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Discussing Sex with Female Patients

To what extent do clinicians discuss sex with their female patients? The results of one study may surprise you.

Researchers from the University of Chicago Medicine recently reported that OB/GYNs don’t talk about sex nearly enough.

After surveying over 1,100 American OB/GYNs, the researchers found that while 63% did discuss sexual activities, many left the conversation at that. Only 40% asked patients if they had any sexual problems.

Fewer still asked about sexual satisfaction and pleasure. Most did not ask about a patient’s sexual orientation or identity. And about a quarter of the participants expressed disapproval of their patients’ sexual habits.

Sex is often hard to talk about. For many – providers and patients alike – it’s embarrassing, awkward, or even an invasion of privacy.

But it’s important. Sexual health and overall health are connected on so many levels. Sometimes sexual problems are signs of underlying physical conditions, like diabetes or cardiovascular disease. Sexual problems can also lead to strained relationships, anxiety, and depression – all issues that can interfere with a patient’s quality of life.

Today, we’ll share some tips on how to have sexual conversations with female patients. (Many of these tips apply to male patients, too.)

Explain why you’re starting the discussion.

Let patients know how assessing sexual health helps you help them. Explain that you ask similar questions to all your patients and that doing so is part of a routine medical exam.

If you can give specific examples to explain why you’re asking certain questions, do so. For example, you might say, “Many menopausal women find that their sex drive decreases. Is this a concern for you?”

Ensure comfort and confidentiality

Make sure the patient knows that the conversation is between the two of you (unless she has allowed you to share information with others). If you cannot ensure that the conversation will be confidential, explain this before you get started.

Consider the 5 Ps

The Centers for Disease Control and Prevention (CDC) has outlined the “5 Ps” of sexual health, which can guide the content of a conversation. The 5 Ps are:

·         Partners. Is the patient sexually active now? How many partners has she had in the last few months? Does she have sex with men, women, or both?

·         Practices. What kinds of sex does the patient current have (vaginal, anal, or oral)? What kinds has she had in the past?

·         Protection from STDs. What kind of protection does the patient and her partner(s) use? Do they use this protection consistently? If they don’t use protection, is she willing to tell you why?

·         Past history of STDs. Has the patient ever had an STD diagnosis? How was the STD treated? Would she like to be tested for HIV or other STDs? How about her partners? What is their STD status? Have they had STDs in the past?

·         Prevention of pregnancy. Is the patient currently trying to conceive? Is she using birth control? What kind?

Of course, these questions are only suggestions. You can adjust them to fit your own patients’ needs.

The answers, however, should yield some important information and “jumping off points” that can help direct your next steps. Does the patient need STD testing? What kind? Does she need a referral to counseling for relationship issues? Should you refer to her to a specialist? Does she need more guidance and education about safer sex practices? Can you suggest resources to help her?

Don’t judge.

Imagine you have a female patient who has had many sexual partners over the last year and does not always use protection. You’re concerned about her risky behavior, the possibility of STDs, and the risk of unplanned pregnancy. You wonder if her relationships are healthy ones and how her decisions affect her mental health.

Your first instinct may be to shake your head and say, “In this day and age, why aren’t you using protection? You should know better!”

Consider her angle. Revealing this information was probably difficult and scary for her. A judgmental response could make her less likely to follow through with testing and treatment.

Instead, be encouraging. Kindly suggest appropriate testing, safer sex, or other referrals, as appropriate. Let the patient know that you’re there to help.

Use inclusive language

Don’t assume that your patient is heterosexual. Some women have sex with only men; some have sex with only women. Some have sex with both men and women. So be careful not to alienate your patient or breach the trust she has placed in you by making assumptions.

Try using inclusive language. For example, instead of asking, “Do you have a boyfriend?” ask “Are you dating anyone?” You could also ask if your patient is in an intimate relationship and, if so, how monogamous that relationship is.

Ask if the patient has any questions

In this dialogue, the patient should have multiple opportunities to ask questions. It takes time to build rapport and trust, and she might not feel comfortable bringing up certain topics until later in the conversation. Or, something else might occur to her during your discussion.

Also let her know that you and your staff are available to answer any questions she may have after the visit.

Ask colleagues for help if you need it

If you’re nervous about taking a sexual history, ask a colleague for guidance. You might consider role-playing for practice. Keep up to date with sexual health news and research, especially the topics that most affect the populations you serve.

The more confident you are in discussing sex with your patients, the more confident they will be in sharing their experiences with you. Help them see that this conversation is an opportunity to work together toward healthy outcomes.