Core knowledge
Sexual health issues arise in many different ways - sometimes your patients or clients will ask you a direct question, and sometimes they may want to ask you something but give hints or cues about a topic, hoping you will recognise their need. Likewise, it could be that you are confident to raise and discuss some sexual health issues, but would feel awkward about others. Getting both parties to openly discuss sexual health can be very tricky!
Alison discovered this when she was testing the urine of a man with diabetes. She told him it was normal and he was about to leave - his hand was on the door handle - when he suddenly said "My best friend doesn't work." Alison was already checking for the next patient to call in, and she abstractly responded "You mean he's unemployed?" Silence hung in the air. "Or retired?" The man said "It doesn't matter, sorry" and left immediately. At the end of the clinic she puzzled over why he'd told her this, and a male GP laughed "Well if you're a bloke your 'best friend' is your penis, didn't you know that? He's probably got erectile dysfunction." It was then that Alison realised the opportunity she'd missed - and all because of the difficulty in sharing language and picking up hints.
Discussing sexual issues
Try the sliding scale activity to indicate how comfortable - or not - you feel about discussing these sexual health scenarios.
Sexual development
It is helpful to have an understanding of what is 'normal' in the context of sexual development. Sexuality is integral to a person’s identity and develops throughout life, from birth to death. A person’s sexuality is influenced by their experiences and social, emotional, physical, cultural, economic and political factors.
It is natural for people across all ages to express their sexuality through their behaviour. Sexual behaviour may be expressed in a variety of ways, including language, touch, exploring one’s own body or another’s, sexual activity, games and interactions, and everyone has the right to express their sexuality.
Too often, words around sex get confused. Take a few moments to think about what you understand these terms to mean - then move the mouse over them to check on their definitions.
If people are able to identify their sexual desires and react to them positively, it can make for a happier life. You may meet patients and clients who are unsure of those desires, and helpful advice includes reminders that they have time, that a person cannot really know their sexuality 'overnight'. They should not rush into any behaviour or relationship they are unsure of.
Children and adolescents who have a disability, have been abused or had experiences which disrupted their social, psychological and physical development may be at increased risk of exposure to, or of developing, inappropriate sexual behaviours. Relevant information, support and boundaries may be required as part of their care, and a 'traffic light' system is a helpful framework for thinking about what is normal and different degrees of inappropriateness (Walsh, 1999). It is always necessary to take into account the social, cultural and family context. Select each 'traffic light' to learn more about the boundaries for normal and abnormal sexual behaviour.
If you have concerns about a person's sexual behaviour, the expectation is not that you should manage the situation alone, but you should raise the issue with professionals who can help. Want to know more about sexual development? Check out the 'Further learning' section of this learning resource.
Does age make a difference?
It certainly does! The spectrum of sexual health needs is as wide as the spectrum of human ageing and development. This next activity provides more information to help you to recognise the sexual health issues that can affect your patients and clients whatever their age, and many are very grateful if you initiate a conversation and show empathy. You don't have to have all the answers - but you should be able let them know who can help. Select each age group to learn more about the sexual health issues that are relevant at this stage. You'll also find lots of information in the 'Useful resources' section.