I remember the first time a patient tried to talk to me about resuming sex following surgery: The words barely made it past her lips, her cheeks flushed. She was desperate to ask but was afraid of my reaction…She felt uncertain that this was her space, and I was there to help. But the truth is, I felt uncomfortable too. Not because I judged her, but because no one taught me how to sit with my own shame, let alone with someone else’s. That was the day I realised something: if we, as healthcare professionals, carry unspoken discomfort around sex, how can we expect our patients to feel safe opening up?
Years later, I started my own research on sexual wellbeing in chronic illness. When I was presenting my project to other academic peers, I was made to feel uncomfortable, judged by their silence. Never had one ask me more about it, or shown interest. All I felt was judgement, and then shame sneaked in. “They surely believe I must be some middle-aged woman with unresolved issues”, I was telling myself. Because shame is sneaky. It doesn’t announce itself. It sits in the pauses, the nervous laughter, the questions left unasked. But mostly sits in silence.
In school, we learn to chart symptoms, not silences. We’re trained to take sexual histories, but almost never told how to hold the emotional weight that comes with them. And so, when sex enters the conversation, even subtly, shame can slip between us and our patients—quietly, powerfully, blocking real connection, preventing conversations that matter. Conversations that really help us get what the person in front of us faces in the adversity of illness. Conversations that really could help them make sense of their life in the land of the sick.
Some of us were raised in households where sex was never discussed. We were taught about our genitalia with the use of euphemisms, and now we feel ashamed when speaking the right words. Others may carry personal wounds or trauma. And all these shape the way we listen, or don’t; the way we speak about sex to our patients, or don’t.
And meanwhile, our patients are waiting. Waiting to ask when they can have sex after their major operation, or is it going to be the same as before, will their partners accept their scarred body? Waiting to admit they’ve lost their way in a world without words, a world where few of us get a compass and are able to navigate without shame. Waiting to say they’ve never felt safe, or never felt seen. Many never do. Not because they don’t want help. But because they’ve learned that silence is safer than vulnerability.
My research gave me the opportunity and privilege to talk to many people about things they never said to anyone before. I don’t know their faces; I was at the other end of an invisible telephone line. But they shared their most intimate stories, their trials and tribulations, they laughed and cried within the same sentence. So, I turned this into my mission: to be their voice, to tell their stories, their worries and shame. Only in this way the clinical world understands that patients want us to ask about their relationships, about their pain during sex, about how less desirable they feel. We ask about blood pressure, sleep and even bowel movements. Why not sexual wellbeing, or safety in relationships? Everybody tells a story. Sexual wellbeing is part of it.
If we want to support our patients’ sexual wellbeing, we have to go first. That means doing our own work. We must recognise and name the discomfort we carry—not to erase it, but to stop letting it lead. We need to shift from keeping the shame and silence to practicing empathy. This doesn’t require becoming a sex psychotherapist. It means becoming human again in the examining rooms. Imagine what would happen if every patient believed they could talk to us about sex without fear of judgment. Without embarrassment. Without shame. Imagine we approached these conversations not as awkward detours, but as central to the patient’s story. Of course, not central to all stories, but many more than you think!
I have now made it my mission and talked to hundreds of healthcare professionals about what patients want from us when it comes to sexual wellbeing. It took courage and vulnerability. But I never let shame sneak on me again from the moment someone from audience stood up, and said (in tears) how their own shame deprived many patients from the care they deserved. Plummer said: ‘The media has become sexualised. Sex, then, has become the Big Story’. But in the examining room is nothing but silence. And change starts with us.
Dr Simona Fourie PhD RN, Clinical Research Facility Operational Lead, Postdoctoral Researcher, MRC Translational Immune Discovery Unit, Radcliffe Department of Medicine, University of Oxford
