Friday, March 12, 2010

Client Comfort in Addressing Human Sexuality Issues

My original blog topic was an extension of Sandra's with a focus on culture and sexuality in Kenya. I typed my blog and saved it as a word document on my laptop ready to post on my designated blog date.

On Monday afternoon one of the staff assistants where I work asked if I could fill in as the guest speaker for the staff assistant retreat (target audience being female aged 35-55), since the scheduled presenter canceled. The retreat was Tuesday, less than 24 hours away. I asked if I could choose the topic. I ran a few ideas by her. She declined each of my suggestions and said that the subject matter I was focusing on would make everyone uncomfortable. Even though my certification as a nurse practitioner is in family practice, I have been exclusive to college and women's health for the past 9 years. All of my suggestions for the presentation were related to sexual health. The staff assistant was adamant that any female sexual health topic would not be well received. We agreed I would speak on Lyme's disease.

I started a literature search knowing that I had only a few hours to prepare for a fun afternoon workshop on Lyme's Disease. It is ironic that my computer has never experienced problems with the many human sexuality literature searches I have explored. Early in my Lyme's Disease literature search my computer crashed. Presently my computer is still under care of the IT Department who said it received a virus from one of the Lyme's sites I visited. This conundrum left me with no computer to prep for the Lyme's Disease workshop and no means of retrieving my previously completed blog. I learned 2 valuable lessons. First, I should always back up my material and second, I should never assume people have comfort with human sexuality issues.

Chris spoke about sexuality education training for practitioners in her blog. I challenge each of you to assist your clients/patients with being comfortable in discussing human sexuality issues.

Patient comfort in sharing sexual information is important to the client - practitioner relationship. Less than 1/3 of patients feel comfortable discussing sexual concerns with their providers, with only 10% of patients spontaneously discussing concerns if not prompted by their provider (Parish & Clay, 2007). Often when the office visit is complete and the practitioner and patient are exiting the exam room a "by the way..." conversation about a sexual concern begins. Embarrassment and lack of time is evident.

Patient comfort is important to alleviate embarrassment and establish a positive provider-client relationship. Patient comfort can be established by respecting diversity, offering an open environment for discussion and sincerity to understand other attitudes, beliefs, opinions and behaviors.

Prior to the Lyme's Disease workshop, the staff assistant told the audience our story of my ideas for a topic and her concerns about my choices. I then mentioned that if I started to feel uncomfortable talking about Lyme's Disease, I might have to change the subject to my comfort zone of human sexuality issues. The audience enjoyed our opening and suggested I pick the topic next time:)

Please feel free to explore more about patient comfort in addressing human sexuality issues with providers in the article listed below.

Parish, S. & Clayton, A. H. (2007). Sexual medicine education: review and commentary. The Journal of Sexual Medicine, 4(2), 259-267.



  1. Alice,

    As someone who recently had her computer taken over by a virus, I really sympathize with your situation. I find an article that interviewed Gynocologists and the findings were that even doctors whose job is to manage womens sexual health did not feel comfortable talking about sexual issues. The discomfort seemed to stem from beliefs about monogamy. "I can't tell the woman how she got the STI because then I am implying she was unfaithful" It sounds like doctors have to also work through their cultural biases surrounding sexuality to be open to helping others especially those who express their sexuality in a way that is different than the doctor.


  2. This post reminds me about what we learned in class: RATIONALE, RATIONALE, and more RATIONALE.

    I am currently faced with a school district that is less than thrilled about having to talk about sexuality issues, but I see how strong rationale help me. And in some ways, the rationale broaden the potential landscape of what we are talking about enough to make sexuality the framework, but not the focus.

    For instance, I have to speak about intersex and transgender bodies. But when I look at my rationale, they have a lot more to do with communication skills, integration skills and teaching methods. I feel strongly that if a topic is rooted in things that educators feel strongly about, the fact that the actual topic is sexuality can, in some ways, melt away to a higher goal.

    Reading The Adult Learner and thinking about learning as a "cooperative act" (p. 89) has really strengthened my understanding (even just for myself) of how human sexuality can just be another part of learning. It doesn't have to be valued over any other information; in my opinion, it should be laced into an existing framework of knowledge, not placed above it.

    Knowles, M. S., Holton III, E. F. & R. A. Swanson. (2005). The adult learner. London, England: Elsevier, Inc.

  3. Great post Alice, and great comments by Darcie and Sarah. This discussion frustrates me because it speaks to the prevalent idea that adults should be treated like children. Who is someone to say what will make a group of 30 year old women uncomfortable (in a medical setting no less!)? If Alice is a great educator (and I know that she is), part of her job is to make sure everyone is comfortable enough so sit in a discussion that touches on sexuality.

    Maybe your coworker was afraid that people would be angry (not uncomfortable), and that she would then have to deal with the fallout. Or maybe she doesn't realize that learning can also happen during periods of discomfort.

    Alice - I'm sure you did a great job educating about Lyme's disease. But those participants were done a disservice by your colleague (who felt she knew what was in the best interest of a group of adults) by denying them your expertise on sexual health.

  4. Alice, I agree with Ryan in that the participants were definitely done a disservice!You shine in the area of sexual health and it would have been an incredible presentation.

    I love this topic and I see how it intertwines with my post about practitioners. It's interesting because the experiences I have had with medical issues has given me ample opportunity to discuss sexual health with my gynecologist and he was so uncomfortable!!! He actually told me he was surprised at how open and up front I was with my questions. His reaction threw me off a bit, but I didn't care. What I'm thinking of now are the people who aren't comfrotable talking sexual health with their doctors and have a response like the one I got. It might deter them from opening up and asking the important questions. Scary thought...


  5. Client Comfort in addressing Human Sexuality Issues
    I remember how uncomfortable it was the first time I had to speak with my male Physician about having a mammogram. I wasn’t sure if he would get offended if I asked for a female or if a female physician was available, what if his hands are cold, what if I say the wrong thing, what if the physician judges me? There’s a frog in my throat, no a golf ball, no words are coming out. Help! Get me out of this office. Most clients are extremely uncomfortable when asking about sex. I can only imagine the discomfort individuals feel when experiencing symptoms that have a negative stigma. I have found it helpful to use humor with metaphors when discussing sexuality. People are often concerned about how and what the doctors response will be to their concerns. Humor can go a long way when trying to create comfort zones around sensitive and tense topics.

    When learning how to ask professionals questions, talk to children or partners about some sexuality topics, the following resources were helpful:
    Swami Nithyananda, Guaranteed Solutions: For Sex, Worry, Fear, Jealousy, Attention-need, Ego.

  6. Hey Alice,
    This seems like a good example of how important it is to understand the environment that sex educators enter. The planning for the target audience and the ability to understand the circumstances for the individuals involved. Often I have found that the people who are involved in the administration of the target population need to be accounted for as well. I personally may not have felt comfortable with the planning of a lesson in such short of time. From what you describe it is difficult to know if the attendees were really uncomfortable or if the planner was uncomfortable with the topic. In terms of the person who rejected your topics, I would question why she shut down. What was it about the group that she felt would make them feel uncomfortable? Or why did she feel uncomfortable? Did someone previously try sex education topics? What was the result?
    Anyway sounds like this person was very anxious and had an extreme attitude stance on the issue of sex. There are many techniques to address attitude change in conjunction with anxiety and fear and are very commonly used in psychology. But before using attitude change techniques it is important, as we have been taught in class, to have a good appraisal of the situation.

    Some good readings for attitude change and anxiety reduction: Attitude Change and Social Influence by Phillip Zimbardo and Influence: The Psychology of Persuasion by Robert Cialdini


  7. Hi Jeremy. I am in agreement with being uncomfortable with planning of a lesson in such a short time. However, my supervisor was present in my office when the staff assistant made the request and he said yes I would. It was one of those unfortunate circumstances where I had no say in the matter:(

    Anyway, a big thank you to everyone for their comments and feedback!

  8. bummer disappointing when someone comes to you for help and then tells you what to do :(

  9. Alice, I was so interested in what you wrote about how few patients feel comfortable discussing sexual concerns with their providers - less than a third feel comfortable, and only 10% will bring it up spontaneously?? I shouldn't be surprised, given the widespread discomfort in discussing sexuality (at least in America), but to see those numbers laid out starkly like that, blew my mind a little.

    It's definitely sad that you didn't get to present on a sexuality topic, since it seems like if practitioners (e.g. staff assistants - practitioners, right?) felt more comfortable with the topic, that might make them more approachable, and patients might feel more comfortable asking those spontaneous questions. It reminds me of what I've heard about parents being sexuality educators for their children: sometimes it's enough for them to be approachable, for their children to feel comfortable enough to come ask them anything.

    I'm actually addressing comfort discussing sexuality in my curriculum/lesson plan project, and one thing I'm covering is simply practicing talking about sexuality, whether using medical terminology to describe anatomy, listing diverse sexual behaviors, or discussing attitudes/values. Though I want my students to learn the terminology and come to massive realizations about their own values, etc, the most important thing I want them to get out of this workshop is just practicing using *language* to talk about sexuality. I think that having that practical experience will help them to feel comfortable talking about it outside of the classroom, too. I think that sometimes, just saying the words out loud can alleviate some of the discomfort, and shame... It's not always a logical experience - it's emotional, and people feel that something bad will happen if they use non-euphemistic language to talk about sex, which is why I think that concrete practice (with positive reinforcement!) will really help.

    I guess this is all well and good when a person can finally get *access* to an audience, but just as an example: how could I convince some medical doctors that they need training in comfort discussing sexuality?? How does an educator make that jump? Or, how would a medical practitioner make that jump?