By Bianca Palmisano

You know this scenario: Your doctor is an hour late for your annual exam appointment. You’re quietly shivering, half-dressed in a paper gown, kicking your feet and anxiously trying to keep track of all the questions you want to ask your doctor. Maybe you just started having anal sex with your partner, and you’re worried you’re going to get some kind of infection if you’re not careful. The doctor sharply knocks on the door. Showtime.

The next ten minutes are an awkward, perfunctory checklist of bodily functions: date of birth, last period, birth control prescription, unexplained bleeding or pain?

Yes, you had sex two days ago – you don’t mention it was with a woman and the doctor doesn’t ask. You try to figure out where to fit in your questions, but don’t know how to start. The doctor begins your pelvic exam, and now you concentrate on ignoring where hands and instruments are going.

The doctor checks your chart, makes a few notes, says everything looks fine, and finally asks –hand practically on the doorknob—do you have any questions?

Your mind races. You can’t possibly start this conversation now. You’d have to correct too many assumptions, and the doctor’s already almost out the door. You shift awkwardly, stammer out a half-formed question about painkillers for your period. She rattles off some statistics, gives you a smile, and heads out the door.

What just happened?

Sound familiar? It shouldn’t, but for too many of us, doctor’s appointments aren’t actually serving OUR sexual health needs, but simply checking a box for our medical providers. These meetings are fraught with stigma, misleading assumptions, and for some of us, a sense of shame.  A recent study by Elisabet Skeppner showed that men with symptoms of prostate cancer waited an average of six months for penile cancer in the US to seek medical attention for their issues, primarily because they didn’t feel comfortable discussing it with their doctor.

Even if your concern isn’t as dire as a cancer diagnosis, chances are that you are not getting the care you deserve at the doctor’s office, hospital, or clinic you visit. Norms of the medical establishment too often prevent the kind of open and honest dialogue about sexual health necessary for ensuring patient wellness and stopping the spread of sexually transmitted infections (STIs).

As a patient, you can self-advocate. Whenever possible, write down the questions you want to ask ahead of time. Keep a file on your phone of any symptoms you’re experiencing and of any changes in your sex life since your last appointment. When you find yourself in the exam room, your question could be as simple as this: “I’ve recently started having anal sex with my female partner. Is there anything I should I know to do that safely?”

If your doctor responds with judgment and not advice, or if they can’t answer your question at all, you’ve just learned that you need to switch doctors.

Of course, in a perfect world, the burden of providing high quality care shouldn’t be on the patient to ask the right questions. But what’s a doctor to do? With the pressure of insurance forms, hospital rounds, and high patient loads, it’s getting harder and harder to spend the necessary time with patients to make sure that they get a full profile of their risk factors and current issues. And of course, many healthcare professionals feel just as awkward discussing sex as their patients do.

If you are doctor that needs some brushing up on this topic, it’s ok. Getting started is easy. Before you even start seeing patients, take a look at your annual exam protocol. Think about what assumptions you make based on the answers you get to your pre-exam questionnaire. For instance, when a patient tells you she is married, do you assume the gender of that partner? Do you assume she’s monogamous? Neither of these are a given.

Take some time to make your protocols more inclusive, and remember to ask ALL your clients about the spectrum of their sexual practices. There’s more to life than the missionary position.

More than anything, though, projecting an open and welcoming attitude about sexual health towards your patients goes a long way. If you’re not ashamed to bring up sex, your patients will have an easier time doing the same.

Whether you’re a doctor or a patient, if you want to learn about how to make sexual health conversations more inclusive, less threatening, and more productive, get in touch with Bianca Palmisano at Intimate Health Consulting (IHC).  IHC offers a full spectrum of professional trainings and mentoring, community education, and curricula development to support individuals in growing their capacity to address sexual health needs across the lifetime.

Citation:
Elisabet Skeppner , Swen-Olof Andersson , Jan-Erik Johansson, Torgny Windahl, Initial symptoms and delay in patients with penile carcinoma. Scandinavian Journal of Urology and Nephrology 2012 46:5 , 319-325