Over the past four decades as an out-of-the-closet adult, with now countless numbers of primary care health providers during those years, I can count on one hand the number of times that a health provider (usually a physician) has initiated a conversation with me about sexual health.
In fact I can count on one thumb of one hand the number of times that a health provider has initiated a sexual history with me. And he was a gay medical school physician in Virginia whom I lost to Johns Hopkins.
All adult patients, but particularly patients who have sex with people of their same sex, need to take the lead in overcoming health providers’ sexual reticence.
Why It Is Important
There are two serious issues at stake here. First, your earlier history of sexual behaviors may have put you at risk for later illness, even if you usually practiced safer sex. For example, men who have performed oral sex on another man, or men who have been the passive partners in anal sex with a condom, run some risk of infection with human papilloma virus (HPV), known to cause cervical cancer in women and anal warts and cancers in men. For more information: http://www.cdc.gov/std/hpv/stdFact-HPVandoralcancer.htm Second, problems with sexual function or experience may be sentinels of other serious health conditions. For example, “erectile dysfunction” (euphemistically referred to as “ED”) may be caused by cardiovascular disease, diabetes, neurological disorders, medications, or substance abuse, among others. Your health care provider needs to know your past and current sexual practices.
It’s a Serious Problem
The professional research literature suggests that physicians’ and nurse practitioners’ reticence about sex and routine failure to take sexual histories with patients is widespread. Less than a third of physicians in a study of urban primary care settings routinely took a sexual history of patients, while better than half did ask about current sexual behavior but two-thirds would ask about sexual history only if a presenting medical condition warranted it (Wimberly, Hogben, Moore-Ruffin, Moore, & Fry-Johnson, 2006). Jayasuriyaa and Dennick (2011) point to a lack of sexual health education in medical and nursing schools. If you’re an older adult, you are even less likely to be asked about your sexual history or current practices. In one study of nurse practitioners only 2% of respondents said that they always conducted sexual history taking of patients 50 and older, while 23.4% never or seldom did (Maes & Louis, 2011).
How to Get Started
It’s your health and it’s your body, so you can’t afford to let someone else’s reticence or lack of formal preparation become an obstacle to your well being. You have to be prepared to initiate the conversation about your sexual history and sexual health.
The obvious first step is to ensure that you have a health provider who is both comfortable and knowledgeable about your sexual health concerns. If you don’t, you might consider changing your provider.
Second, you need to prepare yourself the way that your health care provider should be. The Centers for Disease Control and Prevention have a handy guide to providers, A Guide to Taking a Sexual History http://www.cdc.gov/std/treatment/SexualHistory.pdf with which you can make yourself better informed and better prepared for your next health care visit. It tells you what they should be asking you.
Play safe; stay healthy; and talk to your health care provider.
Jayasuriyaa, A. N., & Reg Dennick, R. (2011). Sexual history-taking: using educational interventions to overcome barriers to learning. Sex Education, 11, 99–112. doi: 10.1080/14681811.2011.538155
Maes, C. A., & Louis, M. (2011). Nurse practitioners’ sexual history-taking practices with adults 50 and older. The Journal of Nurse Practitioners, 7, 216-222. http://dx.doi.org.ezproxy.lib.uconn.edu/10.1016/j.nurpra.2010.06.003
Wimberly, Y. H., Hogben, M., Moore-Ruffin, J., Moore, S. E., & Fry-Johnson, Y. (2006). Sexual history taking among primary care physicians. Journal of the National Medical Association, 98, 1924-1929.