by Will Schott, MD
I want to talk about S – E – X. Maybe that means the birds and the bees, maybe it means condoms, maybe it means pronouns or maybe it means emergency contraception but I want to talk about these things with the people who want—or more likely need—to hear about them.
Like many issues in family medicine, family medicine doctors aren’t best poised to address the sexual education deficits in our country. Rather, this should be addressed within education and government systems. With that said, family medicine providers can and should certainly advocate for more comprehensive and inclusive sexual education within our education systems. In my experience educating groups from pre-teen youths up to undergraduate students, there is no level at which our education system couldn’t do better. I’ll let Planned Parenthood’s website sum this up better than I could: “For example, 15 states require instruction to be medically accurate, and 26 states and the District of Columbia require that it be age-appropriate. While 37 states have laws requiring that abstinence is included in sex education, only 18 states require educators to also share information about birth control.” (accessed on 4/6/21 from: https://www.plannedparenthoodaction.org/issues/sex-education/sex-education-laws-and-state-attacks)
Rather than focus on the inadequacies of our current system, however, I’d like to offer opportunities for positive change. First and foremost, providers can make it clear via actions and words that our offices are safe spaces. Safe spaces to discuss sexuality, health and the interplay between the two. This article can’t cover the breadth and depth of how to do this, but discussing consent and mandatory reporting in a trauma-informed way are certainly great places to start. Another great option is posting signs that delineate a clear safe space for all genders and sexual orientations. If you’re not at a point where you can influence this kind of clinic signage, wearing a rainbow flag or progress pride flag pin can go a long ways. Welcoming spaces can come from words, too, and being clear and conscious about preferred names and pronouns can help people experiencing all genders feel welcome.
A lot of what holds our sexual discussions back are ideas of shame or inadequacy. Sometimes it seems like when it comes to sex, we’re out here driving without manuals. It’s very likely that younger patients have heard very little from teachers or parents, and therefore doctors have the chance to offer real-world advice and that is medically accurate. Doctors have a unique opportunity to use our medical lens to clearly and accurately outline the GU systems of our patients and why we ask the kind of questions we do. It can be so helpful for patients who don’t have great understanding of their anatomy to give them the power to observe, explore and ask questions.
Another important topic in this category is the lack of proper education on consent, so I’ll offer a piece of advice. While the 5 Ps of a sexual history are important (partners, practices, prevention of STIs, past history of STIs and pregnancy plans) I would argue that the 5 Cs taught to me by another provider are just as important. They are: consent, condoms, contraception, consent and consent. Knowing what we know about the rates of intimate partner violence and the greater than 1 in 5 chance of females being the victim of sexual violence during their lifetimes, we have an obligation to discuss consent with all our patients.
Just as it might be for a person beginning to talk about sex, this article isn’t going to be the beginning or the end of discussion about the birds nor the bees. It is, however, an invitation to talk with your patients about sex in ways that can improve their health immensely. Sex means so many things to so many people and we have an obligation in family medicine to explore that with our patients as an avenue towards empowerment and health. If we can provide patients with a safe space to discuss who they are, who they love, and how they love we will do our patients an incredible service at every opportunity.
Dr. Schott was born (Neenah) and raised in Black Earth, WI. He headed west to complete his undergraduate degree in Health Promotion and Education at the University of Utah before going back home for medical school at the University of Wisconsin School of Medicine and Public Health. His medical interests all center around caring for communities and families (cradle-to-grave intergenerational care) with specific interests in American Indian Health, Sports Medicine, and Geriatrics. He is also very interested in the One Health Project which is a “collaborative, multisectoral, and transdisciplinary approach—working at the local, regional, national, and global levels—with the goal of achieving optimal health outcomes recognizing the interconnection between people, animals, plants, and their shared environment.” When not in clinic he loves engaging his community in meaningful ways including youth education, sustainable food development, and improving access to outdoor recreation. He has trouble sitting still and has hobbies that range from skiing to mountain biking to bluegrass music to volleyball to watching soccer to playing the banjo to water skiing to traveling to yoga and hiking. He chose the University of Utah because he fell in love with the Wasatch and couldn’t think of a better place to live and train, surrounded by inspiring people and views with unique opportunities around every corner. He loves how connected the University of Utah is to the surrounding valley and state and hopes to take advantage of every opportunity from 4th street clinic in downtown SLC to rural clinics across the beautiful state.