Is it my business to counsel patients on what is clearly poor sexual technique? Here’s the situation: A young male patient came in with a request for std testing. He reported that a condom had broken during sex last week, and he was worried. In these situations, I always inquire into the circumstances of the breakage. Improper use of the condom? Lack of lubrication? Oil-based lubrication? It turns out that this patient’s condom had broken at some point during 90 minutes of sexual intercourse. I pointed out that condoms can get very dry during extended sexual intercourse, and inquired about whether or not he had used any lubricant. “No,” he said, “But I think you’re probably right. She kept saying ‘I”m so dry, I’m so dry.'” Ok then, we have identified the problem. I pointed out that using lubricant can prevent dryness and therefore prevent condom breakage, especially during long sexual encounters. The patient seemed receptive. I was close to pointing out that his lady friend would have no doubt been happier and more comfortable with some extra lubrication. I was also close to asking him if he usually has a problem reaching orgasm. Neither of these things were exactly relevant to the std testing situation, and neither of them are strictly medical (although the orgasm question can be a medical issue). I settled for reinforcing the proper use of condoms and lubricant, as well as reviewing the different types of std’s and screening. I decided against dispensing any more sex advice, but I couldn’t shake the feeling that I had passed up an opportunity to help this young man become a better partner. But really, is that my job? I don’t want to be inappropriate as a provider, but I also don’t want to encourage what sounded like a relatively unpleasant sexual encounter for his partner.
I’ll be seeing him again for his lab results, so if I can think of a professional-but-rapport-building approach to this issue, I’ll get another stab at it. No pun intended. ha.