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Sexual Health & Intimacy
Discussing Sex With Patients:
Factors That Ease Communication
Heather Hoffmann, PhD
Talking about sex is a common problem from the perspective of
both the physician and the patient. Most people, if not everyone,
would have some level of difficulty with this situation. In the
author's experience, when female patients talk about sex
with their physician, they are often uncomfortable and embarrassed
because it is such a personal issue. It's not just sex, it
is about their sex life and this adds to the pressure.
Part of the
problem is simply vocabulary. Patients, and occasionally physicians,
do not always have the correct words to use when addressing
sex. In the author's current research on this topic, she
found that people frequently do not have shared meaning for many
sexual terms.1 Physicians should not automatically assume that
their patients would know exactly to what they are referring when
talking about sex. They should try to be as precise as possible.
Compounding
the problem is the power dynamic inherent in a patient's
visit to her doctor. No matter whether male or female, nor how
friendly and down-to-earth his or her personality, the physician
is still the authority figure during an office visit and the patient
is less powerful in that situation. The physician must be supportive
while at the same time being careful not to assert control. It
is invaluable for the physician to recognize this dynamic and set
the patient at ease by helping her explain her concern. Without
putting words in a patient's mouth, it is helpful for the
physician to be knowledgeable about sexual terminology and provide
the patient with appropriate vocabulary when necessary (eg, clitoris
versus vagina). Offering the patient verbal prompts or options
can be extremely useful as well. For example, "So, does it
happen in this situation (maybe foreplay), or during that situation
(perhaps intercourse)?"
Patients are often advised to prepare
for a visit to the doctor by thinking about it beforehand, even
writing a script. Physicians
can help by having the patient express her problem while she is
fully dressed, either before or after the exam. Either way, sitting
and conversing in a normal setting, with the patient clothed, can
help the patient relax and speak more naturally. If the patient
seems comfortable, the physician can remain and listen, allowing
her to express herself more fully and "get everything out."
Physicians know the questions to ask. They might typically have
the patient describe the problem, talk about the onset, and ask
her understanding of the situation. They might also ask whether
she has done anything to correct the problem and what her expectations
are for the situation. What does she think the outcome might be?
If a patient realizes there is nothing medically wrong, her physician
can provide further support by validating the fact that she is
nevertheless experiencing a problem and making referrals to the
appropriate professionals. It is important to assess whether the
patient feels her physician is really addressing her needs. Questions
such as "Is this what you expected?" would be helpful
in this regard.
It is useful for physicians to be aware of the
sexual behavior of the patients they treat. They should be prepared
to counsel
patients on such commonly occurring issues such as sexually transmitted
diseases. As much as a physician might disagree with the types
of sexual behavior in which patients may be engaging, physicians
benefit by maintaining a professional distance. Patients may be
involved in situations that really need correcting, but in these
cases, perhaps the physician's best role would be to make
an appropriate referral to a sex therapist or counselor.
REFERENCE
- Hoffmann H. Talking About Sex. The Female Patient. 2003;28(2):39.
Heather Hoffman, PhD,
is associate professor of psychology, Knox College, Galesburg,
Ill.
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