There’s no denying that it’s super-awkward to share sexual problems and concerns with your doctor. And as you wait in a scratchy paper gown for your physician, you may wonder how you’re going to get up the nerve. But as it turns out, if you don’t bring it up, your physician may never ask you about it.

Less than half of all ob-gyns regularly talk with their patients about sexual problems, according to a new University of Chicago study. And just over a quarter of these doctors probe into a patient’s sexuality or enjoyment of sex. These numbers worry lead study author Stacy Tessler Lindau, M.D., an associate professor of obstetrics and gynecology at the university.

COLUMN: Sneaky Health Issues That Mess With Your Sex Life

“Sexual problems can indicate an underlying health problem,” Dr. Lindau explains. For example, pain during sex could signal a fibroid in your uterus or an untreated yeast or bacterial infection—all of which warrant a doctor’s attention.

Sharing your most intimate sexual concerns with someone you barely know can feel scary, even humiliating. But when you let embarrassment stop you from opening up to your doctor, you put your health at risk.

When to bring it up: Talk with your doctor if you start having pain during sex, bleeding with sex, vaginal dryness, lack of desire or arousal or difficulty experiencing orgasm, recommends Lindau.

QUIZ: How Sexually Satisfied Are You?

If the thought of sharing those last two details with your physician makes you do a double take, Lindau has a response: “Female sexual function is part of overall physical function, and a change in your normal physical functioning is something that should be shared with your doctor in order to get the best healthcare.”

Talking points: You can make things less awkward by reframing your sex questions to make them feel less personal, recommends Lindau.

For example: If you want to know more about sex after childbirth, you can mention, “Some of my friends say that sex can hurt after having a baby. Is that true?” Or if you have concerns about not climaxing you can say, “My partner’s worried that I no longer get an orgasm from sex.” You can also bring up your lack of sexual desire by citing an article you read, saying “I saw something that said a lack of arousal could signal other problems—what do you think?”

It’s also okay to lump sex questions with general health issues. You can ask, “What effects could this medication have on my physical abilities?” and your doctor should automatically consider sex concerns in that mix. If he or she doesn’t, speak up—or you might want to consider seeing a different physician.

MORE: Eight Ways Sex Makes You Beautiful