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Holding hands behind the back

Taking to patients about their sexual health

Asking about the 6th P—sexual pleasure, problems, and pride.

by Robin Watkins, CNM, WHNP-BC

published 02/18/21

In a Twitter poll for February’s #MakeSomeLove campaign, Bedsider asked people about their sex lives, including questions about sexual pleasure, satisfaction, masturbation, partner communication, sex toy use, and how the pandemic has changed their sex life. The results are in:

  • While most people are satisfied with their sex lives, over a third said it could use some improvement.
  • Communication was key to sexual pleasure, with nearly 90% of people saying it was “the only path to success!”
  • People are using sex toys for masturbation and partnered sex, but over 50% of people wanted to masturbate more frequently.

Regardless of how someone expresses their sexuality, how often they have sex, whether it is partnered or not, or who those partners are, sexual dissatisfaction is a barrier to achieving reproductive well-being. To understand your patients and their sexual health care needs, providers need to ask about all the parts of the sexual experience, expanding beyond the standard 5 Ps approach to include questions about sexual pleasure, problems, and pride—the 6th P.

For more about how to put these questions into practice, we talked to Power to Decide’s new CEO (and OB-GYN), Dr. Raegan McDonald-Mosley. (If you missed her on Power Talk with Sexologist Dr. Megan Stubbs, and Founder of VagEsteem Vanessa Geffrard, going deep on sexual pleasure, dating during a pandemic, and more, go check it out—you won’t be disappointed!)

What questions should providers be asking their patients about their sexual health?

Taking a transgender-inclusive sexual health history is important for all of our patients to understand the kinds of sex they are having, their risk of infection, pregnancy desires, and birth control needs, but asking about sexual satisfaction and pleasure as well as problems patients might be having are just as important.

Ask patients general questions about how their sex life is going and pause to allow them time to answer: Are you satisfied with your sex life right now? Do you have any questions or concerns? Also ask specific questions: Are you on the same page as your partner(s) about sexual desires and boundaries? Are you having any difficulties or problems when you have sex, such as pain, vaginal dryness, low desire, not having an orgasm, or issues getting or maintaining an erection? Are you having sex you don’t want to be having or experiencing violence in your sex life?

What resources are available for providers?

The National Coalition for Sexual Health launched a new tool, Sexual Health Questions to Ask All Patients, to help health care providers integrate these 6th P questions about sexual satisfaction, functioning, and concerns into practice. I’d recommend checking it out—try putting the questions into your own voice and considering how you can make them a part of your routine when taking a sexual health history in your practice.

Questions about sexual satisfaction and pleasure can feel personal. How do you even start the conversation to ask these questions?

The keys to getting conversations started are normalizing these questions and prioritizing building and maintaining rapport. I like to start by letting them know that I ask these questions of all my patients, even those who aren’t currently having partnered sex, to understand what kinds of services they need. These questions aren’t a test and there is no wrong answer as long as they are satisfied with their sex life and practicing enthusiastic consent during partnered sex. And I let patients know that they always have the option to not answer.

Asking patients questions about their sex life might feel awkward at first, but like most things (including sex!), it improves with practice. Before asking a patient, you can try saying the questions out loud at home first, practicing in front of a mirror, or even testing them out on a trusted friend or family member.

With these tips and recommendations from Dr. McDonald-Mosley, we hope that you can put the 6th P into practice the next time you are taking a sexual health history. Drop us a note and let us know how it’s going at providers@bedsider.org or in the comments below.

Robin Watkins is the Director, Health Care at Power to Decide. Robin is a midwife and women’s health nurse practitioner focused on expanding provider capacity to offer equitable, resonant, and high-quality sexual and reproductive health care. Robin provides clinical care at a community health center in Washington, DC. When she is not talking sex, placing IUDs, or asking One Key Question, you can find her riding her bike on the streets of DC or eating ice cream for dinner.
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