When to See a Clinical Sexologist, and What You Can Talk About

Many people keep their questions about sex to themselves for years, because they don't know who to ask, are afraid of being seen as strange, or think "it'll go away on its own". I understand that feeling well. In my consulting room, the first sentence I hear most often is, "I didn't know if I could see a doctor about something like this." The answer is yes, you can, because sex is part of health, just like sleep or eating.

Who is a clinical sexologist?

A clinical sexologist is a health professional trained in sexology to care for sexual problems, physical, psychological and relational. Some are doctors, others are psychologists or nurses. At Dr. Kris Clinic, care is provided by a family physician who looks after sexual health. The advantage is that physical examination, blood tests and treatment planning can all happen in one place, rather than having to discuss the mind and the body with different people in different places.

The World Health Organization (WHO) defines sexual health not just as "the absence of disease", but as including the possibility of a sexual life that is safe, pleasurable and free of coercion. So the range of things you can talk about is wider than many people think.

What you can come in to discuss

• Sexual function problems in men, such as erectile dysfunction (ED), premature ejaculation, delayed ejaculation or being unable to ejaculate.
• Problems in women, such as low desire, difficulty becoming aroused, difficulty reaching orgasm, or pain during sex.
• Relationships and communication: mismatched desire, drifting apart after having children, or not being able to talk about sex with your partner. Sometimes this suits a couples consultation.
• Sexual orientation and gender identity: exploring yourself, coming out, or starting gender-affirming hormones.
• Sexual preferences or behaviour, such as kink, BDSM or sexual fantasies, when you want to understand whether they are normal and how to keep them safe.
• Behaviour that is starting to feel out of control, such as spending so much time on pornography that it affects work or relationships, or having urges that make you afraid you might harm someone.
• Anxiety after a risk, such as being so afraid of an infection that you cannot sleep, or testing again and again.
• People who work in the sex industry, such as sex workers or sex creators who want to look after both body and mind.

Sexual health

Men's function

• ED, premature ejaculation
• Delayed or absent ejaculation

Women's sexual health

• Low desire, difficulty reaching orgasm
• Pain during sex

Relationships

• Mismatched desire
• Can't talk about sex with a partner

Orientation, identity

• Self-exploration, coming out
• Gender-affirming hormones

Preferences and behaviour

• Kink, BDSM, fantasies
• Behaviour that is getting out of control

Worry after a risk

• Fear of infection, repeated testing

Signs it is time to get help

You don't need to wait until a problem is serious. But if any of the following apply, I recommend coming to talk:

1. The problem keeps happening for more than 3–6 months, or happens almost every time.
2. It causes you distress or embarrassment, makes you avoid sex, or makes you lose confidence in yourself.
3. It is starting to affect your relationship: frequent arguments, or your partner becoming suspicious.
4. You are buying medicines or supplements to take on your own without knowing the cause.
5. Your sexual preferences or behaviour are starting to make you or others unsafe, or involve people who have not consented.
6. You have stress, depression or substance use alongside sexual issues.

Importantly, many sexual problems are an "early warning" of other diseases. ED, for example, can appear years before heart disease or diabetes. So coming in is not only about what happens in bed; it is also a health check.

What happens at the first consultation?

I usually start by listening. You tell me in whatever way feels comfortable, with no need for medical words. Then I ask more about your general health, medicines, sleep, stress, relationships and risk behaviour. If needed, I examine you and order blood tests, such as glucose, lipids or testosterone.

Finally, we make a plan together. It may involve education, practising techniques such as sensate focus, adjusting existing medicines, medication as assessed and prescribed by the doctor, or follow-up sessions as a couple. In some cases I may refer you to a psychiatrist, gynaecologist or urologist if I think you would benefit more.

1. 1ListenTell it your way; no medical terms needed
2. 2Ask moreGeneral health, medicines, sleep, stress, relationships
3. 3Examine if neededPhysical exam, blood sugar, lipids or hormones
4. 4Plan togetherKnowledge, techniques, medicine as assessed by your doctor, or couple sessions
5. 5Refer if suitablePsychiatrist, gynecologist or urologist

Your information is confidential under Section 7 of the National Health Act B.E. 2550 (2007).

Confidentiality and no judgment

Your health information is confidential under Section 7 of Thailand's National Health Act B.E. 2550 (2007) and medical ethics. We will not disclose your information without your consent, except where the law requires it, for example when there is a serious risk to life or a child is in danger.

Your preferences, sexual orientation, occupation or number of partners are not things I will judge. My job is to help you be safe and happy as yourself. This principle is in line with the DSM-5-TR (2022) criteria, which make clear that a preference different from most people's is not in itself abnormal. It becomes a condition that needs care only when it causes distress or harm (read more: Paraphilic Disorders).

Symptoms that should not wait for an appointment: go to hospital now

• An erection lasting more than 4 hours.
• Chest pain, palpitations or feeling faint during or after sex, especially if you use PDE5 inhibitors together with nitrate medicines or poppers.
• Sexual assault: go to hospital within 72 hours for preventive medication and collection of evidence.
• An HIV risk within the last 72 hours: start PEP as soon as possible.
• Thoughts of harming yourself: call 1323 (Thailand's free mental-health hotline; Thai language, ask for English support) or 1669 for medical emergencies.

How Dr. Kris can help

At Dr. Kris Clinic, I provide consultations on sex and relationships both in person and online, for men, women and people of all genders, including looking for physical causes and making a treatment plan that fits your real life. If you are still not sure whether your issue is something "you can see a doctor about", just send us a message and ask first. We will help you work out where to start.