September is Sexual Health Awareness Month. What do you do when a patient brings up sex? Do you initiate the conversation? Is the encounter a series of scripted questions or a real discussion? I am perplexed when I read notes from a provider who has consistently seen a patient over many years, yet there is no notation in the record about sexual orientation, sexual activity and behaviors, partners, satisfaction, identified risk factors for sexually transmitted infections (STIs), and other matters related to sex. However, there are usually multiple test results for regular STI screening. Isn't there more to sex than STIs?
The umbrella of sexual health
In a 2002 World Health Organization (WHO) meeting, experts considered global problems related to STIs, unwanted pregnancies, unsafe abortion, infertility, gender-based violence, sexual dysfunction, and discrimination on the basis of sexual orientation. These experts balanced data with the emerging knowledge about human sexuality and concurrent technologic advances.1
The WHO clarified that the subsequent document created a way to facilitate dialogue among health program managers, policy makers, and care providers to advance their understanding of the role of sexual health in developing services that would promote sexually healthy societies. The team of experts agreed on a definition of sexual health:
Sexual health is a state of physical, emotional, mental and social well-being in relation to sexuality; it is not merely the absence of disease, dysfunction or infirmity. Sexual health requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination and violence. For sexual health to be attained and maintained, the sexual rights of all persons must be respected, protected and fulfilled.1
This definition is broad and encompasses multiple aspects of human existence.
Sexual Health Awareness Month
The American Sexual Health Association (ASHA) was first established as a nonprofit in 1914 in New York City. Its original name, the American Social Hygiene Association, reflected the societal stigma of the day and reluctance to address sexual health publicly.2 The purpose of ASHA was to fight STIs and prostitution. Today, ASHA's mission is to promote sexual health through education, building alliances, and providing advocacy to prevent adverse health outcomes.
ASHA's leadership believes that all people have the right to information and services that will help them achieve optimum sexual health across the lifespan. During Sexual Health Awareness Month (and all year long), participants are encouraged to sponsor programs that promote ASHA's mission. Their website is abundant with resources: fact sheets, learning and teaching videos, links to recent research and news, and policy statements. These resources can help clinicians plan for connecting with patients on sexual health topics.
Promoting optimal sexual health
Providers should use every opportunity to examine our beliefs and values, including the definitions about sex that we accept and put into practice, whether consciously or not. Your knowledge, comfort, and openness in discussing this topic can have an impact on helping your patients achieve optimal sexual health.
Jamesetta A. Newland, PhD, FNP-BC, FAANP, DPNAP, FAAN