An excerpt from Breaking the Silence: Why Opening Up About Your Sex Life Is the Best Medicine for Your Health, Relationships, and Overall Happiness.

I have been practicing medicine for forty-five years, and it has become clear to me that many of the mental and physical problems that people experience—the things that bring them into my office in the first place—are either caused or exacerbated by the stress, frustrations, and emotional suffering that come with sexual dysfunction within a relationship. Sex remains something that couples don’t talk about, even in the privacy of their beds. The secrecy, shame, and hostility that often build up when sex is poor, infrequent, neglected, or disregarded can damage people’s health, destroy their marriages, and ruin their lives. I have seen it happen, and it is unnecessary.

Here’s an example. A man, age forty-eight, came to see me for high blood pressure, something I treat frequently. But as part of our conversation about his well-being, I asked questions about his marriage and his intimate life. Why do I do this? One good reason is that sexual problems are sometimes the main factor behind physical or functional disorders. But I have also become convinced that my patients’ well-being depends not only on treating them for their medical conditions but also on helping them find the path to happiness, and one of the keys to happiness is a healthy, satisfying sex life.

It turned out that this man was worried that his wife, aged forty-four, might have an affair. His marriage wasn’t happy, and after some more careful conversation, he finally admitted, defensively, that he was having trouble maintaining an erection.

As it is for many men, this perceived failure had been devastating for him. It had thrown him into a downward spiral of embarrassment, worry, defeat, guilt, and emasculation. As often happens, his anxiety over his performance led to recurring erectile dysfunction (ED) as fear took its own course and kept building. There was nothing wrong with him physically, but his fear became a self-fulfilling prophecy. By the time I saw him, he was worried that his wife would leave because he couldn’t satisfy her sexually. But he had never spoken about the problem with anyone—including his wife—because of his shame.

Instead, he tried to avoid sexual encounters, using all sorts of excuses to conceal his fear of embarrassment. It is understandable. Imagine any man, together in bed with his loving wife, both ready to enjoy sexual intimacy, and at the peak of arousal, he becomes unable to perform. Efforts to “make it work” end in failure. Now this poor man is lying in the dark, paralyzed with humiliation, with no help. He feels nothing but shame, embarrassment, and guilt, though he has done nothing wrong. His wife, unaware of how devastating this is for him, has no idea how to support him. His only option is to escape and avoid more intimate encounters.

This silence, this taboo over the topic of sexuality, sexual performance, loss of sex drive … it is an epidemic. This is just one case of thousands that I have encountered in my years in medicine, and while all have their unique features, they share one unfortunate thing in common: No physician had ever asked these men or women about their sex lives before I did.

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I have written this book because physicians are missing a major factor for health and happiness: a healthy sex life for men and women. In my career I have seen hundreds of families broken apart because no one talked about their sexual needs or dysfunction until it was too late. I don’t want to see divorce and pain caused by what is, at its core, a communication problem caused by no one being willing to take the first step.

How do I know this is a problem, apart from what I have seen in four decades of practice? Well, consider that in one large international study including twenty-seven thousand men and women, more than half had experienced some kind of sexual problem, but only 19 percent had talked to a doctor and only 9 percent had been asked by their doctor about their sexual health over a three-year period.

That’s outrageous. Furthermore, in medical practice there is no clear direction on who to talk to about sexual problems, so patients believe that they should talk to specialists like urologists and gynecologists. But the first line of defense should be a sympathetic primary care doctor who initiates the process as part of the overall exam and health review and recommends a specialist if needed. Urologists and gynecologists are geared to deal with diseases or disorders related to their field, not to sympathetically analyze the lifestyle and emotions of their patients.

Why the primary care physician (PCP)? Because sexual dysfunction can be a sign of more serious underlying conditions, including diabetes, cardiovascular disease, hypertension, hormonal imbalances, prostate disorders, clinical depression, or the beginning of menopause. Any of those conditions can lead to low libido, inability to perform, and other sexual problems in men or women. If you are experiencing sexual dysfunction, it’s important to see your physician to make sure it’s not a sign of some greater underlying problem.

However, few doctors talk about the reverse of this situation: health problems that can result from sexual dysfunction. In my years of practice, I have had many patients come to me with conditions such as hypertension, depression, anxiety, headaches, insomnia, irritable bowel syndrome, panic attacks, heart palpitations, and other physical symptoms closely linked to psychological and emotional stress. Many enjoyed complete relief from their symptoms—yes, complete relief—after simply opening up to me about the sexual problems they were experiencing in their relationships, finding out there was hope, communicating with their partners, and taking the small steps I recommended, which included such things as taking Viagra temporarily, exercising and losing weight together, or changing certain medications.

That should tell you the power sexuality has over our happiness. Many of the common health problems people experience can be traced back to the anxiety, stress, shame, and anger that accompany sexual dysfunction. Men and women suffer terribly when they feel like they are failing their partner or not getting the sexual satisfaction they need, and they often suffer in silence and isolation. The difference that comes when they talk about it with me and with each other and then take action is life changing. Marriages are saved. Lives are saved. Happiness is back, knocking at their door.

Moshe Kedan is a cardiologist and author of Breaking the Silence: Why Opening Up About Your Sex Life Is the Best Medicine for Your Health, Relationships, and Overall Happiness.

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