LISBON, Portugal — The scene at the Lisbon Congress Centre spoke for itself: a 200-seat room filled to capacity, with doctors standing in the doorway trying to listen from outside. The workshop “Practical approaches to sexual medicine: communication techniques for family physicians in real-life consultations,” led by Watcharaphol Alexandre Kamnerdsiri, MD, PhD, a general practitioner (GP) in Brussels, Belgium, specializing in sexual medicine and andrology, drew one of the largest audiences of the 25th World Organisation of Family Doctors (WONCA) World Conference 2025. The turnout suggested that family medicine is ready to confront one of its most entrenched taboos.

“I was born in Bangkok, studied medicine in Greece, and served as a medical officer in the Air Force. Later, I trained in several European countries and completed a PhD in sexual medicine and andrology. I also studied at MIT in Boston because I believe artificial intelligence (AI) will change how we practice medicine. For more than 15 years, I’ve been a family doctor in Brussels,” Kamnerdsiri told Univadis Italy, a Medscape Network platform. “My passions are sexual medicine and AI in healthcare. Every day I speak English, French, Greek, and Thai.”

He added that he practices in a neighborhood with a high proportion of immigrants, particularly from North Africa. This led to an unusual pattern: His practice became a reference point for men in the community, while his female colleague’s practice became the preferred choice for women. “It’s an unintentional but interesting segregation that inspired my PhD in andrology,” he said.

Barriers That Paralyze Communication

The large number of physicians keen to learn how to address sexual health was not driven by curiosity but by a training gap well documented in European research. A 2022 German study found that nearly half of GPs (48.1%) discuss sexual issues less often than indicated by clinical situations. In Austria, the picture was similar: Only 61.8% of hospital doctors said they address sexual health with patients at least occasionally in daily practice.

The paradox is striking. As Kamnerdsiri pointed out, citing a 2003 study: “While 90% of healthcare professionals agree that sexuality should be part of holistic healthcare, 94% report they are unlikely to discuss sexual health problems with their patients.” This disconnect renders a fundamental aspect of human well-being invisible.

To break the ice, Kamnerdsiri invited participants to respond to an interactive poll. Familiar barriers emerged: lack of time, fear of offending, and the expectation that patients themselves would raise the issue. Research has shown deeper dynamics as well. In Austria, the most influential barriers were “not feeling responsible for this health problem” and “expecting the patient to initiate the conversation,” followed by fear of offending and the physician’s own feelings of embarrassment or discomfort.

The numbers from Belgium, Kamnerdsiri’s home country, are equally telling: 84% of trainees reported encountering one or more barriers, with 77% citing “inadequate time” and patient discomfort as the main obstacles. A gender gap was also observed: Male doctors reported feeling more at ease discussing sexual issues, particularly with patients of the opposite sex, while female doctors more often highlighted the importance of formal training in sexual health.

BETTER Model: A Conversation Guide

“To navigate these difficult waters, we can draw on validated approaches,” Kamnerdsiri explained, introducing the extended PLISSIT model by Sally Davis and Bridget Taylor. This pyramidal framework begins with obtaining the patient’s permission to raise sexual issues, builds awareness of knowledge gaps, moves to “specific suggestions” based on a full assessment, and culminates in “intensive therapy,” meaning multidisciplinary care involving specialists, psychologists, and other healthcare staff.

“There are newer, more detailed models that can also be useful in general practice, even if they were not originally designed for it,” he added, presenting the BETTER model, developed in psycho-oncology. The acronym provides a structured guide for conversations about sexuality:

• Bring it up: Introduce sexuality when discussing other health concerns, reassuring patients that sexual health is a legitimate topic.
• Explain: Make clear that sexuality is a normal part of life and that quality of life, including sexual health, matters.
• Timing: Acknowledge that patients may raise concerns at any time, even when it seems unexpected. Reassure them that questions are always welcome.
• Tell: Inform patients that you can provide resources or refer them to additional sources if needed.
• Educate: Explain potential changes in sexual function linked to diagnosis or treatment.
• Record: Document findings and interventions in the patient’s medical record.

“Documenting the conversation is critical, especially today when many physicians use AI systems to take notes during consultations,” Kamnerdsiri noted. “If you don’t use a secure, closed system, what you write can end up in the data pool training the AI and may resurface inappropriately. In Europe, privacy laws are strict, but patient confidentiality — especially regarding sensitive data — must be protected everywhere.”

Words That Open Doors

The workshop continued with case discussions that challenged assumptions: a 52-year-old man with chronic knee pain who turned out to have syphilis; a 48-year-old woman with vaginal dryness and mood changes dismissed as “normal aging,” but who actually had genitourinary syndrome of menopause; and, in the most extreme case, a nun with abdominal pain who was found to be pregnant.

“Never assume anything about a patient’s lifestyle,” Kamnerdsiri stressed.

He shared practical communication strategies that energized the discussion: depersonalizing the topic (“The computer shows you’re in the age group where we routinely ask about sexual health”), framing messages in positive health terms, asking open-ended questions (“What do you think about relationships and sex?”), and using media references to break the ice.

“Let’s remember that the brain is the most important sexual organ,” he emphasized. “Any disruption of brain function can disrupt sexuality.” That is why sexual health assessments must connect mental health, medication use, trauma history, and social context.

The overwhelming turnout at the workshop reflected a growing recognition within family medicine: Talking about sexuality is not an “extra,” but a fundamental part of medical care.

“Sexuality is an integral part of health. It requires time, sensitivity, and normalization. Avoid prejudice and assumptions. Always document,” Kamnerdsiri concluded.

Kamnerdsiri disclosed having no relevant financial relationships related to this topic.

This story was translated from Univadis Italy.