let's talk about sex

yesterday we practiced taking sexual histories of standardized patients in small groups. We saw three different "patients" (a standardized patient is basically an actor-patient): a teenager who came in for birth control but was engaging in group oral sex with a group of other high schoolers, a man in his 50s who was concerned about his medication causing erectile dysfunction, and a woman who had just started a new relationship in her 50s and had all sorts of questions about what were "normal" sexual practices.

it was pretty fascinating stuff. the things my group learned were pretty effective in taking a sexual history, no matter what the situation is to:

*start by talking about confidentiality and safe spaces - to sort of set the tone for openness.

*make sure the person feels safe (and get details on how they're making sure they're safe) - whether this means barriers to prevent STDs or feeling emotionally safe in whatever relationship

*make sure the patient feels comfortable

*don't forget entirely about medical problems (for example, erectile dysfunction can be caused by medication side effects, but also by drinking more alcohol, as well as some vascular diseases)

*make sure you answer all the questions or figure out resources where the questions can be answered

*be careful about defining normal - we decided to stick to "normal can be lots of things, but what we want to make sure is that it's making you happy and that you feel safe"

any tips ya'll want to add?

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"we are recorders and reporters of the facts - not judges of the behavior we describe"

-alfred kinsey, zoologist, sexologist

Sexuality in Medical School

Yesterday we had a presentation on Sexuality and how to incorporate appropriate questions about it, as well as be sensitive to issues that may come as part of it, into our medical practices.

The session began with us all filling out (anonymously) a questionnaire that was probably 35 questions long. The questions ranged from:

"I am male/female/other" (circle one answer) to

"I have/have not given/received anal sex" to

"I feel very open/mostly open/not at all open about talking about sexuality" to

"I was/was not been sexually molested by an adult before the age of 14"

After we had each filled one out, we sealed them in blank, white envelopes and handed them up to the front of the class, where they were mixed up and redistributed until we each had someone else's (anonymous) survey in our hands.

Then, one of the Attending physicians in the Pediatrics department read each question and answer aloud, and if your person's sheet (the one that was redistributed to you) had circled that answer, you stood up. For example, my person was male, so when the physician leading the forum said "I am male" I stood up, because that's what my person had circled.

It was fascinating to see the range of responses. About ten people stood up when the response "I have never had sexual intercourse"; about half the class stood up to the answer "I have had a sexual fantasy about someone of the same sex"; and only two people stood up in response to the final question "I have lied somewhere on this questionnaire".

Afterward, they collected the surveys which were shredded, and we had a guest panel talk to us about their experiences with the medical system and their sexuality. One of the panelists was a fourth year medical student, who talked about his experience being a gay man with a serious partner applying to medical school - and how it did or didn't come up. He talked about his frustration with not wanting that to be the defining thing about him, but also wanting to talk about how his experiences have given him great perspective and sensitivity that hopefully will be really helpful with his patients. He stressed being not just open but CURIOUS about your patients, their sexuality included, but not just that.

The second panelist was a Professor of Psychology who talked about his experience as a gay man in the 80s going to see physicians and their responses, especially their fears about HIV/AIDS. He also talked about what it was like for him and his partner to take their daughters to different doctors offices, and how they never quite knew how much to reveal or how to fill out the forms that say "mothers occupation:" etc. He stressed that we need to identify when patients make us uncomfortable, because if we just push through, we're doing a disservice to them and to us - because they can tell we're uncomfortable. He also talked about how to nonverbally create a space where people feel open to expressing whatever they need to - including making more inclusive forms and, especially in places where we treat adolescents, putting up a rainbow sticker or a purple triangle to identify a SAFE SPACE. He said adolescents look for those as a sign that it's okay to talk through whatever they need to.

The third panelist was a PhD student in Psychology who talked about the language we use - both verbal and nonverbal, and how it's a big deal every time she has to tell someone she is a lesbian - a "re-outing" of sorts, and it's nice to not have to do that right away. She suggested asking not "are you a lesbian" but "are you sexually active with men?" and when she says, no, saying, "are you sexually active with women?". She also mentioned that she appreciated when doctors didn't dismiss the idea of her ever getting STDs or ever getting pregnant, but didn't push either of those on her.

It was a fascinating presentation and we have small group tomorrow to discuss it (and some readings) further. While some of the stories they told were horrifying and made me appalled at some of the behaviors of some physicians - I am so pleased that this presentation is a part of our curriculum and that everyone seemed really receptive to at least talking about it.

PS: I ran 10 miles today at 8min/mile pace - training for a marathon during medical school feels somewhat less crazy now. Or maybe just crazy feels good.

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"As I grow older, I pay less attention to what men say, I just watch what they do"

-Andrew Carnegie