A family friend recently had knee surgery. The procedure went well, and prior to leaving the hospital, the nurse gave him discharge instructions. He can walk, but he can't drive. He can return to work and resume certain upper body exercises next week, but can only perform lower-body exercises once he starts physical therapy in three weeks.

The detailed discharge instructions that he received made me think about a friend's comment to “Exit Only.” In that post, I answered a reader's question about how to broach the fact that her medical issues impede her from having anal sex with her boyfriend. In the comments section, a friend indicated that she wouldn't feel comfortable talking to her doctor about sex. I don’t think she’s alone in that sentiment.

In a recent study of female cancer patients conducted by the University of Chicago Medical Center, 42% wanted to talk to their doctors about sexual health issues. Only 7% of these women — who ranged in age from 21 to 88 with an average age of 55 — had done so.These patients didn't just want to talk about sex with their doctors. They needed to talk about sex with their doctors.

In thinking of those statistics, I believe that both the doctors and the patients are to blame. As adults, we all need to learn how to advocate for ourselves and our loved ones in a medical setting. (Illness is an unfortunate, but inevitable part of life.) And, health care professionals working outside of pediatrics should operate under the assumption that all of their patients are having sex and advise them accordingly.

“Anything that affects the female sexual organs will have repercussions on body image and on a woman's sex life," said Emily Hill, MD, a fourth year resident in obstetrics and gynecology at the University of Chicago Medical Center, and lead author of the study.

Peggy Brick, a renowned sex educator in her 80s, opens her speaking engagements with one question:

Why do we stop learning about sex around the time we start having it?

She explores how each age and stage bring with it different changes to our lives. Peggy then asks us to think about how we can address the physical and emotional ramifications of these changes in a way that continues to prioritize our need for intimacy.

I maintain that talking about these life changes and their impact on our sexual health is important. In some instances, that will mean having a conversation with your partner, a friend, a therapist or a clergyman. In others, that will mean having a frank discussion with your doctor.

Assuming that you have health insurance and have some choice about which doctor you see, select a physician with whom you feel comfortable. Evaluate the doctor's bedside manner along with his or her education, experience and location. If you can't imagine talking to your doctor about any medical issues that you have or potentially could have (including, but not limited to, urination, constipation, diarrhea, your period, changes in your testicles, a lump in your breast, your sex drive, and depression), then find another doctor!

If you are recovering from surgery or have an injury or health condition, the only way to find out what you are or are not allowed to do is to ask your doctor. And, when you ask, be specific. It's not always enough to inquire as to whether or not you can have sex since you can achieve orgasm by more than one means. For those of you who have sex toys or engage in anal sex, don't assume that a temporary ban on sex does or doesn't allow you to partake in those activities. Ask.

If you don't feel comfortable talking about medical issues directly with your doctor, you can:

1. Write your questions down on a piece of paper and present the paper to your doctor;
2. Ask your doctor for his or her email for follow-up questions; or
3. Broach the topic with a nurse, physician's assistant, technician or receptionist with whom you have a good rapport. That person will either forward your questions to the doctor or answer you himself or herself.

For those of you in the medical profession, it's worth inquiring about your practice’s policies regarding sexual health issues. If the practice appreciates the need for these conversations to happen, how can you respectfully convey that information to patients? (A brief comment during a consultation, a card or pamphlet in the waiting room, or a sentence on a patient form should do the trick.) When it comes to post-surgical or post-treatment discharge instructions, include helpful guidelines regarding sex. A one-line instruction now could save a patient from complications later.

Medical problems arise. Sex is a healthy and natural part of life. Isn't it time for us all to recognize how one impacts the other?

Have you talked to your doctor about a sexual health or sensitive medical issue? I'd love to hear from those who have, as well as those who haven't felt comfortable enough to do so.