Discussing Sexual Health with Your Patients
Sexual health is an essential element of overall health and well-being, yet medical providers and patients often do not discuss this topic.
Many patients have sexual health questions and want your insight, but are hesitant about initiating the conversation. By asking all your adult and adolescent patients a few essential questions, you help to remove the stigma around discussing sex and normalize these discussions.
Refine your skills at facilitating such talks by practicing the following strategies:
Assess your own comfort by discussing sex with various patient groups and identify any biases that you may have. If you are uncomfortable talking about sex and sexuality, your patient will be too.
Make your patient feel comfortable by establishing a rapport before asking sensitive questions.
Use neutral and inclusive terms such as “partner” and posing your questions in a non-judgmental manner.
Avoid assumptions about your patient based on age, appearance, marital status, or any other factor. Unless you ask, you cannot know a
person’s sexual orientation, behaviors, or gender identity.
Try not to react overtly, even if you feel uncomfortable or embarrassed. Pay attention to your body language and posture.
Rephrase your questions or briefly explain why you are asking a question if a patient seems offended or reluctant to answer.
Ensure that you and your patient share an understanding of the terms being used to avoid confusion. If you are not familiar with a term your patient used, ask for an explanation.
Ask for correct pronouns or terminology when talking to a transgender patient. Use those pronouns and support that patient’s current gender identity, even if their anatomy does not match that identity.
Tips for Asking Sensitive Questions
Transition to asking sensitive questions. Let your patient know that you ask these questions of everyone. If a partner, relative, or caregiver is in the room, ask that person to step into the waiting room. He or she can be invited back after the examination.
“ I’m going to ask you a few questions about your sexual health. Since sexual health is very important to overall health, I ask all my patients these questions.
Before I begin, do you have any questions or sexual concerns you’d like to discuss? ”
Additional Questions to Ask
This chart contains questions that follow the Centers for Disease Control and Prevention’s 5P’s approach to taking a sexual history (Partners, Practices, Past history of STI, Protection, and Pregnancy Prevention/Reproductive Life Plan).
Do you know whether your partner has other sexual partners?
- In the past 3 months, have you had sex with someone you didn’t know or had just met?
- Have you ever been coerced or pressured to have sex?
In the past 3 months, what kinds of sex have you had? Anal? Vaginal? Oral?
- (For men who had sex with men: Ask about receptive anal sex, insertive anal sex, or both.)
- Have you or any of your partners used alcohol or drugs when you had sex?
- Have you ever exchanged sex for drugs or money?
Have you ever had a sexually transmitted infection (disease)?
- If yes: Which STI? Where was the infection? When did you have it? Was (were) your partner(s) treated too?
- Have you ever been tested for HIV?
- If yes: How long ago was that test? What was the result?
What do you do to protect your- self from STIs, including HIV?
- When do you use this protection? With which partners?
- Have you been vaccinated against HPV? Hepatitis A? Hepatitis B?
Do you have any desire to have(more) children?
- If yes: How many children would you like to have?
- When would you like to have a child?
- What are you and your partner doing to prevent pregnancy until that time?
- If no: Are you doing anything to prevent pregnancy?
- (Be sure to ask to female-to-male transgender patients who still have female reproductive organs)
Consider asking additional questions to better understand your patient’s level of risk, determine whether you need to recommend screenings or vaccinations, and offer appropriate counseling.