Lets Talk About Sex

Image Courtesy of ShutterShock.

Image Courtesy of ShutterShock.

Ladies: Are you able to talk to your gynecologist, or other health care providers, about problems “down there?”  Many women do not feel comfortable speaking with their doctors about sexual topics, either because they’re afraid of being judged, or because they’re afraid of embarrassing their doctors. Apparently, doctors also do not feel comfortable speaking about this topic. A 2012 University of Chicago survey of more than 1,000 obstetrician-gynecologists found that less than half of the doctors asked their patients about sexual problems. Only two-thirds of them ask how sexually active their patients were. Approximately 25% of them, doctors with strong religious beliefs and some international medical graduates, disapprove of their patients’ sexual practices.

Doctors, medical students, and others who work with women’s health need training on how to speak openly with women from diverse backgrounds. Every woman would feel enough trust in their doctor, as well as comfort with their own sexuality, to ask important, specific, and direct questions that affect her health.

It is important that doctors provide a safe space so that women feel comfortable seeking advice regarding sexual problems and that they’re able to share their sexual history with, as well as ask for sexually transmitted infections (STI) and HIV testing. In addition, some sexual issues can signal larger health problems, such as thyroid disorders, depression, STIs, hormonal changes, or issues with medications.

Even more than these awkward “taboo” issues, there are several other serious topics that women should feel comfortable discussing with their doctors, including: intimate partner violence, birth control sabotage, intimidation, threats, and the unwillingness of their partners to use birth control. Health care providers need to be able to create a plan of care that emphasizes confidentiality, offers resources for addressing sensitive issues, and empowers patients to engage in safer sex practices—including helping them choose a contraceptive method that cannot be sabotaged or even detected by an intimate partner. Providers need to be at the forefront of the women’s health movement. By failing to do so, they leave countless at risk for STIs, unintended pregnancy, and potentially death. Women already battle the social stigma of being “sexual,” as well as attacks by religious institutions, and a lack of access to affordable birth control. Without support from health care providers, women will be unable to take control of their sexual agency, health, and reproduction.

HIV/AIDS continues to disproportionately affect women of color in the U.S. at alarming rates, particularly African Americans and Latinas. Approximately 1 in 32 African American women and 1 in 106 Latinas in the United States will acquire HIV in their lifetime, compared with 1 in 562 White women.

Young girls of color also lack open sexual dialogue with health care professionals. As a result, the rates of HIV and STIs, as well as unintended pregnancies, is disproportionately high among youth of color in the United States—particularly among African Americans and Latinas—as social, economic, and cultural barriers limit their ability to receive accurate and adequate prevention information. It is important that doctors encourage not only abstinence, which is not a realistic outcome, condom use, HIV/STI testing, and treatment.

Lesbian, Gay, Bisexual, Transgender, and Queer (LGBTQ) people also have unique sexual health needs, including: provider bias, limited access to quality health care, a lack of accommodations for queer women and non-English speakers, higher rates of cervical cancer, and lower rates of regular sexual health care. LGBTQ women of color also face racism, homophobia, scare tactics, divisive cultural politics, employment discrimination, stigma, and the “gendering” of health services, which reduces their ability to receive quality health care. Most providers do not ask about sexual orientation or gender identity, nor are they trained in the unique health care needs of LGBTQ people or their health disparities. As a result, they are not screened for issues that disproportionately affect them and they’re put further at risk.

Furthermore, immigrant women are less likely to receive adequate reproductive health care, including cervical and breast cancer screening and treatment, family planning services, HIV/AIDS testing and treatment, accurate sex education and culturally and linguistically competent services.

It is a two-way street—it’s important that medical students and doctors receive training so that they’re empowered to provide a safe space for all women and girls to address sexual health issues; and it’s important that women and girls jot down questions before their appointments and then frankly say to their health care provider, “I know this is not the most comfortable topic, but can we please talk about sex? Or, can you refer me to someone who I can speak with?”

By Samantha Erskine

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2 Comments

  1. Gia

     /  March 30, 2015

    This is such an important, current issue — one that I feel like almost never gets talked about!

    Yes, discussion needs to begin within the community. Young women often take their social cues and form opinions based on their peers; this communal input colors everything from the way they should wear their hair to the sexual partners they should have. We learn by imitation, so it is vitally important that each of us take every opportunity to have an open, honest conversation — about what we like, what we want for ourselves, and especially about sex.

    That said, it is embarrassing that trained physicians should feel too embarrassed to ask their patients about their sexual practices. I think to say that 25% of them judge their patients is an inaccurate statistic; that number is probably closer to 100%. It is human nature to differentiate and judge. The difference is that a woman should be able to trust that her doctor will act in her best interest to preserve her health and decrease her risk of living a shortened life. That means asking a woman (and anyone, really) basic questions to determine whether she is at greater risk of exposing herself to the plethora of STIs out there. Failure to do so is a disservice to the patient and a denial of the hippocratic oath.

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  2. Rosemarie

     /  March 31, 2015

    Reproductive health in America is a large issue that is often overlooked and definitely needs to be addressed at the community level as well as increasing training and education among providers. Health care providers need to have the appropriate training on issues related not only to race and ethnicity but also on the disabled and LGBTQI population. Finding a model that encompasses how to approach these diverse populations while still providing quality care is a constant challenge within the healthcare system.
    Many of these challenges can be addressed through collaborations with community based organization that work with these particular groups. Often times women within these minority groups may face various others social barriers and challenges that may can prevent them from obtaining adequate healthcare. By addressing their needs from a holistic approach and encouraging open dialogues between healthcare providers and patients we can work on closing the gap in health disparities among minority populations.

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