Island Med Student

Recently, I learned how to perform a rectal exam. Luckily, we have mannequins to practice on before actually performing the exam on real people. Our professor gave us a demonstration, which included telling us about the relevant questions to ask during an exam. However, one thing that he said struck me as odd. He told us that we should make sure to ask all men if they are homosexual, especially if we see rectal tears or bleeding. To me, this seemed very short sighted.

There are homosexual men who don’t have anal sex, plenty of heterosexual women who do, and many combinations in between. To simply ask men if they are homosexual seemed to miss a lot of other possible factors. It got me thinking about how many physicians take very good histories and ask open-ended questions, yet sometimes miss relevant details related to their patients’ sex lives. I know that I’ve experienced this as a patient, and I’ve seen other doctors and students make this mistake.

A patient’s sex life is obviously quite relevant to both their physical and mental health. In order to properly address all of a patient’s concerns, it’s important to know relevant details such as their sexual activity, preferences, safe or unsafe practices, and level of functioning. It could be relevant to their transmission of STDs, medication side effects, emotional issues, and many other aspects of their health.

I think that the problem of physicians not delving deeply enough into a patient’s sex life is probably related to embarrassment, a lack of time, and a general ignorance with respect to the varieties of sexual experiences. I know that so far in my medical education, I’ve received only one very brief lecture about human sexuality, and I’d hazard a guess that many medical curriculums are similarly lacking information in this area.

Many people, physicians included, make a lot of assumptions about other people’s sex lives without being truly informed. For example, a doctor might ask a patient if they are heterosexual or homosexual, without providing for all the other options that exist. There is also a strong age bias that older people don’t have sex. However, there are many older people who would quickly dispel this myth. If a physician fails to ask an older person about their sex life, they could be missing out on many important clues to their level of health and potential problems.

The doctor-patient relationship is very intimate. Physicians have to ask patients about some of their most private details. Without this level of intimacy, the relationship breaks down, and patients can receive less than optimal care. I’m not saying that it’s completely one sided. There are plenty of patients who are less than honest with their doctors. But I think it’s important that as physicians, we do everything we can to put our patients at ease and to help them feel comfortable sharing intimate details with us. And in order to do this, we can’t forget to appreciate all the varieties of human experience, including sexual. We should try to be more mindful of individual differences, ask more open-ended questions, and we should not be afraid to talk about sex.

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