For Teachers & Professionals

9 Principles for Sensitive Talks about Sexuality

Talking about sexuality might be difficult for a variety of reasons, like the perception of privacy around the topic and taboos about disclosure. In the medical setting, further barriers are provided by time and environmental constraints. One of the main concerns regards how one should talk about it. Here are discussed nine important factors to deliver a sensitive conversation, usually used with sexually abused survivors, but that can also be useful for the general population.

1. Respect

Respect is defined as regard for the feelings, wishes, or rights of others. It means acknowledging the inherent value of each individual, upholding basic human rights with conviction and compassion, and suspending critical judgment. The patient must feel listened to, validated and comprehended. A patient is not just a number or “one of the many just walking in”, they must be valued as a person. There must not be any kind of judgment in regard to the patient’s sexual beliefs, practices, preferences or doubts.

2. Taking time

Time pressures – a reality in today’s healthcare system – constantly challenge clinicians to balance efficiency with good care. Leaving sexual topics at the end of the discussion or not finding the time to talk with the patient, might lead to feelings of being depersonalized and devalued. For some, being rushed or treated like an object diminishes their sense of safety and undermines the trust between the health care provider and the patient. It may lead many practitioners to become exclusively task-oriented, questioning whether they can afford the time to really listen to their patients. It is important to remember that feeling genuinely heard and therefore valued is healing in itself, and in some cases may be the most effective intervention a clinician has to offer.

3. Rapport

Rapport is essential to every therapeutic relationship. Being warm and compassionate facilitates a good relationship. A good relationship fosters feelings of safety, leading to more disclosure and cooperation. Rapport is strengthened when clinicians are fully present and patient-centred. Coldness and distance have a negative effect on the relationship, but even an overly familiar style of communication may be perceived as invasive and even disrespectful. 

4. Sharing information

Knowing what to expect decreases anxiety for most people. This applies when a doctor has to explain the necessary visits and interventions, as well as the consequences of those interventions. As the term sharing information implies, it is a mutual process of information exchange in which both parties feel heard and understood. A place to begin is to ask patients what information they want or need and to invite questions. Asking for feedback from the patient is also important.

5. Sharing control

While for victims of abuse this theme is fundamental, also for other patients it may be helpful. Sharing control of what happens in the clinician-patient interaction enables individuals to be active participants in their own care, rather than passive recipients of treatment. In this way, the clinician works with, rather than on, the client. The patient must be given the opportunity to make choices about the treatments.

6. Respecting boundaries

When one has to address sexual topics, the provision of health care often requires clinicians to work in close physical proximity to patients and to seek information of an intimate nature. It may be helpful to start giving information about what one has to do and asking for consent, for example, “I’d like to address a topic which most clients refer to as important, would it be okay and helpful for you to talk about the possible effects on sexual functioning?”. Violation of a client’s personal boundaries may occur unintentionally. For example, a practitioner, when rushed for time, might ask very personal questions without previously establishing a rapport. By demonstrating respect for and sensitivity to personal boundaries, clinicians model healthy boundaries and reinforce patients’ worth and right to personal autonomy.

7. Fostering mutual learning

Patients must learn to become full, active participants in their own health care. Health practitioners instead need to learn about the health effects and sexual health effects of different diseases, and can see also the patients as further teachers. Most people are willing to disclose how they feel and what their needs are. Most people might be tolerant in tolerating missteps and the inevitable discomfort that comes with addressing difficult topics.

8. Understanding non-linear healing

Healing doesn’t proceed on a stable line. It has highs and lows and patients and clinicians must learn to tolerate the distress and frustration that comes with the seconds. Being understanding, compassionate and tolerant about oneself and toward the patients might strengthen the relationships between the clinicians and the patient and the relationship with oneself.

9. Demonstrating awareness and knowledge of the specific problem

Being aware of the problem and constantly trying to be updated on the latest research are fundamental tools. The patient thus may feel “in the right hands” and be more willing to trust and comply with the clinician’s indications.

REFERENCES

Schachter, C.L., Stalker, C.A., Teram, E., Lasiuk, G.C., Danilkewich, A. (2008). Handbook on sensitive practice for health care practitioner: Lessons from adult survivors of childhood sexual abuse. Ottawa: Public Health Agency of Canada.