Many times I believe oral sex is left out of the discussion of sexual health. When we have discussions with patients of different genders and different sexual orientation, I believe oral sex needs to be included in sexual health discussions. As a colleague was discussing yesterday during chemotherapy teaching, she instructed a patient to not exchange bodily fluids with someone for several days after chemotherapy. It made me wonder. We never asked the patient’s sexual orientation and the patient voiced that she wasn’t interested in sex, but we really do not know what she wanted to know about sexual health. It was a missed opportunity. In the future, I plan to alter my teaching and make sure to utilize this opportunity to discuss safe sexual health and ask open-ended questions.
This is a very valid point. We need to remember to ask and to normalize any questions they might have about sexual practices. We need to remember as clinicians that just mentioning different sexual practices opens up communication about these issues, essentially giving our patients permission to ask about anything. I find that patients are often initially embarrassed, but often bring up the issue themselves at future dates because they know they can ask.
Thanks for bringing up this topic, as I agree that we very rarely address it here also. I am wondering whether someone has actually created a short checklist for these topics – it could be very useful in two ways. First, you can let patients glance at it, and tell them here is a list of topics covered with every patient, thereby completely normalizing the discussion. Second use it just like that pilot’s check list to make sure, (no matter how many times you have piloted this discussion) nothing gets left out.
I am so glad this issue was raised, and love all of the suggestions that were offered. I like the check-list idea: it could normalize the full range of sexual activities that folks engage in simply by having the options included on the list! just like you all have said, it can increase openness to discussion and when patients are most open about what’s really going on, I think that allows us to provide the best care. I think there are many ways in which we can enhance existing practice in order to provide evidence-based care to gender diverse individuals and folks who identify with any type of sexual orientation. I have heard lots of non-medical provider folks in various settings minimize oral sex and at times not even consider it to be sex. However, in terms of disease prevention, sexual health practices, etc, it can be very important! Feel as though I am preaching to the choir though 🙂