Sexuality is a natural part of being human and nearly everyone has at least one sexual relationship during their lifetime. Despite the normalcy of human sexuality, sex is a difficult topic for many patients and health care providers to discuss. Unfortunately, this lack of communication contributes to sub-optimal screening rates for sexually transmitted infections (STIs) and HIV, low use of pre-exposure prophylaxis (PrEP) to prevent HIV infection, and inadequate treatment of sexual problems, even though good sexual functioning is a critical quality of life issue.
Improving sexual health communication between patients and providers is more important than ever. The CDC’s recent 2015 STD Surveillance report showed that rates of chlamydia, gonorrhea and syphilis are increasing after years of steady decreases. In 2015, there were more than 1.5 million reported cases of chlamydia alone, two-thirds of which were among young people aged 15-24. Despite this high burden, a 2014 study showed that physicians only spend an average of 36 seconds per visit discussing sex with teens.
The surveillance report also contains interesting data on where people are getting tested for these STIs. While STD clinics still provide valuable testing services, reduced funding has forced many clinics to close. More people are thus turning to private practice providers for STI testing. However, many private practice providers are ill equipped to address sexual health in a comprehensive way. Inadequate time, lack of training, competing priorities, and discomfort with discussing sex, particularly with their youngest and oldest patients, keep many providers away from this topic. However, without discussing a patient’s sexual history, providers cannot deliver good sexual health care. They cannot know whether to screen for STIs, to counsel about sexual behavior and risk reduction, or whether a patient is suffering from any sexual problems. Furthermore, because patients are unlikely to raise these topics on their own, it is critical that the provider initiate this conversation.
To help address the lack of patient-provider communication around sexual health, the National Coalition for Sexual Health recently released Sexual Health and Your Patients: A Provider’s Guide. The guide lists tips to enable providers to have sexual health conversations in a neutral, non-judgmental manner that will help patients feel at ease. To normalize these discussions while also streamlining the sexual history taking process, it offers a core set of essential sexual health questions providers should ask all of their adult and adolescent patients, as well as additional questions to elicit more information if necessary. The guide also includes a summary chart of recommended preventive sexual health services so providers can easily identify the services each patient needs.
Sexual health is an essential element of overall health and sex needs to be discussed in the healthcare setting, just as other behaviors and aspects of health are discussed. To learn more about the National Coalition for Sexual Health and its work, visit www.nationalcoalitionforsexualhealth.org.