How Can We Improve Our Own Sexual Health?

In previous installments of this series, policy experts have said that sex education in schools often misses the mark. The Future of Sex Ed released national sex education standards. But in many places, including public schools, young people aren't getting the info they need.

Comprehensive sex education programs are deficient in the medical system, too.

There is a disconnect in the American medical system between what sexual health requires and what providers cover in the exam room, according to Edward W. Hook, M.D., a Birmingham-based professor of infectious disease at the University of Alabama School of Medicine.

A review of 33 different research studies carried out in the U.S. and published in June 2020 indicated that current sexual health discussions did not meet the needs of patients.

"Communications are not very good between healthcare providers and their patients," Hook said.

In the U.S. and Canada, a summit on the current state of medical school education in sexual health suggested a lack of sexual health education. There is little consistency in required sexual health training at medical school, according to the report.

The escalating rates of STIs around the country underscore these gaps.

"The United States, in particular, has issues regarding stigma, sex and sexuality. That's true, more in the U.S. than it is in most other higher-income countries," Hook said. "We have the highest rates of syphilis, gonorrhea and chlamydia—three reportable sexually transmitted diseases [STDs] despite spending a lot of money on public health."

Hook is one of the medical experts behind the American Sexual Health Association’s Ask the Experts page. He has collectively answered more than 9,000 sexual health questions over the years. One of his most frequent inquiries is from people who want more information after they've received a positive STI test.

"A lot of our questions come from people who have made what they perceive to be a misstep or have had a positive test for an STI," Hook explained. "They then ask questions about whether they need other tests and whether those tests are accurate. What are the chances that they acquired an infection through an encounter?"

All of these questions, he noted, are easy enough to answer but should have been covered by the medical professional they spoke to.

Even after a trip to the doctor, people are often left in the dark about what to make of their results. A common resource for people to receive answers to their questions and concerns surrounding sexual health should be the doctor’s office.

But in Hook’s perspective, many doctors are ill-equipped to start that sexual health conversation.

"Most healthcare providers are not very well-trained in taking a sexual history or talking about sex and sexuality," he said. "And when they do talk about sex, more of them are prepared to talk about disease rather than health and infections."

Research published in October 2017 in the Journal of the American Sexually Transmitted Diseases Association suggested that doctors don’t have the tools or resources for ample sexual health conversations. The indications were that this was likely due to a multitude of reasons ranging from lack of training and resources to comfort, communication and time.

You might think doctors would make it a regular practice to offer sexually active patients a full STI panel or an HPV vaccine at the appropriate age. Too often, that's not the case.

Just as you may feel embarrassed to bring up something that's affecting your sexual health, your doctor may have the same reticence.

Start the conversation. Share your health concerns and request relevant screenings, including HIV, a pregnancy test or treatment. Your doctor has seen it all before. Never hesitate to provide as much detail as you can to get the help you need.

According to the National Coalition for Sexual Health, more than 50 percent of the general population is not receiving recommended sexual health services like vaccines, contraceptives and counseling.

You will have to advocate for yourself at your next appointment since you're the only one who knows your body. Hook recommended being as informed as possible so you know what to ask for, which means you'll need to do your research.

"Don’t wait for your provider to bring it up or assume you’re automatically getting what you need," said Jennifer Rogers, M.P.H., the Maryland-based program director of reproductive and sexual health at Altarum, a nonprofit organization seeking to improve health outcomes for patients who receive Medicare and Medicaid.

In practical terms, though, how should patients start that conversation?

"You can start by admitting that it feels awkward to talk about sexual health," Rogers said. "Or you can write down your questions on a notecard and hand them to your provider or simply include your concerns on the patient intake form. Then, your provider should definitely run with the conversation."

She also recommended referencing the National Coalition for Sexual Health’s guide for taking charge of your sexual health before visiting a provider.

A couple of suggested conversation starters from the guide include:

• "I know I’m here to get a checkup, but can we talk about my sexual health for a few minutes as I have some questions?"
• "I'm having some trouble with my sex life."

The guide recommends writing down specific questions you have beforehand, so you don’t forget to ask.

If you’re not comfortable broaching your sexual behavior or health with your current provider, it's worth finding a provider you're comfortable with. If you feel that you're being judged, it might indicate that it’s time to switch doctors.

"Some providers are not comfortable having open conversations about sexual health or sexual concerns. If that’s the case, ask your friends or family to recommend someone you can trust, research providers through an online rating site or ask a representative from your healthcare plan for a list of top-rated providers in your area," Rogers suggested.

Good sexual health practices should always begin before you start having sex.

"Good sex starts outside the bedroom with things like valuing yourself, treating partners well and feeling like you can talk honestly and openly with partners about your wants, needs and sexual desires," Rogers explained.

Advocating for your sexual health can also happen in the context of a relationship, Hook added. This could include making sure to discuss your prior STI history with a new partner or getting tested together before having sex.

It means practicing key elements such as consent, pleasure and satisfaction—and addressing whether your needs are being met.

Be your own advocate. Whether we're talking in the context of a doctor's office or within a relationship, make it your business to inform yourself from trusted, medically accurate resources and make an ongoing plan for your sexual health.