Encouraging Health-Care Providers, And Ourselves, to Talk About Sexual Risks


See all of our coverage of STD Awareness Month 2013 here.

Published in partnership with the National Coalition of STD Directors (NCSD).

We have always known that health-care providers play a critical role in the health and wellness of their patients. Research has shown that patients who are told by their physician that they should “lose a few pounds” are much more likely to do so than if the provider never mentions their weight. In addition, many of us have a little anxiety when returning to the doctor if we haven’t met a goal that was previously discussed with us.

A similar concept is true in the area of sexual health. Some providers have avoided the discussion of sexual health with their patients because they fear it will present a level of discomfort for the patient or themselves. Moreover, some providers may feel that asking their patients questions about their sexual experiences would evoke feelings of judgment.

These sentiments are barriers to adequate health care and create missed opportunities. However, there is now a greater emphasis on providers engaging their patients in an open and truthful dialogue about their sexual behaviors. Research also suggests that, contrary to the traditional school of thought, the majority of patients want their provider to ask them about their level of sexual risk-taking. The emphasis on engaging patients in an accurate sexual history discussion is further strengthened by providers’ awareness regarding sexually transmitted diseases (STDs) that thrive in areas such as the throat and rectum. These areas may not be tested if the provider neglects to take a full sexual history and ask the necessary risk assessment questions.

To facilitate the discussion between providers and patients, my organization, the National Coalition of STD Directors, and the National Alliance of State and Territorial AIDS Directors have created a tool that serves as a guide for the rationale and taking sexual histories a routine. Providing Optimal Care for Your MSM Patients provides sample questions that providers can use with their clients. The questions focus on a patient’s partners, practices, past, and protection, or what counselors have coined the “four Ps”.

Although developed with men who have sex with men (MSM) in mind, the resource can be used for all patients and is easily adaptable to various settings. This is one of several resources that can affect a provider’s ability to engage the patient in important discussions about sexual health. In addition, it is imperative that patients insist they receive optimal care, which necessitates an honest and forthcoming dialogue about their risk. Patients should be prepared to give their provider any information that the provider may have missed. After all, no one wants a doctor to give them an eye exam if they’ve just broken their ankle. Having an open dialogue requires the provider to ask specific personal questions and necessitates that the patient answer those questions truthfully.

Let’s encourage our providers and ourselves to initiate a dialogue about our sexual risks. Some of us may have providers that routinely ask about partners and behaviors, and we applaud them, but others need may need a prompt. We should let our providers know how valuable their messages are to our overall health and wellness by informing them of any behaviors or changes that have occurred in our sexual lives. It’s the only way to ensure that we are getting the best level of care.

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  • Mercedes Allen

    “Although developed with men who have sex with men (MSM) in mind, the resource can be used for all patients and is easily adaptable to various settings…”

    Usually when I see this kind of statement, it’s a way of saying that a group doesn’t feel a need to do much to accommodate trans women (who are 49 times more likely than the average person to have HIV according to a recent study), and it’s up to us to submit to invalidating, erasing and alienating terminology as “men who have sex with men” (or else the onus is on us to imagine different terminology in place of “MSM”), in order to access services or participate… as a way of saying, “of course, we’re here to help you, we’re just not willing to change how we think about, dignify and act toward you.”

    I don’t want to project that onto your effort here, because there’s no indication if that’s your intent. But there’s also no indication that it’s not your intent, and in my experience, it has been the status quo with HIV research.

    So if you’re wanting to start dialogues, here’s one conversation-starter. Because I’ve run into this time and again, and have been frustrated with the apathy and indifference. I don’t know how I’m supposed to do HIV outreach, when all the tools I’m given are yet another microaggression.