works fine!”
I ended up discussing different options with the pleasant elderly lady – including the difference between simple lubricants and estrogen creams to treat the symptoms of vaginal atrophy. My gut reaction at first was “HELLLLLP!”, but, I must say, the consultation was absolutely fine in the end. The lady was pleased and we came up with an agreeable management plan. She left the consultation with a smile just like the one she had on her face when she walked in the door – her kyphotic spine possibly even straighter than before. With that in mind:
For doctors, medical students and allied health professionals – don’t be startled when an elderly person asks you about sex. They’re allowed to have it as well. They might even be more ‘sexually active’ than you are, so don’t judge them. If they have a bigger smile on their face than you do, maybe you’re doing something wrong. They might even be able to offer you some advice.
For elderly people who may, in the off chance, be actually reading this story on the internet – don’t feel ashamed about asking your doctor about sex – even if the doctor is the same age as the youngest of your grandchildren. If you’re having problems with intercourse – you’re not alone – many elderly, and younger couples I must add, have difficulties with their sex life. You won’t be the first person to ask your doctor about it. This proves it.
For GPs – if you experience a sudden rise in elderly patients questioning you about sex – please don’t get on my case. Just think of the joy you’re bringing to your patients…just don’t think about it too much…
Disclaimer – I can confirm I have NOT pre-emptively purchased stocks in the Lubricant business, hoping that this story will cause the sales of lubricants to skyrocket, therefore paving the path to my fortune…if there is in fact a fortune to be made off lubricants…
Well, that is a refreshingly candid little chat Dr. John, and yes, it did bring a smile to my face and more than one chuckle. Being part of the over-the-hill gang, these types of challenges do crop up. Cheers, Harold
comments appreciated Harold, glad it made you chuckle. hopefully topics like this will bring a smile to people’s faces, and help them to be more open about going to their GP to seek help
Jon, this was wonderful! Thanks