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Comments wanted on sex advice
Michael Dansinger, MD posted:
A few years ago I wrote a blog post (copied below) about the health benefits of having sex, and that doctors rarely bring up the subject.

Please provide comments and/or suggestions for doctors on this subject. I know we doctors can do much better:

What if doctors prescribed having more sex to treat diabetes?
Sound crazy? I don't know any doctors who prescribe sex to treat diabetes, but after hearing a recent lecture I'm starting to wonder, "Why not?"

There's a general notion that sex is favorable to good health, but most doctors don't specifically encourage their patients to have more sex. Naturally, we don't want to encourage unprotected or unsafe sex associated with sexually transmitted diseases, or sex that leads to unwanted pregnancies. Also, we don't want to encourage reckless sex that leads to car accidents or dislocated hips or other unforeseen injuries, and the last thing we want is for someone to have a heart attack during sex and blame us for it.

However, I can't think of a single patient I treat who is likely to have any of those "bad outcomes" from having more sex. Having a heart attack during sex is very rare, and, in fact, increased sexual frequency is associated with reduced risk of heart disease , and is encouraged after recovering from a heart attack .

Sex is one form of exercise that most people like! It's good for the heart and circulation, and helps maintain good blood flow to the sex organs. "Use it or lose it " is a fair statement, particularly in older people and those with diabetes.

Erectile dysfunction occurs in over half of men with diabetes, especially after several years of poor blood sugar control, and maintaining sexual frequency may potentially help delay or avoid erectile dysfunction. Not surprisingly, eating right and exercising can help partially reverse erectile dysfunction in men, by improving blood pressure , blood flow, body fat and hormone levels. Women with diabetes may also be at increased risk for sexual problems and it stands to reason that maintaining an active sex life may help prevent such problems.

Healthy sleep habits are very important for diabetes management — and sex and sleep are closely related, (enough to be considered "bedfellows" perhaps). Sex improves sleep, and vice versa . Similarly, problems with sleep can interfere with sex . Sex releases hormones that help promote sleep (especially in men), and sleep promotes hormones that favor good blood sugar control and appetite control. By the same token, inadequate sleep quality or quantity promotes hormones that worsen blood sugar control, appetite, weight gain, diabetes and heart disease.

So here we have a cycle of gradually decreasing health, sleep and sex over time. As one aspect worsens, the others may too, on and on it goes. The shame of it is that people generally like sex and sleep and feeling good.

Can we break the cycle? Is it as simple as turning off the TV an hour earlier and having more sex ? Unfortunately, it's not always so simple.
Doctors are in a great position to help patients recognize and reverse this cycle, and should embrace the power of healthy sexuality to fight chronic illness, but most are not doing so. It is not because doctors are unaware of the health benefits of sex. It is not that doctors are afraid of the remote negative outcomes mentioned above. Doctors don't bring up sex because it's so easy not to, and because patients don't typically bring it up on their own.

This mirrors the reasons doctors and patients often don't bring up obesity and weight loss during the course of a routine health visit. Because visits are often rushed, the problem is not acute, there are lots of other priorities and starting the discussion seems risky.
I know we can do much better.
- Michael Dansinger, MD

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