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Talking about Sexual Health with Clients

by Pam Stenzel, MA, MFTSexualHealth

Let’s face it, talking about sex is hard. But the conversation has become increasingly difficult in the midst of a culture that is constantly “triggered” and will need extensive therapy when “their truth” is questioned. It is also complicated by a generation that puts far more emphasis on “feelings” over facts and are willing to create their own personal reality while dismissing the evidence of science.

How do we have honest, difficult conversations with the highest risk group for STI infection, unexpected pregnancy and sexual dysfunction? Young people between the ages of 15 -24 currently account for close to 60 percent of new STI infections, according to the latest CDC Surveillance published in October of 2019. [] Since 2014, there has been a 19% increase in cases of chlamydia, an astounding 71% increase in cases of primary and secondary syphilis, and a whopping 185% increase in congenital syphilis. These facts matter, especially to the clients we serve.

When I first began to engage with clients about sexual health and ask them if they had been tested for STI infections, I would get a look of confusion. “Why would I worry about STI’s? I used a condom, most of the time. I have only had 3 partners. I shower right after sex, every time.” I would proceed to provide what I thought was very basic information about sexually transmitted infections, how they are transmitted, how many people were infected and what the possible consequences could be to themselves, or their future fertility, or their unborn baby. Almost every single time, the response was “I didn’t know” or “nobody told me!”

One of the benefits of beginning the conversation about sexual health and hopefully moving to a bigger conversation of healthy relationships, is that we are reaching young women and men amid a crisis. Waiting for the results of a pregnancy test, or certainly an STI test, is the most teachable moment you will ever encounter. All the typical dismissive reasons for not dealing with the consequences of their behavior have flown out the window. I now have the opportunity, by simply and carefully asking questions on the intake, to begin to break down all the resistance to the discussion and the denial that has prevented them from considering consequences, and without judgement begin to give facts. Facts must prevail over feelings.

When we begin a discussion dealing with the sexual health information, which is objective and can be discussed in the context of optimal health and concern for the physical safety and wellbeing of the client, we have established a level of care and concern that then allows us to delve into the more subjective area of emotional and relational health. It is on this foundation that we can begin to chip away at so many myths about sex and intimacy that have been foisted upon us by the culture.

Recently, when discussing with a client her chlamydia tests results, she confided that she had tested positive for chlamydia the year before and even once in high school. This college sophomore was now in my clinic to be tested because she had a new partner and wanted to be given the “all clear.” I began to describe the possible consequences of repeated infections to her, especially as a female, which include pelvic inflammatory disease and possible future fertility issues. She said she never knew that information, especially that she would most likely be the one dealing with these physical consequences, not any of her male partners. I asked her directly, “Was the sex worth it?” She paused for a second, then laughed and said, “Definitely not!" With that kind of start, we have the foundation to move the discussion into the deeper issues of healthy relationships.

It is so important that our staff and volunteers are well prepared to not only have these conversations, but make it a priority to provide this information that so many of our clients have never been given. Just as with a pregnancy decision, we are not making choices for the client. The choice is ultimately theirs, but we never want anyone making life and death decisions without having all the information. They deserve to know the truth about the consequences of the choices they are making, both physical and emotional. We cannot let our fear, or our discomfort with discussing sex, prevent us from having these important conversations. Each one deserves our respect and deserves to hear that they are fully capable of making good, healthy choices for themselves and their future.

Pam Stenzel, M.A.; M.F.T.

Pam Stenzel is the current Senior Regional Clinic Coordinator for Community Pregnancy Clinics located in Florida. She has spent over 30 years speaking to students on sexual integrity both nationally and internationally. She is married, the mother of 3 adult children and grandma of 2 beautiful granddaughters.