Breaking the Stigma Around Intimate Health Care in Los Angeles
By Dr. Leonard W. Liang, MD | Urology | Downtown Los Angeles
There is a pattern I see regularly in my urology practice. A patient comes in and describes a problem they have been dealing with for two, three, sometimes five years. Somewhere in that conversation, they mention they almost did not make the appointment. They were embarrassed. They assumed the problem was just part of aging. They were not sure a doctor could help.
That delay has a real cost. Conditions that are straightforward to address early become more complicated over time. Moreover, the quiet suffering that fills that gap, the adjustments, the avoidance, the impact on relationships and self-confidence, is unnecessary in most cases.
Intimate health care in Los Angeles is something people put off more than almost any other type of medical care. The stigma around it is real, well-documented, and worth talking about directly.
Why Do People Delay Intimate Health Care?
The reasons vary, but the pattern is consistent. People feel embarrassed. They assume their symptoms are a normal part of aging. They worry about being judged. As a result, they wait.
A 2024 systematic review of healthcare-seeking behaviors among women with pelvic floor disorders identified stigma as one of the most frequently reported barriers to seeking care. Women described embarrassment, shame, and fear of judgment as primary reasons for delaying medical advice. This was true even when symptoms were significantly affecting their quality of life.
A study published in PLOS One in 2023 found that among women with urinary incontinence, shame had the greatest negative impact on treatment-seeking behavior. It outweighed other factors, including age and barriers to care access.
Men face a different but equally powerful version of this. According to a 2024 commentary from the Mayo Clinic Men’s Health network, men are less likely than women to see a primary care provider. They are more likely to avoid seeking care for an active health issue. Furthermore, they often will not make an appointment unless a partner encourages them.
The result is a significant gap between how common these conditions are and how rarely they get treated. That gap is not a reflection of how treatable the conditions are. It is a reflection of how hard it is for most people to bring them up.
What Conditions Are Most Affected by Stigma?
The conditions most affected by stigma in urology tend to fall into two areas: urinary function and sexual health. Both touch on things people find deeply personal. Both are also among the most treatable conditions in medicine.
Erectile dysfunction affects an estimated 30 million men in the United States, according to the National Institutes of Health. Most do not seek treatment. The ones who do often wait years. In the meantime, the condition frequently signals something else, such as vascular disease, hormonal changes, or metabolic issues. Waiting does not just affect sexual health. It can delay the discovery of a related health issue that matters for other reasons.
Urinary incontinence affects tens of millions of women and a significant number of men, particularly those who have had prostate treatment. It is one of the most treatable conditions in urology. It is also one of the most underreported. People buy pads, rearrange their lives around bathroom access, stop exercising, stop traveling, and quietly withdraw from situations they used to enjoy. All of this happens rather than mentioning it to a doctor.
Pelvic pain, painful intercourse, and changes in sexual sensation are similarly underreported across both men and women. These symptoms are often dismissed as psychological or hormonal, or simply something to live with. They almost always have an identifiable and addressable component when evaluated properly.
How Does Silence Make Things Worse?
One of the most overlooked consequences of stigma around intimate health care is that it does not just delay treatment. It compounds the problem.
For men with erectile dysfunction, the avoidance cycle is well-established. First, the condition causes anxiety. Then, the anxiety worsens the condition. As a result, the worsening condition increases avoidance. By the time someone comes in, they are often dealing not just with the original physical issue but with a layer of performance anxiety and relationship strain that built up over years.
For women with incontinence or pelvic floor dysfunction, the pattern is similar. Avoiding exercise to prevent leakage leads to deconditioning. Avoiding intimacy due to discomfort leads to relationship distance. Avoiding the doctor due to embarrassment allows a manageable condition to become more entrenched over time.
Research consistently shows that untreated urinary incontinence is associated with higher rates of depression, social withdrawal, and reduced quality of life. None of that is inevitable. Therefore, seeking care early is one of the most important things a patient can do.
What Happens When You Come In?
The conversation in the exam room is almost always easier than the one patients imagined having. This is something I hear regularly. People built up the appointment in their minds as something uncomfortable and difficult. In reality, it was just a medical conversation. No judgment. Just information, options, and a plan.
Moreover, the range of what is available has expanded considerably in recent years. Treatment options now include both non-invasive and minimally invasive approaches for most conditions.
For erectile dysfunction, options include oral medications, ViaSure shockwave therapy, injection therapy, and surgical options for appropriate candidates.
For urinary incontinence, first-line treatment starts with pelvic floor training and behavioral modifications. Medications and minimally invasive procedures are available when conservative approaches are not enough.
For menopausal women experiencing vaginal dryness, discomfort, or urinary symptoms, options include localized hormonal therapy and in-office treatments like MonaLisa Touch, which addresses the tissue-level changes driving those symptoms.
What all of these have in common is that they require someone to make the appointment first.
What Does Intimate Health Care at Dr. Liang's Practice Look Like?
Patients at Dr. Liang’s office are given the time they need. Appointments are not rushed. Questions are expected and welcomed. The goal is for every patient to leave with a clear understanding of what is going on, what the options are, and what realistic expectations look like for each one.
In addition, Dr. Liang conducts consultations in both English and Spanish. This matters for patients who find it easier to discuss sensitive health topics in their first language.
Furthermore, Dr. Liang has been named among the Top 3 Urologists in Los Angeles by Los Angeles Magazine. He trained at the University of Michigan, completed a chief residency at Kaiser Permanente Los Angeles, and holds a fellowship from UCLA. Learn more about Dr. Liang’s background here.
When Is the Right Time to Seek Intimate Health Care?
The honest answer is: sooner than most people do. If a symptom is affecting your daily life, your sleep, your relationships, or your self-confidence, it is worth a conversation with a urologist. You do not need to have reached a breaking point. You do not need to be certain it is a medical issue.
In fact, the earlier a condition is evaluated, the more options are available. Some conditions that require a procedure when caught late can be fully managed with behavioral changes or medication when caught early. Therefore, the cost of waiting is often higher than people realize.
The barrier to making an appointment is almost always smaller than it feels from the outside. Moreover, the relief of finally addressing something you have been managing quietly is often far greater than patients expected.
Book an Intimate Health Care Consultation in Los Angeles
If you have been managing something privately that a urologist could help with, this is a reasonable place to start.
Dr. Liang’s office is located at 1513 S Grand Ave, Suite 300, Downtown Los Angeles, CA 90015. Office hours are Monday through Friday, 9 AM to 5 PM. Call (213) 749-0662 or book online at leonardliang.com/contact-us.
