This document provides guidance on discussing sexual health with clients. It defines key terms, explores reasons for discussion and barriers to discussion. It then offers practical techniques for guiding sexual health conversations, including creating a comfortable environment, avoiding assumptions, using inclusive language, and assessing sexual history and function in a non-judgmental way. The goal is to make clients comfortable sharing information to address their health needs.

1. “Let’s lift the curtain on talking
about Sex”…ual Health
123 Sexual Health Clinic
17 Norfolk Street,
Whangarei.
Sue Cooper RN
Jan Smith RN

2. Objectives
 What is it and why is it so important to
discuss it with our clients?
 Exploring the barriers to discussion
 Practical techniques for guiding sexual
health discussion
 Putting theory into practice:
Let‟s talk about sex!

3. Defining our terms
 Sexuality: Begins before birth and lasts a lifetime
 Shaped by our values, attitudes, beliefs, behaviors,
physical appearance, personality, spirituality
 Involves giving and receiving sexual pleasure, as well
as enabling reproduction
 Sexuality is a total sensory experience, involving the
whole mind and body—not just the genitals.
EngenderHealth. 2002. Sexuality and sexual health
[Online minicourse.] Available: EngenderHealth Web
site, www.engenderhealth.org [March 4, 2002].

4. Defining our terms, cont.:
 Sexual Health: The integration of the physical,
emotional, intellectual and social aspects of sexual
being in ways that are positively enriching and that
enhance personality, communication, and love. (WHO
Technical Report Series #572)
 The ability to express one‟s sexuality free from the risk
of sexually transmitted infections (STI‟s), unwanted
pregnancy, coercion, violence, and discrimination.
EngenderHealth. 2002. Sexuality and sexual health
[Online minicourse.] Available: EngenderHealth Web
site, www.engenderhealth.org [March 4, 2002].

5. Why discuss sexual
Health?:
 Foster comfort and trust between Nurse and client.
 Explore underlying issues that affect a clients‟ health
needs and quality of life
 Support the community‟s knowledge and influence to
maintain healthy sexual and reproductive behaviors
 Help clients‟ negotiate safer sex behaviors, and
prevent infection and unwanted pregnancy
 Enable them to address sexual concerns
 Assist them to understand changes in their bodies
throughout their life cycle
 Improve their satisfaction with health services
www.engenderhealth.org [March 4, 2002].

6. Why don’t nurses like
talking about ‘it’?:
 Lack of comfort and knowledge
 Biases, negative feelings and beliefs related to chronic illnesses,
sexuality, aging, and/or life changes
 Fear of offending others
 Time limitations/institutional requirements/settings
 Lack of privacy
 Cultural or religious beliefs
 Not being sure of where to start the conversation, how to continue it,
and/or how to end it.

7. What is SEX?:
 Hugging
 Kissing
 Masturbating
 Manually stimulating your partner
 Vaginal penetration
 Anal penetration
 Vaginal or anal penetration with objects
 Oral-genital stimulation
 Sexual excitement while looking at or reading pornography
 Telephone or 'cyber' sex
 Dressing up in 'sexy' clothes
 Other

8. When is it SEX?:
When it‟s done by:
 Man and woman?
 Two people of the same sex?
 Groups of people?
 Young married couple?
 Old married couple?
 Unmarried people?
 Strangers?
 People of different ages?
When it‟s done for:
 Emotional reasons, for money/drugs/ resources
 In a public place, In a private place or with coercion.

9. When is it sex?
 Sex is when the clients defines it as SEX!

10. Don’t ask, don’t tell…don’t
know!:
 64% women 18-44 said it‟s up to health
professional to initiate conversations about
STI‟s YET… Only 10% said physician raised
subject of STI's other than HIV/AIDS
 Only 3% brought up STI‟s themselves
Larkin. JAMA Women‟s Health Newsline,
Background Briefing, posted July 13, 1998.

11. A practical approach to
discussing Sexual Health
 Our clinic is a sexual health clinic…so Sexual behavior, desire, and identity
easier for us to initiate a conversation do not always align
around sex Sexual behavior and identity can
change over time!
 Create a comfortable/private
environment for the client (preferably A client who identifies as straight may
with their clothes still on!) have (or desire to have) same-sex
partners
 Confidentiality A client who identifies as gay may
Assure patients that all information is have different-sex partners
confidential. A client who identifies as bisexual
may have only same-sex or only
 Build a rapport with your client different-sex partners
first…ask the easy questions
Sex outside committed relationships
 Avoid assumptions happens!
Be open to what client may tell you! Some committed relationships may be
with more than one person
Elderly people have sex
 “Sex” has different meanings to
different people Disabled people have sex

12. A practical approach to discussing
Sexual Health cont
 Use clear, non-judgmental language.
Listen to how your clients describe
themselves and their partners, and
follow their lead (unless terms sound
derogatory)
 Use diagrams, gestures and
humour if appropriate
 „Normalise‟
“we ask all our clients the same
questions, some of the questions
are quite personal and it might be
the first time a health
professional has asked you these
questions. I will try and explain
why I ask a certain question as I
go… but if at any stage you feel
uncomfortable please feel you
can say „pass‟. Is that ok with
you?

13. A practical approach to discussing Sexual
Health cont
 Be curious, respectful and  Use gender-neutral language
empathic when referring to partners
 If a male patient has sex with  If you are not sure what
men but does not refer to terminology to use, ask your
himself as “gay,” we should client! Instead of “Are you
not use the term “gay”. The married?” or “Do you have a
client may consider himself boyfriend/girlfriend” ask:
heterosexual or bisexual.  “Do you have a partner or
 If a female client refers to her spouse?”
wife, clinician should also say  “Are you currently in a
wife, even if couple is not relationship?”; if yes, “Tell me
legally married about it.”

14. A practical approach to discussing Sexual
Health cont
 Assess patient comfort with  Assess sexual function
sexual identity and desire  Do you have any concerns about
 Do you have any sexual sexual function?
concerns or questions you‟d like  Do you have any pain or
to discuss? discomfort during intercourse
 Do you have any concerns or (anal or vaginal)?
questions about your sexuality?  Do you have any problems with
erection? Ejaculation? Orgasm?
 Have you had any change in
sexual desire?
 Be patient,  Assess sexual trauma/violence
victimization if not covered during
thorough, and earlier history
 Has anyone ever forced him or
culturally sensitive herself on you sexually, or
touched you in a sexual way that
was unwanted?

15. A practical approach to discussing
Sexual Health cont
 Considerations for Transgender  Bisexual people may be in a
clients committed relationship, casual
relationship(s), or have no
 Gender identity is distinct from relationship, and may have sex
sexual orientation (don‟t assume one-on-one (more common) or in
transgender people are gay, a group (less common)
lesbian, bisexual, etc.)
 Someone who identifies as
 Transgender people express the bisexual has not always had a
same range of sexual behavior sexual relationship with both
and identity as non-transgender same and opposite-gender
people partners
 Someone who has sex with
partners of more than one gender
does not always identify as
bisexual

16. A practical approach to discussing
Sexual Health cont
 Approach each Do not hesitate to ask
patient as an your clients for
individual, avoiding clarification of certain
any assumptions, terms or behaviors.
and using the history
 Let them teach
to get accurate
information about you!
sexual practices

17. It does get easier!
 Let‟s put the theory
into practice.
A little privacy
please?!!!