Sex: Why You Need To Be Taking It More Seriously

Most people find talking about sex really difficult and embarrassing, and healthcare providers are no exception to the rule. It’s no surprise that we often avoid the subject entirely, as it is considered to be a sensitive and potentially awkward conversation – especially if you don’t know the person you’re talking to, as is the case with healthcare providers. But learning about the sexual behaviour of patients is becoming a vital part of the process now, as part of creating a high quality, patient-focussed and more efficient form of health care. In a survey of 500 men and women over the age of 25, 85 per cent of the participants expressed an interest in discussing sexual topics with their doctor, although 71 per cent stated that their GP would most likely dismiss their concerns. The knowledge a GP has of their patient’s sexual history gives them the opportunity to educate and counsel them about STDs, HIV and viral hepatitis. But without this knowledge, they’re unable to know which tests and vaccinations are needed. Such diseases are mostly ‘silent’ and unnoticed so they can lead to more serious illnesses, as well as spreading to partners which increases the prevalence of the disease within the community. So when a GP doesn’t ask the question about sex, they aren’t just affecting the patient themselves – they’re also affecting the health of the people in the wider community as well. The new initiatives aim to greatly lower the risk of HIV and other sexually transmitted diseases, which have risen significantly in recent years.

 

Studies show that gathering information about a patient’s’ sexual behaviour can be done in a very simple and effective way by asking three basic sexually-related questions regarding ones behaviour and risk:

• Have you been sexually active in the last year?


• Do you have sex with men only, women only, or both?


• How many sexual partners have you had in the last six months?

 

These questions help to give a really broad sense of a person’s sexual behaviour and their level of risk, which makes it easier for a GP to tailor a deeper discussion about their needs. It’s vital that GPs ensure that they assure their patients that this is something that they do with all their patients so that the individual doesn’t feel as though they are being singled out for their behaviour. This is especially the case for high-risk populations who have been marginalised or oppressed historically, such as transgender men or women, homosexual men and women, groups at high risk for HIV and STDs, and viral hepatitis. In order to help these groups, it’s important that their sexual history is described to their GP. This means asking questions such as:

• How often should people be tested for HIV and STDs?


• What vaccinations should be offered to whom?


• Why are some MSM at higher risk for HIV and STDs?

 

It may take time for GPs to feel comfortable speaking to their patients about sexual matters, their health, identities and desires. But once this becomes more routine, the stigma surrounding sex and sexual behaviour will also become less of an issue. This is important both in and out of a health care setting to make honest conversations about sex a more common occurrence. There are plenty of services available to provide education and help to people who need advice on sexual matters, as well as STD testing and advice on unplanned pregnancies – if you’re concerned, you should speak to your GP who can offer more information on the services in your local area.

Categories: behaviour, health care, healthcare, healthcare providers, high risk, Sex, sexual, sexual behaviour, sexual history, sexual matters, STDs, viral hepatitis

Halt "don"t ask, don"t tell" in doc"s office

By Katie Kerwin McCrimmon

An informal “don’t ask don’t tell” policy in doctors’ offices is preventing lesbian, gay, bisexual and transgender patients from getting optimal health care, according to a report released today called “Becoming Visible.”

Conducted by the LGBT advocacy group One Colorado in concert with the Colorado Medical Society and the Denver Medical Society, the report finds that most doctors are comfortable caring for LGBT patients.

Yet, most don’t ask about sexual orientation or gender identity. At the same time, many LGBT patients believe that medical providers may be biased against them and don’t speak up. The lack of frank discussions between providers and patients can undermine care.

Dr. Mark Thrun of Denver Health: ““We doctors are afraid to offend our patients. So nobody talks about sexual health.”

Experts say it’s up to doctors to break the silence.

“Providers need to recognize that they hold the power in these relationships. The onus is on the medical community,” said Dr. Mark Thrun, director of HIV and STD prevention and control at Denver Health and a board member for One Colorado. Thrun, who is gay, helped conduct the research for Becoming Visible, which included extensive surveys with about 400 doctors.

“We doctors are afraid to offend our patients,” Thrun said, “so nobody talks about sexual health.”

In the clinic where Thrun treats people for STDs, he said he asks all his  patients about their sexual orientation and gender identity, but that’s not standard among doctors, especially among older providers.

And Thrun said studies show doctors are the least comfortable among medical providers in talking about sexual health. Nurses, social workers and nurse practitioners seem to be more at ease asking relevant questions.

Ashley Wheeland, health policy director for One Colorado, said the report helps triangulate the gap between patient views and physician perspectives.

The new report “Becoming Visible” finds that doctors aren’t always comfortable asking patients about their sexual preference or gender identity. Without this information, doctors can’t give optimal care. (Photo by Mark Manger. Courtesy One Colorado.)

“There is a disconnect in how LGBT feel in our health system and how physicians feel they’re treating LGBT people,” Wheeland said.

Doctors now overwhelmingly recognize that sexual orientation and gender identity are vital to health and that’s a huge change from just 10 years ago, said Wheeland.

Better training for doctors and simple practices to make LGBT patients feel more comfortable can make a big difference in overall health, she said.

A previous One Colorado report called Invisible http://www.one-colorado.org/news/lgbt-health-report/ surveyed about 1,300 LGBT people in Colorado and found that patients are more likely to get an array of helpful preventive services from flu shots to dental care and annual checkups if they have a good trusting relationship with their providers and believe that they are receptive to working with LGBT patients.

LGBT patients are also at higher risk for some health problems including HIV, heart disease, breast cancer and depression, so knowing their sexual history is vital.

“If I don’t know that my patient is LGBT, I may not be asking the next questions that might drive screening tests or future referrals,” Thrun said.

“And as a doctor, I need to know who my patients are, who is going to twist their arm to get them to take their meds, who takes care of them at home, who helps them stay healthy. Whether straight or gay, I need to know who your support systems are,” he said.

The major findings and recommendations from the report include:

• Physicians report high levels of comfort in serving lesbian gay and bisexual patients. Fewer providers are comfortable serving transgender patients, who are the most stigmatized among LGBT patients.


• Physicians care about how they are serving the LGBT community and recognize that sexual orientation and gender identity are vital factors in overall health.


• Physicians and other providers should ask patients about sexual history and preferences.


• Subtle signs of support for LGBT people — like rainbow or equality symbols — can let patients know they are welcome. The survey results show few providers have policies in place to show that they are LGBT-friendly even though simple changes to forms or visual cues could go a long way in helping LGBT patients feel more at ease.


• Colorado physicians are more comfortable when patients disclose sexual orientation or gender identity and are less comfortable asking patients directly.


• Physicians generally believe they are already treating their LGBT patients equally, but not all LGBT patients are getting the care they need.


• Primary care physicians were more likely than specialists to acknowledge the role that sexual orientation and gender identity may play in overall health.


• Younger physicians and those in urban areas offer more LGBT-friendly policies than those in rural areas.

Along with the report, One Colorado and the report partners also created a continuing education program for physicians on how they can better care for LGBT patients. (Click here for more information.)

Categories: denver health, gender identity, lgbt friendly, lgbt patients, lgbt people, medical providers, sexual health, sexual history, sexual orientation

STI Testing: The Who, What, Where, When and Why

Getting tested for sexually transmitted infections (STIs) is an absolutely vital part of sexual health, both for the sake of your wellbeing and that of anyone you come into sexual contact with. When you have an STI, there are often no symptoms to alert you to the fact that you have been infected, meaning that you could be passing it on to others and letting your own wellness deteriorate without even realising. Therefore, you need to take control of your health by using condoms and getting tested for STIs.

 

Once you begin having sex, it’s a good idea to have regular sexual health check-ups. Whether you have multiple sexual partners or you’re starting a new relationship, you and your partner need to be tested – and recently tested – before you stop using condoms. If you have had unsafe sex, or some of the symptoms of STIs such as pain, discharge or itching in your genital area, you should consult your doctor. Most STIs are treatable but, if left untreated, you may end up experiencing some unpleasant symptoms and even long-term problems such as infertility.

 

Having a test is simple and painless, and easily available from your local GP, family planning clinic or sexual health clinic. There is no single test to detect all STIs, which means you’ll have to have a chat with your doctor about your specific symptoms. Your doctor will also want to discuss your sexual history, so be prepared to talk about that. It can be tempting to lie about or paint a rosier view of your sexual history, but you need to be completely truthful. Even if you’re embarrassed, your doctor will need to use the information from your conversation to work out the tests you should have.

 

If you have an STI such as gonorrhoea or chlamydia, a simple test will be able to pick up the STI soon after you have been infected, even if you haven’t shown any obvious signs or symptoms. However, other STIs – like HIV – won’t show a positive result as quickly and your doctor will advise you on when to be re-tested. As a general rule, the testing will involve a blood sample, urine sample, swab or just a physical examination – depending on which STI is being looked for. Lots of places provide low-cost or even free STI testing for young people, but you’ll need to ask when you make your appointment, and maybe look online for the most price-efficient option in your local area. The cost also depends on the tests required.

 

If you’re worried or embarrassed about someone else finding out about your STI test, you don’t need to be concerned. Your doctor will be legally obliged to keep information that you give him or her confidential, regardless of how old you are. The only exception would be if you are under the age of 16 and an issue of your safety arises. However, the results of STI testing are completely confidential. The results are stored in your medical files and sexual health clinics normally keep separate records to the files kept by your doctor or local hospital. That said, if you do test positive for an STI, you absolutely need to tell your recent sexual partners so that they can be tested too. One of them may have passed it on to you unknowingly, and may be doing so with other people. To help minimise the embarrassment of getting in touch with former partners, many clinics will provide you with letters or other ways to ease the process.

Categories: Costs, doctor, sexual, sexual health, sexual history, sexual partners, sti testing, STIs, Symptoms, tested, Testing