Talk About Sex

I do, every day. It goes with the territory when you're a doctor. Sex matters. Having it, not having it, who you have it with and how, what you do and don't do; it can all affect your health, so, for better or worse, we'll be asking about it.

There are ways and ways to ask patients about their sex life. In med school they taught us the phrase "sexually active." We were supposed to ask the patient, "Are you sexually active?" It sounds silly to me now, but it was presented as Standard Of Care. In other words, everybody does it that way. It was deemed an efficient use of time. One question, cut to the chase.

I even did that for a while, until I realized that many people had no idea what I was talking about. I'd get the blank look far too often, and end up having to ask some other way. Or they'd focus on the "active" part of the question. One of my colleagues got the answer, "Not really. I just lie there." And I heard the opposite extreme when a young man bragged, "Oh yeah! I break condoms all the time!"

So I quit asking it that way. For a while I asked, "Do you have a sex partner?" That seemed to work okay. If they answered in the affirmative, I'd follow with, "Male or female?" and then questions about how long they had been together, whether they used safe sex practices, etc. It took a lot more questions than the one, efficient, "sexually active" query, but it got the job done.

(By the way, we don't say "safe sex" anymore, did you know? Now we're supposed to say "safer sex." Nothing, after all, is 100% safe. Or 100% anything. G-d forbid someone should sue us when they get chlamydia having "safe sex!")

Another of my colleagues tried this one out: "Are you having sex?" Until one of his patients gave him a look and said, "Well, not right NOW!"

The open-ended question is a great way to ask about most things. "Tell me about your back pain," for example. But even I would feel a little weird saying, "Tell me about your sex life" to a patient.

No matter how we ask, there will always be a way to misinterpret it. Some of the medical literature uses the term "sexual debut" for someone's first time. "A woman should have a PAP smear 3 years after her sexual debut." Isn't that priceless? It sounds like there should be a huge party with gauzy dresses and tuxedos. "Introducing the sexual debutantes!"

I finally hit on an opening question that works for me most of the time. "Do you have sex with men, women, both, or neither?" Most people seem to be able to hear that one, and respond without rancor. Interestingly, I have never seen a woman act offended by this question, whether she is straight or gay. On the other hand, quite a few straight men act appalled that I would even consider the idea of them having sex with men. "WOMEN! Only WOMEN!" they huff. I wonder: is homophobia a sex-linked trait?

The other day, I finally got "Neither" in response to my question, which made me realize it isn't quite the catchall I thought it was. Was this a virgin (not as rare as you might think at the university)? Nope. On further questioning, the person revealed that they had in fact had their sexual debut some years earlier but were currently single. No sex for...hmmm lemme think...two whole weeks now!

That brings up another whole arena: sexual definitions. "Monogamy," "long term," "sex;" you'd be surprised at some of the concepts folks have. Fodder for another post.