Achieving the Comfort and Competence
to Discuss Your Patients' Sexual Health

The presenter(s) should:

• Become very familiar with the content of this workshop before the presentation.
• Review all PowerPoint slides, along with the presenter guide and the content of the sample sexual history discussion guide. Review the clinical cases, if you choose to use them. (See slide-by-slide talking points: slide 31 below for more information.)
• Remember to print copies of the sexual history guide for each participant; this is a practical tool students can take with them after the workshop.
• Print copies of the doctor and patient roles for the clinical cases, if you decide to use them.
• PRACTICE!!! Determine how much time you have to make your presentation and then time yourself before the actual day. Decide how in depth you wish to go with each slide and what information to prioritize, if time becomes an issue.
• Book a room and collaborate with other student groups to advertise to your colleagues about this wonderful opportunity. If you can, provide food; that's always a plus!
• HAVE FUN AND ENJOY! You're going to do a wonderful job!

Slide-by-slide talking points:
Italicized portions may be spoken directly to the audience. Bolded portions indicate important points to be stressed.

Please note that there is no Slide 1

Slide 2:

Welcome participants to Achieving the Comfort and Competency to Discuss Your Patients' Sexual Health, and introduce yourself and any other student or physician presenters.

Slide 3:

Set the agenda by reading the goals this workshop aims to accomplish. You may ask the audience to suggest anything additional they hope to gain from the presentation.

Slide 4:

Ask participants to listen closely as you read Dusk: a vignette. Use it's "element of surprise," if you will, to introduce the concept of how we view sexuality and how our own experiences and preconceived notions may shape our interactions with others.

Slide 5:

Now, define sexuality by reading through the points listed. You may ask the audience to add to this definition if you wish.

Slide 6:

Define sexual health, preferably reading aloud the second, briefer, definition. Refer to aspects of the first definition if you wish, or if time allows.

Slide 7:

List the ways by which discussing sexual health benefits the patient, the doctor, and the community. You may ask the audience to add to this list.

Slides 8 AND 9:

(8) Add that sexual health is a quality of life issue and refer to the study cited to stress the important role sexual satisfaction plays in the lives of our patients. These results are from a random-digit-dialed telephone survey of 500 adults age 25 and older; the results are weighted by age to reflect the U.S. population. (9) Then, present the degree to which patients' fears of dismissal and of embarrassing their physicians may act barriers patients face to seeking proper sexual health care.

Slide 10:

You may simply state: So, are they right?

Slide 11:

Ask the audience: What do you think? Request that each audience member take out a sheet of paper (you may want to provide these before beginning the presentation) and follow the instructions on the slide. Assure them that this exercise is for their personal benefit; they will not be required to share their lists with anyone, and should therefore be as honest with themselves as possible.

Slide 12:

Stress how our discomfort with sexual health care may begin before we even become physicians. These figures are exactly why we are all here today-applaud their efforts to lead a positive trend towards obtaining the skills to adequately address their patients' sexual health.

Slide 13:

Cite this study to suggest one of many barriers doctors may face to adequately addressing patients' sexual health. These results are based on a survey of 389 internists and family physicians from a large Minnesota health plan.

Slide 14:

These results are from a survey of 482 women ages 18 to 44 who visited a new physician for routine gynecological or obstetrical care. Use this study to stress: Despite doctors' reluctance to initiate sexual health discussion, our patients really do expect us to ask! Clearly, we cannot depend on our patients initiating these conversations themselves, and this two-sided reluctance can be quite detrimental to the patient's health care. If we don't ask, and they don't tell, nobody will know what they need to! As we will explore shortly, we must approach our patients consistently regarding sexual health, while at the same time empowering them to approach us, as well.

Slide 15:

Teens are known for talking about sex with each other, yet this trend seems to stop at the doctor's door. The teen years is a critical time for doctors to help patients deal with changes in their bodies, desires, and/or sexual activities. However, this CDC survey of 15,000 U.S. high school students shows that physicians and teens are missing out on an important opportunity to address sexual health, especially in younger, less sexually experienced teens, who may be the best population in which to establish preventive habits to ensure better lifelong sexual health.

Slide 16:

We've shown that many doctors are not talking to patients about sex; now let's find out why. List the reasons provided and then ask the audience if anyone would like to add anything. While no one is required to disclose the lists they wrote earlier in the program, some participants may want to share some of the reasons they had brainstormed.

Slide 17:

This is the fun part! We're going to learn some practical skills for approaching sexual health with our patients. Our goals, once again are to promote your comfort and competence and, in that, to foster comfort and sexual health competence in our patients, as well.

Slide 18:

Call participants' attention to the sexual history discussion guide in front of them. (Remember to hand these out before beginning the presentation.) Review the Principles section of this form.

Slide 19:

Add to the principles these details about how to approach a patient who is very hesitant to discuss their sexuality with you. Certainly, these are good tips for any patient encounter in which you discuss details that are private or personal to the patient. Remember, your primary goals are to build a positive, trusting relationship with your patient to ensure that there is an open exchange of information regarding their overall health.

Slide 20:

Before we begin a sexual health discussion, we need to understand the vocabulary we may use to discuss or understand our patients as sexual individuals.

Slide 21:

When we ask our patients if they're sexually active, or when they describe to us a sexual experience, it's important that we understand the wide variety of activities and behaviors that those terms encompass. We must never assume that sex is just one thing, for our patients' health and our relationship with our patients may suffer from that. Read the list of what sex can be; when you reach "other," ask the audience to add any if they wish. Stress how sometimes we must think outside our own experiences in order to better address our patients' health. For example, if a patient engages only in oral-genital stimulation with his or her partner, it would seem more appropriate to discuss prevention of STI transmission rather than pregnancy. Take home point: sex can mean different things to different people, making it crucial for us to be aware of these various meanings and to clarify terms when discussing sex with our patients.

Slide 22:

Similarly, sex can take place in a number of settings. Stress again the importance of being open and sensitive to the different sexual experiences our patients have and of clarifying terms in the clinical encounter to best understand our patients' health.

Slides 23, 24 AND 25:

In addition to understanding what sex can mean, it is important that we understand that sexuality is a very individual thing, and each of our patients may experience or relate to sexuality in a unique way. In order to best understand our patients as individuals, we should be familiar with some additional vocabulary. Define sex, gender (gender role), gender identity, sexual orientation, sexual behaviors, and sexual practices. You may ask the audience to add to these definitions or to identify and define any other terms they believe are important to understanding a patient's sexual individuality.

Slide 26:

Now that we've reviewed the principles and vocabulary that serve to facilitate sexual health discussion, we're going to concentrate on how we actually frame the encounter to best utilize these principles. Review the framing section of the sexual health discussion guide.

Slides 27, 28 AND 29:

Now we've touched on a few questions you may want to open and close the discussion, but what about everything in between? Use this pilot study of 57 patients responding to videotaped interviewing styles to demonstrate the success of different methods of interviewing. Encourage participants to consider which questioning styles they feel most comfortable with and if they feel they styles will best facilitate effective discussion with their patients.

Slide 30:

Hopefully, by now, you all feel ready to ask some questions; but, what should those questions be? We have provided you with a sample sexual history discussion guide, which lists several areas of discussion your might like to explore with your patients. Remember, this is simply a guide and you may want to tailor your discussion to individual patients. However, I urge you to remember the principles we've already discussed and never to use assumptions about your patients as an excuse to "tailor" entire sets of questions out of the interview! Review the remaining sections of the discussion guide: Assessing risks, Addressing concerns, Fertility issues, and Talking points.

Slide 31:

Now let's put it all into practice! An important component of this workshop should be practical application. At this point in the workshop, you should consider one, or both, of two options. Firstly, you may break up the audience into small groups and assign the "doctor" and "patient" roles of the attached cases to individual group members. Remember, the important part here is not to let the "doctor" see the patient description; we want to see how much of that information they are able to obtain using the techniques reviewed. Have them conduct a sexual health discussion as if they were in a clinical setting and then encourage each group to discuss the interview together. If you have more than one physician present, assign them to facilitate a group, or to rotate between small groups to check on their progress. Time permitting, return to the large group format and have one member from each group report on the experience of their group.

AND/OR

Secondly, your physician presenter(s) may wish to demonstrate sexual history discussions with real or mock patients in front of the large group. Work with the physician(s) to create a format that works best for your program.

Slide 32:

Make available these further resources for interested students.

Slide 33:

(Contributors)

Slide 34:

Allow time for questions, comments, and group reflection. This is a wonderful time for the physician to add any comments and for students to access the physician's expertise on the topic.

NO MORE SLIDES