News & Articles
Young people hanging out

Counseling patients about sexual health: Approaches for health care providers

Date: September 6, 2017

Family nurse practitioners (FNPs) are well educated to counsel patients about preventative health strategies and disease management. From proper nutrition to cancer screenings and beyond, FNPs can help inform patient populations about how to stay as healthy as possible and deal with illness, should it occur.

Sexual health is one area of health management that primary care providers should focus on. Evidence suggests, however, that too few providers initiate this dialogue with their patients.

Why is discussing sex and sexuality important?
As explained in a report published by the World Health Organization (WHO), good sexual health is critical to maintaining overall well-being. After all, sexuality can affect a number of areas of an individual’s life, including physical and emotional health. The consequences of poor sexual health are numerous and varied. From sexually transmitted infections (STIs) to sexual dysfunction, unwanted pregnancies and societal discrimination, issues of sex and sexuality can, in some cases, be physically or emotionally damaging.

To ensure better sexual health in patients, the WHO stresses that health care providers should approach issues of sexuality with an open mind and a positive attitude, promoting this view to their patients. A core component of a sex-positive approach is education. Patients with a deeper understanding of issues of sex and sexuality, as well as a positive understanding of sex will be more likely to experience a healthier sex life.

An article published by the Association of Reproductive Health Professionals underscored the importance of patient-provider communication in this context. The article explained that research has found that patients who do not communicate with their health care providers about sexual health issues are at a higher risk for STIs, including HIV. Conversely, patients who routinely communicate with their primary care physicians about sexual health are statistically more likely to enjoy better sexual health. Individuals who speak with their primary care providers about sexuality are more compelled to use condoms during intercourse, reducing the risk of STIs.

Patient-primary care provider dialog concerning sexuality is perhaps even more critical in light of a 2015 U.S. Centers for Disease Control and Prevention report stated that STI rates are on the rise for the first time in almost a decade. Cases of syphilis increased by around 15 percent between 2013 and 2015. The reported incidences of chlamydia and gonorrhea also rose during the same time period. The increase in gonorrhea cases was reportedly 5.1 percent, and chlamydia rates climbed by 2.8 percent.

Barriers to successful dialogue
Despite the importance of open conversations between primary care providers and patients regarding sexual health, providers commonly avoid having conversations about sexual health with patients, Roxanne Nelson, BSN, RN, explained in an article published by Medscape. Nelson cited a study that found that more than half of primary care doctors, around 56 percent, do not offer frequent sexual health counseling, wherein topics such as safe sex and a patient’s sexual history are discussed.

There are many reasons for this lack of conversation. The Association of Reproductive Health Professionals fact sheet stated some of these factors:

  • Providers report feeling as though there is not enough time in a typical appointment to have an impactful conversation.
  • Many providers feel embarrassed or ill-equipped to broach the sensitive topic.
  • Some providers worry about offending patients.
  • Many providers are concerned that they do not have enough education to lead a successful dialogue.
  • Primary care providers are not the only barrier to sexual health counseling. As reported in the Association of Reproductive Health Professionals fact sheet, when asked why they opted not to discuss sexual health with their primary care providers, a majority of patients — some 68 percent — cited embarrassment as the primary reason.

    Strategies for an effective conversation
    Although discussing sexual health has the potential to be uncomfortable for both patients and primary care providers, the undertaking still is imperative, nonetheless. Primary care providers can employ a number of strategies to facilitate a smoother and more successful conversation. Some of the most impactful approaches include:

    A couple walks together

      1. Creating a rapport
      The first step toward a meaningful conversation begins before the issue of sexuality is raised. As advised in guidelines provided by the National Coalition for Sexual Health, primary care providers should take steps to build a rapport with their patients. This step is paramount because individuals will be more inclined to discuss the topic of sexual health if they are in the company of a primary care provider with whom they feel they can trust and are comfortable with.

      2. Having materials on hand
      One way that primary care providers can enable patients to feel more comfortable and empowered when it comes to discussing sexual health is by promoting sexual health concerns throughout the clinical space. This method is especially important when encouraging young people to discuss the issue. Promotional strategies, according to the Adolescent Health Working Group, include having reading materials readily available in the waiting room, having signage that highlights patient-provider confidentiality and having information on where to source contraception.

      3. Critically evaluating personal attitudes
      As advised in guidelines from the National Coalition for Sexual Health, before initiating a sexual health conversation with patients, primary care providers should critically assess their own attitudes toward sex and sexuality, as personal biases and misconceptions can negatively influence conversations with patients. Primary care provider should ideally be able to answer a patient’s questions with complete honesty and without judgment, the National Coalition for Sexual Health guidelines noted.

      4. Not making assumptions
      It is critical for primary care providers not to make any assumptions while initiating discussions about sexual health. A common assumption that primary care providers make, according to Rita Lee, writing in an article published by the National Institutes of Health, is that all of their patients are heterosexual. The presumption of heterosexuality is often articulated via the language used in questioning. A primary care provider may ask a female patient if she has a boyfriend or husband, jumping to an assumption of heterosexuality.

      Lee details two ways that this assumption is problematic. First, if a primary care provider assumes a patient is heterosexual, the provider may then fail to provide the best sexual health counseling possible for the patient. Gay and bisexual men will need to be counseled about sexual health concerns that may be less applicable to heterosexual patients. The presumption of heterosexuality will lead to a missed opportunity in this regard. Second, a primary care provider’s assumption of heterosexuality can create distrust and resentment from patients, which in turn can derail meaningful conversations.

      The best way for primary care providers to avoid risk in this area is to always adopt neutral language, as noted in the guidelines from the National Coalition for Sexual Health. This approach means using gender-neutral pronouns when referring to sexual partners. It also involves asking if the patient has sexual relationships with either men or women, or both, or gender-neutral individuals. Primary care providers should never assume to know a patient’s sexual orientation from his or her outward appearance or behavior.

      It should be noted, however, that assumptions don’t just involve sexuality. A primary care provider may assume that a patient does not have sex because of his or her age, culture or disability status. An article by Dr. Folshade Omole et al, in The Journal of Family Practice found that the elderly have sex at a much higher frequency than is commonly assumed. The study found that some 30 percent of 80-year-old married men and women still engage in regular sexual activity, as do 90 percent of married adults between the ages of 60 and 64. For this reason, assumptions about who is or is not having sex should always be avoided. Primary care providers should work to broach the topic of sexual health with all patients, from adolescence through old age.

    Consider Bradley University
    Registered nurses can make a difference when it comes to educating patients about sexual health and other preventative measures by studying to become a family nurse practitioner. An easy first step toward this profession is applying to Bradley University’s online Master of Science in Nursing — Family Nurse Practitioner program. The online setting makes it possible for students to continue working while studying for their new career.

    Sources
    http://www.ahwg.net/uploads/3/4/5/5/34557719/sexual_health_toolkit_2010_final.pdf
    https://www.cdc.gov/std/treatment/sexualhistory.pdf
    http://www.arhp.org/Publications-and-Resources/Clinical-Fact-Sheets/Sexuality-and-Sexual-Health
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1070933/
    http://www.medscape.com/viewarticle/849345_1
    http://www.who.int/reproductivehealth/publications/sexual_health/defining_sexual_health.pdf
    http://www.mdedge.com/jfponline/article/81281/infectious-diseases/how-discuss-sex-elderly-patients
    https://nationalcoalitionforsexualhealth.org/tools/for-healthcare-providers/asset/How-to-Discuss-Sexual-Health.pdf
    http://onlinedegrees.bradley.edu/nursing/msn-fnp/
    https://www.cdc.gov/nchhstp/newsroom/2015/std-surveillance-report-press-release.html

    TO LEARN MORE ABOUT BRADLEY UNIVERSITY'S ONLINE DEGREES
    DOWNLOAD BROCHURE