By Janis Roszler

I want us to talk about sex more in society. I really do.

See, I am a diabetes educator as well as a marriage and family therapist. In these roles, I write and speak to professionals and laypeople about the need to discuss sex and intimacy—in the places where it matters, like in our families, in our relationships, and in the medical exam room where real help and healthy change can take place.

Plenty of people need to have these discussions. According to, a reliable website that offers sexual treatment information, more than half of all men over the age of 40 have some form of erectile dysfunction caused by relationship stress, diabetes, heart disease, hormone levels, prostate cancer, and more.

This may surprise you even more: A report in the Journal of Sexual Medicine found that one in four new ED patients is under the age of 40. So these “sex talks” are for everyone.

About 40 percent of all women struggle with sexual issues, too. Their problems include vaginal dryness, decreased libido, pain during intercourse, and even urinary tract infections that delay intimacy. Add these male and female concerns together and you have a lot of unhappy couples and too many sexless marriages.

David Schnarch, PhD, author of the book Intimacy and Desire, confirms that “virtually all couples have sexual desire problems sooner or later.”

Why Should We Care?

When individuals and couples have problems in the bedroom, it impacts other areas of their lives.

I once met with a couple to discuss how to manage the husband’s diabetes better. We talked about meal planning, label reading, exercise, medication dosing, and more. Later, I learned that he had erectile dysfunction (ED). She was angry and hurt by that. She assumed that his performance problems meant that he was no longer attracted to her.

During our session, they agreed to all I suggested, but I worried whether his furious wife would really support his efforts to be healthier. I doubted it. In fact, I feared that she might even go a step further and try to sabotage those efforts.

Overall health and sexual health are highly related, and sometimes libido or sexual performance issues are a red flag that bigger issues may be lurking. And many sexual health issues can be treated, bringing couples closer together.

The Talk Isn’t Easy

Doctors and other health experts work hard to offer patients reliable and important medical guidance. But they don’t always ask how things are going in the bedroom.

According to a 2004 study by the University of North Carolina and Emory University, only 35 percent of primary care physicians routinely asked about sexual health issues. Even as recently as 2014, the American Medical Association was still urging medical schools to expand their curriculums to teach students how to discuss these sensitive topics.

Based on my own observations, things are improving, but there seems to be a lack of research that shows how much progress is being made. I’m tempted to fill that gap because the topic is just too important to ignore.

Several years ago, after presenting to a group of healthcare providers in Los Angeles, I reflected on the tips I shared to help them discuss sexual concerns with their patients. I ended my talk with an urgent plea to speak to every patient they saw.

But what about my own patients? I suddenly realized that I was ignoring my own advice. I talked to a few patients about their sexual life, but not to all of them. That had to change. So, I pledged to speak to each and every one I met with from that moment on.

The next morning, I entered an exam room to see my first patient. It was a tall rabbi wearing a long coat, black hat, beard and side curls. Yes, God has quite a sense of humor. But I couldn’t break my pledge, so I did what I advised my LA audience to do: I listed different diabetes-related complications, then mentioned how poorly managed diabetes can cause problems in the bedroom.

And then I waited, just as I instructed my audience to do. I let the patient think about this, then respond.

The minute those words left my mouth, the rabbi became silent and stared at the ground.

I broke into a cold sweat. Did I offend him? Did I cross a line? After a lengthy pause, he looked up at me with tears in his eyes and said that he and his wife hadn’t had sex in 10 years.

Wow. When the problem first began, he told his doctor, who promptly handed him a prescription for Viagra. Unfortunately, the pills didn’t work, which wasn’t surprising because ED pills don’t work in many men with diabetes. After that session, his doctor never asked for an update and the rabbi was too embarrassed to mention it again.

He just assumed that his sex life was over.

And that’s how things remained until I made my pledge. With the issue now in the open, we were able to discuss different options and he left with renewed vigor, determined to resolve a problem that had burdened him for a very long time.

There is a time and a place to talk about sexual matters. And we must do so. Not just people with diabetes, not just aging couples, but everyone! Sex education is important for people of many ages, and learning how to speak up to your doctor could help more than just your health; it could potentially save your relationship.