I have been working in the Drexel Student Health Clinic this month for my Women’s Health Elective Program in College Health. I have seen a wide range of illnesses and well visits. My passion is OB/GYN, so I decided to reflect this blog post on addressing safe sexual practices to females in a college setting (however, this may be applied to every patient in general). It is important to address sexual health with college students due to the high rates of sexually transmitted infections in this patient population. According to the CDC, patients aged 15–24 years acquire half of all newly diagnosed STIs (2). Moreover, one in four sexually active females in this age group has an STI (chlamydia, gonorrhea, HPV, etc.) (2)
Taking a sexual history and assessing sexual health are important aspects of routine wellness exams. Sexual history taking is a vital part of elucidating specific problems that many female college students present with such as fevers, sore throat, fatigue, abdominal/pelvic pain, genital lesions, and abnormal menstrual bleeding or irregular menstrual cycles among other common complaints. The American College of Obstetricians and Gynecologists (ACOG) recommends taking comprehensive sexual histories including asking questions about partners: asking if the patient is currently sexually active, with how many partners, and if those partners are male, female, or both; inquiring about use of protection against STIs; inquiring about past history of STIs in the patient or patient’s partner(s); and discussing prevention of pregnancy if not currently trying to become pregnant (1).
Sexual histories are extremely sensitive questions to ask and may make the provider and the patient uneasy. Important points to make as a provider are normalizing the conversation and establishing a good provider-patient relationship so that there is a safe space to discuss sexual histories accurately and without the feeling of judgement or shame on behalf of the patient. ACOG recommends asking open ended questions to facilitate this approach (1). Other approaches to normalizing the conversation are to create a welcoming environment in the clinic including providing accessible free condoms and posting infographics that support open conversations about safe sex practices and STI testing.
The Drexel Student Health Clinic promotes the “Yes Means Test” campaign from the American Sexual Health Association. This campaign simply promotes STI testing for any adolescent every year or with every new sexual partner (3). If the patient states that they are sexually active (“yes”), then an STI test should be offered in all cases without reservation. Additionally, Drexel Student Health Clinic provides free condoms in its patient bathrooms and in the patient waiting room. Altogether, from the moment a student walks into the clinic to when they discuss their sexual histories with the provider, hopefully they feel supported and motivated to discuss their sexual health in order to best serve them comprehensively. Lastly, it is important when discussing sexual health to complete the encounter with proper counseling on safe sex practices such as using protection every time, recommending that the patient to get tested for STIs with each new partner or once a year, and addressing any concerns for safety or family planning.
Anne
Gavenas, DUCOM 2020
Works Cited:
- “Sexual health.” Committee Opinion No. 706. American College of Obstetricians and Gynecologists. Obstet Gynecol 2017;130:e42–7.
- “STDs in Adolescents and Young Adults - 2017 Sexually Transmitted Diseases Surveillance.” Centers for Disease Control and Prevention. https://www.cdc.gov/std/stats17/adolescents.htm#ref1.
