For Teachers & Professionals

Addressing Young Women's Sexual Health in a Non-Judgmental Way

Young women demonstrate a persistent lack of knowledge about safe sexual practices and engage in sexual behaviour that puts them at risk for sexually transmitted infections and unplanned pregnancies. Traditional expectations of femininity and the female sexual role characterize women as passive sexual gatekeepers. Within this paradigm, women do not need to, or even shouldn’t need to, be knowledgeable about sex. As a result, one may expect that young women who internalize traditional gender ideologies may not be as likely to seek out important information on sexuality, as it does not fit with their prescribed role as passive recipients of sexual interest and desire. Sexual health knowledge can be beneficial for many aspects of women's sexual functioning, beyond preventing undesirable consequences. Sexual health knowledge is also linked to increased sexual assertiveness in young women, expanding the need for sexual counselling. 

Many young people, and in particular young women, are reticent to talk to their physicians about sexual behaviour because they typically consider the information to be private. Exacerbating this issue is the fact that many physicians are also uncomfortable discussing sexual topics with their patients.

What can physicians do? They can learn to become competent in their verbal and non-verbal communication. Here are some tips.

1. Competent Use of Checklists

At times, a physician may use a checklist to guide communication with a patient. However, some participants noted that the use of a checklist could also be limited. It is important to balance the use of a checklist while also creating the space for a patient to open up about her feelings. Doctors shouldn’t forget the importance of open and targeted questions.

2. Transitional phrases

Transitional phrases are often used to prepare the patient for what’s coming next and include phrases such as “I am now going to ask you questions about your previous health.” Participants often preferred transitional phrases to ease into communication about sexual behaviour. This preference may be the result of the patient’s belief that awkward transitions indicate a physician’s discomfort and serve as a catalyst criterion for a closed privacy boundary. Other examples of transitional phrases are: “I ask all my patients this”, and “Some usual concerns also are…”. It must be remembered that when a physician initiates communication about sexual behaviour, there is an underlying message that the discussion is socially acceptable. 

3. Avoid answering your own question before the patient can answer

There is a counterproductive pattern of physician communication, wherein the physician simultaneously asks and answers questions in a monologue. This communication strategy signals a physician’s discomfort and desire to change the subject and creates a boundary for the patient. An example is: “Let’s make sure you’re not pregnant. Are you sexually active? No, you practice safe sex, you’re not pregnant at all.”. This communication pattern of asking and answering questions for the patient signals what answers feel like the “correct,” or “desirable” answers. Not only does this style of communication stymie the patient’s response, but it also may reinforce patient fears about the deviance of their behaviour, pushing the patients to not further ask or search for help for fear of being judged.

4. Remain human

How a doctor thinks about the patient (i.e. as a human, or alternatively, as a simple medical diagnosis) orients communication with a patient and serves as a catalyst criterion for either opening or closing a privacy boundary. The patient must feel treated as a person, as a human being with emotions and thoughts. For two minutes, sit down and think, “What is this person feeling? Why are they feeling like this? How would I feel if I was going through this?”. By integrating the understanding of the patient’s unique experiences into the interpretation of a patient’s health concerns, a physician can create a communicative space where the patient feels they can open up about sexual behaviour. 

5. Non-verbal competencies

A physician’s non-verbal communication played an important role in whether the participants felt comfortable opening up. Women describe important non-verbal behaviours to be eye contact, body language, and tone of voice. They do an interpretation effort, that is part of an effort to evaluate the level of physical discomfort and communication competence, and this gives information if opening up on privacy concerns or not. These results link the importance of non-verbal behaviours and patient privacy decision-making. 

Sparse training in physician-patient communication about sexual behaviour creates the opportunity to develop communication interventions that privilege the preferences of the patient and help physicians develop the skills to encourage patients to open up 

REFERENCES

Curtin N., Ward L. M., Merriwether A., Caruthers A., (2011). Femininity Ideology and Sexual Health in Young Women: A focus on Sexual Knowledge, Embodiment, and Agency, International Journal of Sexual Health, 23:1, 48-62, DOI:10.1080/19317611.2010.524694

Hernandez R., Petronio S., (2020). “Starting that Conversation Is Even Harder than Having It”: Female Patients’ Perceptions of Physicians’ Communication Competence in Communication about Sexual Behavior, Journal of Health Communication, 25:11, 917-924, DOI: 10.1080/10810730.2020.1864518