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Shame-Free Sexual Healthcare

+Shame Free Sexual Healthcare

A Roadmap to Better Practice Management

by Bianca Palmisano of
Intimate Health Consulting
designed by Lillian Nguyen

Sexual Health: The Blind Spot You Didn’t Know You Had[

“But my staff doesn’t have a problem with sexual health.”

Between IC-10 codes and healthcare exchanges, reimbursement rates, and physician shortages, providing quality sexual health care is rarely the top concern on medical professionals’ minds.

But the lack of support that practitioners receive regarding their patient’s sexual health problems creates hundreds of tiny problems (with simple solutions) that drain time, energy and resources from an already overtaxed practice. The good news is—addressing those concerns isn’t complicated and can take a practice from doing “just fine” to being “the best of the best.”

Every day, patients come into your practice with sexual health questions:

  • I’m a survivor of sexual assault and am frightened of the invasiveness of a pap smear. What should I do?
  • How do I stay safe when having sex with my partner, who is a transwoman?
  • I'm HIV+ and sexually active with multiple partners. How often should I get an STI test and what should I test for?
  • What birth control is right for me if I’m planning on getting pregnant in the next year?
  • What should I do if sex is painful for me?

Many medical practitioners are unprepared to answer these questions.

A study by the Medical College of Georgia reported that the majority of medical schools provide just 3-10 hours of sexuality education, and recommended that an “expansion of human sexuality education in medical schools may be necessary to meet the public demand of an informed healthcare provider” (Department of Psychiatry, 2003).

Within this paucity of standardized education, very little, if any, training focuses on clinical empathy or counseling skills for addressing stigmatized issues related to sexual health, function, and pleasure. Unless you are a population and gender-based health care specialist—and sometimes even then!—you have not received any custom training on how to compassionately and non-judgmentally diagnose and treat sexual health disorders.

Thinking Questions:

  • What are some examples of patient questions which caught your practitioners off guard?
  • Which client base is your staff the least ready to serve currently? HIV+ individuals? Transgender people? Survivors of sexual violence?
  • What type of training or support has your staff already received about the topic of sexual health?
  • How would sexual activity affect the health concerns of your average patient?
  • Are your staff comfortable asking patients if their sex life is satisfying?

Why Does Sexual Health Matter

In a society where sex is considered a very private matter, doctors and patients alike are unlikely to bring up the topic of sexual wellness during a routine examination, or to seek out treatment when they are experiencing difficulties. In a recent study of men seeking treatment for erectile disorders, only 10% of the total sample reported being asked about possible sexual problems during previous routine general practitioner visits. Yet in this same sample group, more than three-quarters of respondents suggested that health professionals should routinely ask patients about their sexual performance(Gülpinar et. al 2012).

The hesitancy of doctors and their patients to discuss issues of sexual performance and enjoyment has cascading effects in sexual health diagnosis and treatment. Delays in seeking treatment attributed to embarrassment or discomfort range from 6 months (US, penile cancer) to 36 months (UK, erectile dysfunction), despite the widespread belief that medical care would be beneficial (Skeppner et. al, 2012).

Within sexual healthcare, there is an even greater need for competent and respectful care for LGBT patients, particularly those identifying as trans* or non-binary. The 2008 report “The State of Transgender California” noted that 30% of surveyed trans* individuals postponed urgent and routine medical care due to perceived disrespect or discrimination from health care clinicians. 26% of those who postponed care reported that their conditions worsened as a result (Transgender Law Center, 2009).

These macro statistics are punctuate by heartbreaking first-hand accounts of transgender individuals who were actively denied medical care due to their gender identity, as in the case of Shaun Smith, who died in 2012 when emergency responders refused to administer her care after discovering that she was a transgender woman. Without proactive work by practice administrators and trainers, individual provider prejudices about LGBT people are unlikely to be discovered until a patient complains of mistreatment—or worse.

The Bottom Line

There are a lack of core standards and competencies for sexual and reproductive health that integrate population and gender-based health care across public health and primary care, leaving specialists of the field in a “silo,” un-integrated into primary care and inaccessible to many patients.

That means there is a HUGE unmet need from patients, LGBT and straight, who are not receiving appropriate care. Physicians trained to dig for these hidden health issues will be rewarded with better health outcomes and increased client bases due to referral networks and word-of-mouth referrals from patients receiving exceptional care.

Moreover, ignoring sexual health concerns can definitely hurt a healthcare facility’s bottom line. In an industry where anywhere from 20-50% of lab tests ordered by physicians are considered unnecessary, money is positively leaking out of practices where physicians refuse to engage on sexual health. Sexual health complications are the symptoms most likely to be disguised by patients due to embarrassment or stigma, leading healthcare providers to diagnostically “fumble in the dark” with incomplete health information.

Latent sexual health questions from patients are also incredibly like to result in “hand on the doorknob” questions, where a patient spends their 15 minute check-up with the doctor on unrelated concerns, only broaching the real reason for their visit as the doctor heads out the door. This leads to scheduling backups, or incomplete care when a doctor is unable to devote the appropriate amount of time to the issue.

Establishing Standard of Excellence care in the arena of sexual health can return dividends for any practice, both from increased revenue when new clients seek care and from better medical outcomes by reducing treatment-seeking delay and misdiagnosis.

Thinking Questions:

  • List three demographics that are underrepresented in your patient core. What would it do for your bottom line if you had 5 more of each of these clients regularly seeking preventative care. How about 10 more? 15 more?
  • What liabilities does your practice have around inappropriate patient care?
  • How will the ACA’s “pay for performance” model change the way you think about adequate patient care? What are your top priorities for assuring maximum reimbursement?

Where Can We Go From Here?

It’s hard to unsee a problem that’s been brought to the surface, and with such simple solutions, we hope that you’ll choose to become a champion for quality sexual healthcare in your area.

Option 1

Dismantling the sexual stigma and systems of oppression which prevent patients and doctors from addressing sexual wellness Our society’s lack of investment in sexual health is rooted in systems of oppression that value certain types of identities and behaviors over others.

If you drill down deep enough, you’ll find that most people have a very complicated relationship with societal standards about what sex looks like, who is supposed to have it with whom, how oft en and where it should happen. 

In an ideal world, we would work to dismantle these social standards and let everyone live the life that they’re meant to live. There would be fewer assumptions about sex, because we would have erased the idea of “normative” versus “non-normative” sexuality. But that process is going to take a long time.

Option 2

Invest in external training that focuses on nonjudgmental techniques for tackling sexual health concerns While the wider world is working to break down discrimination and oppression against people of all different identities and proclivities, your practice can invest in training to address some of the most egregious stereotypes and misunderstandings about sexual health, sexual orientation, and gender identity.

Dozens of trainings exist which equip practitioners not only with important factual information about sexual health, but with the counseling and hands-on skills necessary to implement the information.

When Looking for Appropriate Training, Keep These Questions In Mind

  • Does the trainer have credentials that speak to their involvement with sexual health and stigma, not just a medical discipline like gynecology/urology?
  • Does the training explicitly use the language of inclusion?
  • Does it have content about people who identify as LGBTQ, (dis)abled, people of color, low socioeconomic status, sex workers, English as second language learners, or survivors of sexual violence?
  • Is the training “too good to be true” in terms of timing or price?
  • Does it claim to cover a large amount of material in an hour or less?

Option 3

Invest in internal capacity to educate and change healthcare culture The train-the-trainer model is a cost-effective alternative for mid-sized practices. With this approach, your practice would license material from an appropriate training provider for a given number of years and receive training on how to teach the material yourselves. These trainings could then be implemented by a qualified staff member or practice administrator for the length of the material license, without requiring an external trainer to come in year-after-year.

Keep in mind: curricula purchased for this purpose should NOT be a standardized product, but should be customized for your particular practice, specialty, and staff needs

To determine if investing in a train-the-trainer model makes sense for you, think about these key things:

  • What kind of turnover does your practice experience? How often would this training need to be implemented?
  • Do you have an internal staff member who can take on the yearly (or biannual) task of facilitating this training?
  • Which is the more valuable investment in your practice: staff time or budget?

>>If you found this ebook helpful, or you would like more support or resources around training, visit:
and get in touch.

Shame-Free Sexual Healthcare

Shame Free Sexual Healthcare guides healthcare professionals through the process of addressing gaps in training resources around sexual health. Bianca Palmisano offers a concise and compelling explanation for the dearth of resources available to healthcare providers and shares thinking questions to apply to your practice. All client-facing professionals should be equipped to talk about sexuality and able to support the specific needs of minority communities, including LGBTQ people, sex workers, and survivors of assault. Shame Free Sexual Healthcare starts a conversation about how to make comprehensive, culturally competent, and integrative sexual healthcare a reality.

  • ISBN: 9781370792269
  • Author: Bianca Palmisano
  • Published: 2016-09-04 03:05:42
  • Words: 1635
Shame-Free Sexual Healthcare Shame-Free Sexual Healthcare