September is recognized as Sexual health month, specifically September 4th, 2021. As the days become shorter and nights longer, sexual awareness should become aforethought for providers with their patients. Whether it is “the Talk” with adolescents or with our seniors, you should be ready to have that conversation. In addition to asking about risk behaviors, a complete sexual history can also focus on and address any concerns about sexual function and satisfaction.
Obtaining a sexual history is just as important as the physical exam. A sexual history screens for high-risk sexual behaviors may identify sexual problems and is an opportunity to provide information and support to patients. Addressing the “5 P’s” is the best approach: partners (who, how many), practice (penetrative or not), protection for STDs (condoms, vaccines), past history of STDs, and pregnancy. Never make assumptions about the patient’s sexual orientation. Providers can also remind them that the answers will be kept confidential.
Starting the conversation about the need for the HPV vaccine makes a great ice breaker. The questionnaire, One Key Question, is another way to address sexual activity and the need for birth control. This questionnaire should be performed at every visit as sexual activity and risk for pregnancy and STDs is high among those aged 15-24. Self-swab collections of vaginal infections in patients less than 21 may not be as traumatic as using a speculum with just as sensitive results.
Just because the patients are not able to become pregnant anymore, do not count out sexual function. Erectile dysfunction and vaginal dryness can lead to major issues in their lives and may indicate other medical issues. Many want to discuss sexual issues but are waiting for the provider to bring it up. Hormonal therapies tend to improve the quality of sexual experience among seniors and transgender people.
It is important to avoid assumptions about patients’ sexual orientation or the gender or gender identity of their partners. Transgender people may be at any stage of the transition process when seeking care. When medically necessary, providers may consider asking about current anatomy and what, if any, hormonal or surgical interventions have been undertaken or planned.