Initiate the Discussion
As you can see, many hidden issues fall into the category of sexual health that may be unspoken and, consequently, remain unaddressed. By initiating the conversation, you may be able to add the role of detective to your credentials. Bringing up the subject is easier than you may think.
To open the conversation with male patients, you can ask such questions as: How are things between you and your spouse/partner? Are you and your spouse/partner still intimate? Has your rheumatic condition affected your sexual functioning?
Opening a dialog with female patients can be as simple as asking when they last saw their gynecologist, asking about birth control or asking about vaginal dryness when discussing sicca symptoms.
My husband, Chris, a nurse practitioner, offers his patients the chance to talk about their sexual health concerns by asking them: Do you feel comfortable talking to me about sexual health issues?
Sexual Health: Top 10 Tips
Based on my 21 years as a rheumatology nurse and unofficial sexual health expert, here are 10 suggestions to help you address a patient’s sexual health concerns.
1. Bring up the topic of sexual health with patients, their spouses and partners. Talking about sexual issues isn’t the easiest thing in the world, but people are more likely to ask questions and ask for help in the privacy of the exam room. Just because a patient doesn’t bring up the subject doesn’t mean they’re not thinking about it. You can help normalize the discussion of intimacy and sexual health by including sexual health questions in each visit. That way, you’ll be able to respond quickly to patients’ questions and help with any problems.
An individual’s attachment history, sexual history, relationship history and trauma history can be uncovered over time.
A sexual health history can include the following questions:
- Are you currently sexually active?
- Are you currently sexually active with more than one partner?
- What kinds of protection do you and your partner(s) use during sexual activity?
- How has your illness or disease affected your sexual activity?
- How have your medications affected your sexual activity?
- Have you ever had a sexually transmitted disease or knowingly been exposed to a sexually transmitted disease?
- Have you ever had, or do you now have, any discharge, rash or sores in your genital area?
- Are there any sexual issues you would like to talk about?3
Asking about birth control choice(s) is also important. Certain medications are linked to health risks. Medications used for rheumatic diseases can also be contraindicated in individuals with human immunodeficiency virus (HIV) or hepatitis C. Reactive arthritis can be activated by certain sexually transmitted infections (STIs), such as gonorrhea and chlamydia.
2. Become aware of common sexual health concerns among patients. Patients may be thinking about: