InCrowd Survey: Physicians Find Difficulty in Providing High-Risk Patients With Sexual Healthcare

Two new studies look at the dynamics of discussing sexual health during a doctor’s visit, with implications for adolescents and seniors, groups recognized by the CDC to be at higher risk of sexually transmitted infections and related diseases.

A recent study from the Pediatric Academic Societies, which surveyed almost 600 adolescents, found that 45% of these patients are not asked about sexual activity during their annual medical appointments. Only13% percent are offered sexually transmitted infection (STI) screening.

To understand the physician side of the equation, InCrowd conducted a MicroSurvey of 125 internal medicine, primary care, and pediatric physicians in April 2018. The group averaged 8 years in practice.

Physicians were also asked to provide the percentage of patients ages 11 and above with whom they discuss various sexual health topics. The responses confirm that the practitioner-patient dialogue is inconsistent, as physicians on average:

• Obtain a sexual history from 55% of patients.
• Discuss sexual health in general with 44% of patients.
• Have conversations about sexually transmitted diseases or infections with under 40% of patients and encourage a similar percentage to pursue screening
• Provide in-office literature on sexual health-related topics to 27% of patients.

Least frequently discussed are patient sexual orientation and LGBTQ-related medical issues, topics considered with 24% of patients.

InCrowd also asked physicians to specify their level of comfort in speaking to adolescent, adult, and senior-aged patients about sexual health:

• Only 37% of physicians said they  were “extremely comfortable” discussing sexual health with seniors.
• 40% were “extremely comfortable” speaking with adolescents.
• 60% were “extremely comfortable” talking to adults.  

Physicians can be uncertain about how to approach patients regarding sexual health. A physician from South Carolina with 17 years experience said she was “concerned that patients will perceive judgement or be offended by certain questions. Trying to avoid giving patients that impression sometimes hampers my best discussion.”

At the same time, it can be patient attitudes that limit a physician’s ability to educate. One physician from Texas with 12 years in practice responded, “Most patients are embarrassed to speak about sexual health. Even more so, my older population is less likely to open up about LGBQT as their generation was taught it was not accepted at all.”

In open-end verbatim responses, physicians provided further detail on barriers to their discussions with patients:

• 36% said the largest barrier was patient discomfort.
• 24% responded that the time available to them during annual appointments limits their ability to have these conversations.
• 19% indicated a lack of patient privacy was an issue, as parents, spouses, or partners often remain in the room when the physician is performing an assessment.
• 15% of practitioners indicated that they were not comfortable themselves in approaching the topics.
• Only 6% reported no barriers to these conversations during a medical visit.

Recognizing the wide range of topics to discuss at these annual appointments, a physician from Wisconsin with one year in practice explained, “Most patients present with acute concerns or chronic conditions (e.g. Diabetes, HTN) that take a lot of time to address, therefore we have no time to discuss sexual health issues.”

Physicians who do not experience barriers to educating patients may utilize their own unique strategies. “I talk about [sexual health] with everyone,” a physician from Connecticut with 8 years in practice responded,“I can introduce it within a discussion about taking care of the health of the whole person.”