Most GPs know the medicine of sexual dysfunction perfectly well. What stalls the consult is not knowledge; it is the first sentence. Once the topic is open, most doctors can run the rest of the conversation competently. Getting there is the hard part, and it is a specific, learnable skill rather than a personality trait some clinicians happen to have and others don't.
Why the opening line matters more than anything that follows
Research on Australian general practice consistently identifies lack of time and fear of causing patient discomfort as the two biggest barriers to raising sexual health, ahead of embarrassment and lack of training. What that tells us is that most of the hesitation lives in the two seconds before the question is asked, not in the clinical content itself. A well-built opening line does two things at once: it signals that this is routine, expected, and non-judgemental, and it hands the patient an easy way to engage or decline without feeling put on the spot.
A line that works
"I ask everyone this as part of a general check-up: how are things going with your sexual health at the moment?"
Three things are doing the work in that sentence.
"I ask everyone" removes the implication that something about this particular patient prompted the question. It is not "I noticed something," it is "this is what I do." That single framing shift does more to lower defensiveness than any amount of gentle tone.
"As part of a general check-up" places the question inside a familiar, low-stakes category, the same category as blood pressure or weight. It tells the patient this is medicine, not an interrogation.
"How are things going?" is deliberately open and low-pressure, rather than a closed yes/no question that invites a reflexive "fine." An open frame gives the patient room to say as much or as little as they want, and gives you a genuine answer to work with rather than a conversation-ending "no issues."
What to do with silence or a flat "fine"
Not every patient will take the opening. That is fine, and it is not a failed consult. A brief, low-pressure close after a "fine" or a shrug keeps the door open for next time: "No worries, it's always fine to bring it up later if anything changes." You have planted the fact that this is a topic your rooms are comfortable discussing, which matters more than getting a disclosure in that specific visit.
Making it a habit, not an event
The line above only works if it is used consistently, not reserved for consultations that already seem sexual-health-adjacent. Reserving the question for "relevant" presentations is exactly the pattern that keeps sexual health invisible in general practice, and it is the pattern the next article in this series looks at directly.
Want to rehearse this exact conversation before trying it in clinic? The Sexual Health Clinician course includes AI-simulated patients so you can practise the wording risk-free.
