Appearing in Medscape this week is an important message from the Centers for Disease Control and Prevention (CDC). Gail Bolan, MD, of the Division of Sexually Transmitted Disease (STD) Prevention, speaks about the importance of skilled sexual health interviewing and teaching on the part of the medical provider. Her message is directed towards a provider interviewing an adolescent, however, her points are very relevant for all of us in health care who wish to ask respectful and meaningful questions regarding a patient's sexual health.
Dr. Bolan recommends that we avoid assumptions about the patient's sexual orientation, behaviors, or number of partners. Using gender-neutral language may be important, and you can take cues from the patient in order to use consistent language. Being nonjudgmental and supportive is also important, and we may need to become more comfortable ourselves with topics related to sexual function.
The article continues to recommend using the "5 Ps" when taking a sexual history. The "Ps" stand for: partners (learning the number, sex, and current sex partner history), practices (does the patient engage in anal, vaginal, or oral sex), protection from STD's (condom use or use of other forms of birth control), past STD history (the patient's or the partner's history of STD), pregnancy prevention (is the patient trying to get pregnant or needing to discuss birth control).
The above description of sexual history may be most relevant for a medical provider for the purposes of ruling out disease risk and need for further care. However, many of these questions are very important for the pelvic rehab therapist to be able to ask. For example, although we use standard precautions, if a patient is dealing with a current STD, internal treatment may be inappropriate for both the patient and for the therapist. If a female patient is trying to get pregnant, certain therapies are contraindicated, so it is helpful for us to know that we should check in with patient status.
It is always appropriate to use language the helps a patient feel most comfortable, and this includes avoiding assumptions about marital status, gender of a patient's partner, and sexual behaviors in which a patient engages. Many of us were not prepared for having such intimate discussions with our patients, and it can challenge our own belief systems and create feelings of discomfort or uncertainty. It is helpful to have resources including mentors or colleagues to discuss these issues with when they do occur.