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What your doctor should know about sex, drugs, and depression
Many of us are anxious about going to the doctor's office: "What do my blood results mean?" Will my doctor suspect that this bulge is cancer? Because the physical exam might make us feel exposed and cause mild discomfort, we may shower, shave, and put on better-than-average clothing before going out for our physical in an attempt to reduce this discomfort.
However, it is during the intimate discussions—whether about crushing despair, increasing alcohol consumption, or sexual problems—that our palms begin to sweat. When we know what to expect, these challenging conversations can be more comfortable and fruitful.
Sex
Because most people do not share their sexual history, expect your doctor to ask you a few direct questions as part of your complete exam. Regardless of age, gender, or marital status, doctors question all patients about their sexual history.
I often discuss sexual activity with my patients because mood, substance use, and various medications can all have an impact on sexual functioning. The most commonly prescribed class of antidepressants, selective serotonin reuptake inhibitors (SSRIs), for example, is more likely to reduce libido than treat depression. (They achieve remission in roughly 30% of patients, but they cause sexual dysfunction in 60% to 70% of them.)
What your doctor might ask
The five Ps are partners (number and gender), practices (kind of sexual contact), protection (means of contraception), STI history, and pregnancy. He or she may also want to know if you take any medications or supplements that could have an effect on your libido as well.What your doctor should know Your doctor should be aware of your risk of contracting an STI, including any risky behaviours or substance use. Furthermore, your doctor should be informed of any changes in libido, difficulties obtaining orgasm, difficulties maintaining an erection, or a delay in ejaculation. This helps your doctor think about important things like hormone levels, medical conditions, and medications.
The use of drugs
This is another difficult subject because virtually everyone reduces their substance use. Most individuals realize that smoking or drinking too much alcohol is bad for them—it's not a matter of education. Patients may resist disclosing their use because they do not want their doctors to "teach" them.People who use narcotics frequently experience shame, one of the most powerful negative emotions we can experience and one that people will make tremendous efforts to avoid. It's important to remember that your doctor's responsibility is not to judge and particularly not to reprimand. Assuming you trust your doctor, thinking of him or her as an ally can be beneficial. When you're ready, you and your partner can brainstorm strategies to reduce your usage (harm reduction) or stop using it entirely.
What your doctor may inquire about: It is common practice to inquire about cigarettes, alcohol, and illicit drug usage. If you drink, smoke, or use substances, expect your doctor to ask extensive questions about the amount, frequency, attempts to quit and urges.
The truth is what your doctor needs to know! Consider the previous week and total the number of drinks, cigarettes, and pills consumed. Also, tell your doctor if you want to reduce your dosage or stop using it entirely. Your doctor can work with you to maximize your therapy, whether it's through medicine to lessen cravings or by connecting you to support groups.
Mental well-being
Most primary care clinics check all patients for depression on a regular basis, and some may also screen for anxiety disorders. If you test positive, your doctor will most certainly ask you more questions about your mood, anxiety, and possibly whether you have had hallucinations or paranoia. This isn't because your doctor thinks you're insane; rather, these symptoms may accompany a serious illness and may influence treatment options.What your doctor might ask
Your doctor will ask about your sleep, food, interest in activities, feelings of guilt, and any changes in concentration or energy level to screen for depression. Your doctor will also inquire as to whether you have considered suicide. These queries can feel invasive and intimate, especially if you went to the doctor for something unrelated, like heartburn. However, your doctor is asking these questions to gain a better picture of the duration and severity of your symptoms so that an accurate diagnosis can be made. It's also beneficial to think of your doctor as an ally in this situation. If you are concerned about this information being included in your medical record, you can request that it be labelled as sensitive. Unless they are taking care of you, no one can look at your medical records without your permission.What your doctor should know Depressed mood and anxiety can sometimes be linked to an underlying physical ailment such as heart, lung, or thyroid issues. Mention any physical symptoms you've seen, even if they don't appear to be relevant. If this is your first episode of feeling anxious or depressed, consider any recent life circumstances that may have contributed (such as a recent break-up, job loss, or move), since this may aid your doctor in distinguishing between an adjustment problem and a major depressive episode. Discuss how much coffee and alcohol you drink, which could affect how well you sleep and how stressed you are.
In conclusion,
It's understandable that you feel nervous about disclosing the most personal facts about your life to your doctor. Rest assured that unless there is a real risk of serious injury to yourself or others, your doctor will keep this information private. It's helpful to remember that doctors discuss sex, drugs, and mental health with practically all of their patients, and they'll meet you where you're at. Relax, take a deep breath, and keep in mind that the doctor is on your side.
