The Sex Question You Swallow in the Waiting Room

What is the question patients almost never ask you directly, and what do they do instead? [gentle music] I try to normalize it as much as possible, and I say, "Listen, I believe sexual health is part of your overall health, and I think it can be a really important piece to discuss with your doctor or nurse practitioner.

If you're comfortable, we can talk about this.

If you're not, I'll leave the door open for you to come back at any point." And it's surprising to me, Michelle, sometimes even if I've had, like, a 15-year relationship with a patient, they'll sort of be like, "Mm.

Okay.

I don't wanna talk about that." But then, like, maybe in two or three visits they'll kinda be like, "Do you remember when you brought up that question about my sexual health, and I kinda didn't ask anything? But I actually do have questions." So I think sometimes as clinicians what's helpful is to just, like, keep an open door, know that it may not happen.

It may not happen even related to when you're seeing a patient for a sexual health-related issue.

So I think whenever I'm teaching my residents and medical students, I often will say, like, "Let's be opportunistic in some of the things that we're talking about." So if someone's coming in for their HPV or Pap test, let's use this as an opportunity to find out a little bit more if they would like to talk about things a little bit more in terms of their overall sexual health.

And so ask them questions around their sexual lives, and do they have pleasure? Do they have pain? We often focus on pain because we often look for pathology in healthcare settings rather than looking for-

for-The other side of things, which is like, do you find this enjoyable? And that's a big one that's hard to, like, kind of get around 'cause patients often, and even clinicians, we're not u- accustomed to asking about pleasure in our healthcare spaces.

But I think it's such an important thing to ask about.

So in the middle of, like, a HPV test or a Pap test, that's a really clear opportunity to whenever we're doing a routine sexual history.

So if we're about to ask somebody about, "Would you like to have STI testing done?" Clearly there's, like, a laid out algorithm that we have that we ask questions of, like, "When were you last sexually active? When was your last period?" If you're a menstruating individual, we have specific questions, and then I add on the other ones, right? Like around the pleasure and otherwise.

I also ask a specific question around, like, "Is there anything that you would like to talk about that you're wondering if it's related to your sexual health? But it may not be, but you're wondering about it." Like, let's start from a place of curiosity so we can sort of explore that and see what I can do to help.

Because what I have as a family doctor is a toolkit of options for my patients.

And so depending on what they're coming in with, I'm able to offer that.

And I actually have a physical toolkit in my office where I work with my patients and I say, "This is what lubrication looks like.

This is what a dilator looks like.

This is what a toy looks like." I prescribe vibrators in my practice because some insurance plans cover it as a medical tool, right? So this is where you can do these things and actually open up this conversation.

And I realize that this is not necessarily the standard that happens.

I just really find it in a space that has offered me opportunity to speak to my patients in a way that, one, often they're surprised because they're like, "Oh, I didn't...

I thought you just talk about blood pressure and other things." [laughs] But this is an important part of our patients' lives, and I really think that we need to shift the narrative from, like, sexual health being a separate thing to our overall health, to, like, really seeing it as a part of our entire healthcare journey.

What kinds of sexual health worries do people wait too long to bring up?

So I think pain is a really big one that comes up because we normalize pain often, especially in our patients.

I do a lot of work in perimenopause and menopause, and as we age, there's sort of this thought that we stop being sexually active, for example, and so pain is very common, especially because of the symptoms that happen postmenopausally and in something called genitourinary syndrome of menopause, where there's changes to the body and it leads to dryness and discomfort during intimacy.

So I think pain is a really big one.