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Broaching the subject
 It
is best to start with general, open-ended questions to get the conversation
rolling. Later you can probe with more pointed questions to obtain specific
information. You should introduce the discussion in your own way, depending
on the setting, the client, and the type of service the client is seeking
or the complaint the client presents with.
Examples
Assure the client that the
questions are routine and that everyone is asked the same questions. For
example:
“I am going to ask
some very personal questions now. We ask these questions of everyone,
because we believe that sexual lives are an important aspect of health.”
Assure the client that the
questions will have direct bearing on the client’s health care and
the decisions made during the visit:
“It is important
for me to ask you these types of questions so that I can help you to
make health decisions that are right for you.”
Be sure that the client feels
comfortable:
“If there are any
particular questions you do not feel comfortable answering, feel free
to let me know.”
Introduce the questions within
the context of STI risk (including HIV):
“As you may know,
AIDS and other sexually transmitted infections occur a lot in this area.
I’d like to talk with you more about your situation so that we
can determine if you might be at risk. We discuss this with all of our
clients so that we can make sure everyone gets the information and family
planning method that best meets their needs.”
You may start with some very
general questions to get the conversation going, such as these:
- Do you have any questions
or concerns that you would like to discuss about your sexual relationships?
- Can you tell me about your
spouse, sexual partner, or partners? Whom do you live with?
- Tell me about your sexual
experiences.
- What questions do you have
about what might happen to your body during sex?
- Are you happy with your
sex life? Why or why not? Do you talk with your partner about it?
- Tell me about your first
sexual experiences (particularly for younger clients).
More pointed questions can
often be integrated into a discussion of medical history, demographics,
or risk factors pertinent to the service being provided. If the information
does not emerge through general discussion, ask probing questions on HIV and STI
risk, family planning, prenatal or postpartum concerns, or other relevant
issues.
 Examples of some
specific questions
When answering clients’
questions or addressing their concerns, try to find ways to include information
about the normal range of sexual responses, age-appropriate changes to
expect, and what constitutes sexual dysfunction.
When providing information
on contraceptive methods or medications for management of disease, include
information about how sexual function may be affected. For example, when
providing hormonal contraceptives, tell the client that some women experience
heightened sexual pleasure because they no longer fear pregnancy, while
others may experience decreased vaginal lubrication or diminished desire.
Let clients who are using oral contraceptives know that if they do experience
a problem, they may be able to change the type of pill they use to correct
the problem.
When providing condoms, tell
the client that for some men, condoms can be helpful to sexual functioning
because they reduce sensitivity, which can prevent premature ejaculation
or help in maintaining an erection. For other men, condoms can interfere
with an erection. Let the client know that if he or his partner experiences
difficulties, he can return for counseling, since such difficulties can
often be overcome. When providing antihypertensive medication to a male
client, explain that he may experience erectile difficulties.
© 2007 EngenderHealth
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