As a medical student, Sexual Health can seem daunting at first. You need to ask a series of personal questions in quick succession, often followed by an intimate examination. But with the right approach, patients’ Sexual Health can be looked after smoothly and confidently, optimising their overall health and wellbeing.  

Potential challenges in a Sexual Health Consultation 

To best support our patients, it’s important to know some of the common barriers to communication we might face when looking after them.  

• Embarrassment– talking about Sexual health can feel intrusive for patients, and this can be worsened by the idea of discussing their personal life with a stranger. Patients may feel apprehensive about needing to have an intimate examination or to talk about ‘taboo’ topics like abortion or psychosexual problems. 

• Fear of judgement– patients may feel nervous that if they disclose something about themselves (e.g. being a Sex Worker or being LGBTQ+) the doctor looking after them may treat them poorly because of it. Some may also worry that details of their consultation may not be kept private. This can mean patients don’t share things which could influence their care and potentially lead to poorer outcomes for them.  

• Cultural attitudes and stigma– different cultures have vastly different beliefs, and this can particularly affect people in a Sexual Health context. Patients may be facing homophobic or transphobic discrimination from family or friends. They may have pressure from a religious perspective (for example not to have sex before marriage) and may face disapproval for accessing reproductive healthcare (termination of pregnancy, contraception or blood transfusion after a miscarriage, to name a few examples). 

• Internalised shame- aside from fear of others’ judgement, some patients may experience internalised stigma and shame. This can affect their healthcare journey in many ways; they might present with a problem at a later stage, feel uncomfortable disclosing certain details (e.g. how many partners they’ve had in a certain time frame or what gender their partners are) or be experiencing low self-esteem, low mood or anxiety. 

• Additional communication needs– patients may have hearing or sight loss, English may not be their first language, or they may have an Intellectual Disability. These are just some examples of situations where poor planning from a Clinician could make their patient feel disempowered and unable to communicate their needs.  

• Poor health literacy– our patients come from a wide range of backgrounds and may have vastly diverse levels of awareness about their health. Without proper health education and health promotion, they may end up experiencing far poorer long and short term clinical outcomes.  

So, how can we make things better? 

• Reflection- reflection alone or with others can be very helpful for identifying topics you may find hard to discuss with others, or any preconceptions or judgements you might have. Knowing this before seeing patients allows you to address them and approach patients care in a non-judgemental way. 

• Practice makes perfect! Take Sexual Health histories as often as possible (ideally from real patients). Getting familiar with the format of a Sexual Health history and finding your own style of asking questions will increase your confidence. If there are any topics you find embarrassing to talk about, practice asking about them the most! If you seem awkward or nervous to ask a question, your patients will feel awkward and nervous about answering it.  

• Communication aids– find out about whether your patients have any accessibility needs before their appointment and organise for them to be met. Some common examples are booking sign/foreign language interpreter, ordering braille leaflets, offering an extended appointment, or providing easy read information for those with Intellectual Disabilities or poor literacy.  

• Talk to everyone about confidentiality– in addition to the usual introductions and checking the patient’s details, I like to remind them that everything discussed in the consultation will remain confidential. This can help put people at ease and reassure them that whatever they say will not be shared with anyone outside the team looking after them. The one exception to this is if they disclose something that could mean they or someone else is in danger. It’s important to tell them this as well; the last thing you want is for a patient to disclose something and to then have to explain to them that you will have to share it (e.g. with Social Services or the Police) when you just told them that everything they say is kept private. Being open and honest from the start helps build trust and rapport, leading to better outcomes and increased patient satisfaction.  

• Communication is key! Check in regularly to make sure they’ve understood everything you’ve said so far. Rather than a closed question like ‘do you understand?’ I often find something more open like ‘I know that was a lot of information at once- what do you understand about what I’ve just explained?’ works better. This way, you can ensure you’ve provided enough information for patients to make informed decisions about their care. Using patient friendly language and giving space for patients to ask questions are also very helpful. 

• ‘Vocal Local’– patients will often come in very nervous for a procedure or examination (very understandable- these situations can be vulnerable and scary!). One of the most basic things you can do to ease anxiety is chatting to them as you go. Always make sure any examinations or procedures are explained clearly and in a way that each patient can understand. Offer to play their choice of music if you can, or chat to them about a topic outside of healthcare. It can be even more helpful to have a second person in the room to provide vocal local so you can concentrate and do the procedure smoothly and quickly. Distraction techniques like these can help patients manage nerves, discomfort and pain, strengthening their relationship with healthcare and hopefully meaning they’ll be less apprehensive about returning if they need to! 

I hope the tips in this article have been helpful- why not brush up on some theory next? Here’s a quick revision session on diagnosing, treating and tracing STIs! 

Written by Dr Gaayatri Sharma (F1)

With thanks to Dr Harriet Howard (ST1 CSRH) for reviewing and validating this article.

References and Resources

https://www.youtube.com/watch?v=_UT8hnPT84o&t=828s

Easy read leaflets image- Sexual Health Easy Read Booklets – Suffolk Ordinary Lives

Stigma and shame image- Substance Use Services Blog Series: Different Kinds of Stigma, Shame, and Self-Compassion – Deltassist Family and Community Services SocietyDeltassist Family and Community Services Society

Embarrassment in sexual health image- Survey Says! Lifting the Covers on Sexual Health | Curely

Poor health literacy image- Health literacy: how can we improve health information?

Vision and sight impairment image- Sensory Inclusion Service – SEND – Local offer

Communication image- Effective Communication in the Health Field by Brooke Panzarella | NHC