Approaches to Discussing Sexuality

Many refer to the process of exploring a client’s sexuality as a “sexual history taking.” In this course, we will avoid this term, since “history taking” may imply a structured set of questions (e.g., a checklist). While this term is not incorrect, we avoid it in order to emphasize the importance of a two-way, interactive discussion between the provider (or counselor) and client.

The client’s needs, concerns, and risks related to sexuality and health should be explored in a sensitive manner, using appropriate counseling techniques (such as open-ended questioning, paraphrasing, and reflecting). The purpose of this discussion is to:

• Identify sexual problems
• Identify and assess health risks
• Inform family planning and other reproductive health choices

Power dynamics in counseling

When talking to clients about sexuality, providers must keep in mind the power dynamic inherent in the provider-client relationship.

In any clinic or social-service setting, clients have less power than providers: clients must conform to the scheduling of the clinic, must abide by the facility’s rules, and must rely on the provider for information and resources that the client may need; furthermore, the client does not control access to information shared with a provider during a counseling or medical session. This disparity often leaves clients feeling vulnerable, creating an environment where they are less likely to feel comfortable talking about sexuality, a subject that is already difficult or taboo to discuss in most cultures.

Additional power dynamics that may affect a counseling session include economic, class, gender, and age differences between provider and client. For instance, a male provider must be aware of the potential effects of his relative power in society on his interactions with a female client, particularly when talking about sexuality, and adolescents may feel disempowered in the presence of an older provider. In any of these situations, providers must take steps to quickly build trust with clients and to create an environment where clients feel comfortable talking about sexuality. This can be done by being nonjudgmental, assuring clients that their confidentiality will be respected, acknowledging how difficult it can be to talk about sexuality, and even acknowledging the power dynamic.

Beginning a discussion

When a client presents for preventive services or with a reproductive health complaint, a provider can take the opportunity to begin a discussion related to the client’s sexual life by asking questions.

The appropriate way to ask these questions will vary from culture to culture, and there may be subtle cultural distinctions in wording that will determine what is appropriate or inappropriate in a given setting. (For example, in some cultures it is possible to be very direct, while in others, questions must be asked in a more indirect manner.) However, it is important to remember that clients may be much more receptive to discussing these issues than providers often believe they will be.

The next section will offer some ideas on how to broach the subject with clients and will list issues that are most critical to the client’s health and decision making.

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