In the Healthy Heels blog, we’ve talked lots about communicating with partners about if and when one may engage in sexual activity, various methods for practicing safer sex,  talking with partners about STIs, and even the benefits of open communication around sexual health with your peers.

In honor of our “Let’s Talk About It, UNC” (LTAI – which we’re pronouncing, “la-tay UNC”) program this month, we ask: “what about talking to your healthcare provider about sex?”

Sexual health is a personal topic and oftentimes a very sensitive subject to talk about with anyone, so when you are asked sensitive questions in an exam room with a healthcare provider you’ve only met a few times, it can be a little uncomfortable.  This blog post is dedicated to de-awkwardizing those discussions: we’ll cover why it’s important to talk about sex and sexual health with a provider, expectations for some questions to anticipate, and questions you may want to ask.

Why talk about sex?

Sexual activity and sexuality are normal parts of our lives, and sexual health is an important part of overall health.  As such, it can be important for both the healthcare provider and patient to talk openly and candidly about sex and sexual health during clinical appointments or exams.

From a healthcare provider’s perspective, talking about sex during an appointment is a normal part of talking about one’s general comprehensive health behavior.  In most settings, a health care provider will ask about sexual activity routinely. IMPORTANT: This does not mean that talking about sexual behavior necessarily relates to a specific health concern or to you! Even if you have not previously engaged in sexual behaviors, or are currently abstinent for a variety of reasons, it may seem unrelated to talk about sex, but it’s important to remember that your sexual health as an integrated component of your overall health and wellness is related to other areas of health in your body and life.  Here are some examples:

•   Some nutritional supplements or drugs that you might take for infections may have an interaction with prescription contraception.
•   Some drugs may influence one’s sexual health – like anti-depressants influencing sexual libido.
•   Some drugs or supplements may change body chemistry and increase risk for yeast or other infections, particularly when regular sexual activity is involved.

Healthcare providers may also ask about the type of sex you’re having and the birth sex and gender of sex partners in order to give personalized screening and prevention recommendations. For example, if someone is only having oral sex with females, they may recommend using dental dams, but if someone is having vaginal sex with males, they may recommend using condoms.

From a patient’s perspective, clinical appointments are an opportunity to voice health concerns and get reliable, personalized information on sexual health questions or concerns.

Questions to anticipate

Providers frequently ask about the following during a clinical appointment:

• Sexual activity – whether or not you’ve had sex before
• Number of sex partners in some period of time (currently, in the last year, etc.)
• Types of sex (oral, anal, vaginal, other)
• The gender of sex partners (if you have specified a sexual orientation, this question may still be asked because a person’s orientation may not always correlate with their sexual partners)
• Use of contraceptives or barrier methods (hormonal birth control, condoms, or dental dams, for example)
• Testing history for HIV/STIs
• Appearance of symptoms such as rash, sores, fever, etc.
• Alcohol or other drug use around sex
• Pap history, including whether you have had an abnormal pap and subsequent tests
• Pregnancy history (if you have been pregnant before and whether those pregnancies resulted in a live birth, miscarriage, c-section, or abortion)
• Some providers will ask about sexual satisfaction too

It’s important to note that there are no right or wrong answers to any of the above, though it is important to be honest about your responses. Remember, everything you talk about with a provider is protected information.

Things to bring up or ask about

A provider may ask you lots of questions, but it’s important that you feel comfortable speaking up about sexual health during appointments as well! Even if a health care provider doesn’t ask questions about sexual health, you should feel free to bring up any of the following:

• Any changes since your last appointment (ex: appearance of symptoms, changes in lubrication or sensation)
• Problems or challenges using contraceptives or barrier methods (side effects, itching or burning with condoms, etc.)
• Results of any previous tests
• HIV/STI testing recommendations, if not already offered by the provider
• Any questions you may have about HIV/STI testing or prevention
• Concerns you have about any prescriptions suggested by your doctor (ex: negative experiences in the past, fear of side effects). If something affects your willingness or ability to start or complete a treatment, speak up!

Didn’t get all the answers to your questions? If you have questions about sexual health, you can always ask a trained sexual health educator at Student Wellness by using our confidential online C.H.A.T.S feature, or by emailing sexualwellness@unc.edu. You can also make an appointment to talk to staff in Student Wellness in a face to face  setting by calling 919-962-WELL.