Sexual Health Woven into Practice
Who wants to talk about sex?
Sexual pleasure is a human right and a key component of sexual and overall health. Yet, it is often overlooked, glossed over, avoided, or judged and shamed. Many times, health providers simply do not know how to ask about sexual health and pleasure because they either never learned, have a values conflict, are afraid they are going to make the client uncomfortable, or don't know what to do with the information once they have it. Research shows, however, that clients want their providers to ask, to talk about the deeply personal, and to help them heal!
Healthcare providers are one of the few professions who seek to understand the deeply tender, private, and sacred parts of one's life. As such we have a duty to provide comprehensive healthcare including sexual health, or refer them to someone who can do so, free of judgement .
Talking about sex
If a client presents with a sexual health concern or you think sexual health is a factor in the presenting problem, you can use DOUPE* as part of your assessment:
Gaining consent to discuss sexual health:
"We’ve been talking about your general health and
your sexual health is part of your general health. Do you have any questions about your sexual health?" or "We’ve been talking about your general concerns and often sexual concerns are part of general concerns. Do you have any sexual concerns or need for more information?" (Foley, 2015, p. 80)
D - Description: What is the concern? What is a typical situation when this happens?
O - Onset: Has this been lifelong or more recent? Did the onset occur with any other change? Does it happen every time or just in one situation or with one person.
U - Understanding: What’s your understanding of why this is happening?
P - Past: What’s your experience trying to fix the problem?
E - Expectations: What do you hope to get out of treatment? How will we know treatment has worked?
(*DOUPE information directly taken, with minor edits, from Foley, S. (2015). Biopsychosocial assessment and treatment of sexual problems in older age. Current Sexual Health Reports, 7(2), 80-88, specifically pages 80-81)
You know how much time you have in your assessment - it is ok not to dig for more information at this stage. You are just starting to gain an understanding of their concern. You can take time between sessions to learn more about the problem and how to address it clinically.
