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Nursing Sexual Health Assessment
The sexual health assessment is a very important piece of the nursing assessment. However, many nurses and nursing students find this part of the assessment to be awkward. When completing a sexual health assessment, there are some tips and techniques you can use to make it less uncomfortable for both you and the patient and at the same time, allow you to get the information you need.
Why Do a Sexual Health Assessment?
Sometimes nursing students will ask why patients with seemingly non-sexual complaints need a sexual health assessment. For example, why should they assess the sexual health of a patient who came in to the hospital complaining of chest pain? There are many reasons we assess the sexual health of all of our patients, including:
- Undiagnosed and/or untreated sexually transmitted diseases can affect other body systems (e.g. syphilis can cause mental illness like symptoms)
- Medications we give for certain diseases and symptoms can affect libido and arousal (e.g. Beta blockers for high blood pressure are notorious for causing difficulty with erection and sometimes ejaculation)
- The patient may have questions, but feel too uncomfortable to initiate a conversation with a healthcare provider about sexual concerns. If we initiate the conversation, the patient is more likely to open up.
- Sexual concerns can affect mental health (e.g. A 13 year old is so afraid to tell her father she is a lesbian that she decides to kill herself rather than risk family rejection)
- Sexual concerns can be symptoms of other medical or psychiatric illnesses (e.g. diabetes and heart disease can cause difficulty with libido and arousal; bipolar mania often causes an increase in libido)
It is important to remind ourselves of these reasons when completing the sexual health assessment. If we are aware of why we are asking the questions, our assessment will come across as genuine and concerned rather than awkward and rushed.
Questions and Phrasing
It is important to phrase questions in a nonjudgmental way, such as:
Some people who take “X” (medication) have trouble with libido and erection. Have you had any issues with this?
Many people who have “X” (diagnosis) have changes in their sex drive. Have you noticed any changes?
Leading the questions with information about why you are asking and by sharing that other people have had similar experiences makes this conversation more comfortable for the patient. A comfortable patient is more likely to be open and honest.
If the patient denies any sexual concerns, end the conversation with your version of this:
“I know talking about sexual concerns can be uncomfortable. If you think of any questions later, you can ask me or any of the other nurses here. Our primary concern is to get you as healthy and happy as possible.”
This leaves the conversation open and allows the patient to reflect on his/her concerns and ask questions at a later time.
- Always make sure to respect the patient’s privacy. You may think an 80 year old patient does not have any sexual concerns, so you may ask questions in front of their children, but this is a mistake. People can have sexual concerns and questions at any age, so take advantage of a time when the patient is alone to ask these types of questions.
- Don’t act uncomfortable with the questions. If you are uncomfortable, the patient will be uncomfortable. Ask the questions the same way you ask about pain, bowel movements, breathing, etc.
- Be careful of your nonverbal body language. Make eye contact, act interested and concerned, but not overly interested. You do not want to make the patient feel like you are coming onto him/her.
- Be careful of how you ask questions. This is an example of a question that should be rephrased: “You don’t have any sexual concerns, do you?” This type of question leads the patient to say no. The patient would have to disagree with you if they did have sexual concerns.
- Keep your personal beliefs to yourself. Everyone is different and as a nurse, you inevitably will meet a patient who has different beliefs than you. It is important that the patient not know that you disagree with their sexual behaviors or lifestyle. For example, maybe you believe people should only have sex if they are married. If the patient is aware of your belief, but is having premarital sex, the patient will be unlikely to discuss any sexual concerns with you. The same goes for lesbian, gay, bisexual, and transgender patients. If the patient can tell you do not approve of their sexual orientation, they will not be open and honest. In fact, people can become quite hostile if they feel they are being judged by their healthcare provider.
- If a patient asks you a question that you do not know how to answer, ask the patient if it is okay for you to ask another healthcare provider or to do some research. Do not share the patient’s personal information with other nurses and staff without the patient’s permission, even if you feel you are acting in the best interest of the patient. There are strong trust issues involved in sharing intimate details with a healthcare provider, and if the patient finds you have blabbed to other people, the patient will lose trust in you and may even transfer those feelings to healthcare providers in general.
If you keep these tips and techniques in mind when completing your nursing sexual health assessment, it should help decrease any awkwardness and allow for open communication with your patient. Remember, sexual health is a part of the bigger picture and we must have all the pieces in order to see it.
© 2013 Leah Wells-Marshburn