I first started working with the Lindau Lab (the powerhouse behind WomanLab) in my senior year as a college student at the University of Chicago, and early on I came to learn that they were a cool group of women. One meeting in particular stood out early in my internship: Gillian and Chenab, patient educators in our group, needed to practice their presentation on sexual self-care for patients. There we were: a scientific research group eating lunch around the table while the patient educators went over the anatomy of female genitalia, different types of lubricant, how to (not) wash your vagina, and so on. I thought to myself, “Wow, I have landed in a group of really cool women.” Women who openly talk about vulvas, vaginas and sexual health and know the importance of open conversations in moving the field of female sexuality forward. As a medical student, I have come to recognize the difficulty in – but even more so the significance of – starting a dialogue about sexuality with others.
Last year I left the ladies of WomanLab to start medical school at USC’s Keck School of Medicine. One of my favorite parts of my medical training so far is that, every Tuesday, we go to the hospital and practice taking a thorough medical history with patients (real people)! Now, when I say thorough, I mean thorough. We cover current medical problems, as well as past medical history, family history, and social history. The social history focuses on the familial, recreational, and even environmental aspects of a patient’s life – factors that can impact one’s health. Sometimes these conversations can take a couple hours depending on how chatty the patient and I get!
You might think that some of these topics, like social history, have nothing to do with health, but they do – you never know where you might find something that sheds some light on a medical problem. That said, it’s easy as a student to feel awkward or as if I’m intruding on someone’s personal life, even when I know it’s important for their health. I’ve mostly overcome that feeling now, but it was most prominent when we began learning how to take a sexual history. And this is coming from someone who has experience speaking frankly and openly about sexual function over lunch and as a researcher with WomanLab!
As you might imagine, it’s a little nerve-racking to ask a stranger if they’re sexually active, whether they have sex with men, women or both, and how many partners they have. It can become even more nerve-racking when that stranger is sick, in pain, or tired, as many patients are. I know my classmates felt just as, if not much more, uneasy about broaching the subject.
During my third clinical session, I was lucky to get a friendly and open patient. He and I went through many parts of his history and when I felt the time was right, I asked the question, “Are you currently sexually active?”
I didn’t expect too much of an answer. He would tell me yes, I would ask him if his wife is his only partner, I would follow up with questions about condom use or sexually transmitted infection testing, he’d answer those questions, and that would be the end of that conversation.
“No,” he answered. I nodded, showing that I understood, and waited for him to continue. He told me about how he and his wife have not been sexually active for two years now because he has been unable to sustain an erection. He told me how they have been trying to explore intimacy in other ways and how he doesn’t actually want to take medication for it. We talked for 10 minutes about this, and at the end of it, he thanked me, saying that no one had ever thoroughly talked to him about his sexual dysfunction.
It’s been several months now, and I no longer feel nervous about these questions. I understand that sex is just another aspect of a patient’s life I need to know for a more holistic understanding of health. In an effort to normalize the subject, I passed this story on to my clinical group, some of whom had also expressed some nerves about discussing sexual history with patients.
I hope that you, dear reader, will continue the conversation and speak up, whether that’s with your partner, your friends, your doctor, or your patient. Or, with us! Email us at firstname.lastname@example.org or join us on Twitter and Facebook.