Review

Let’s talk about sex

Sexual health promotion in general practice
Hilary Curtis, Tony Hoolaghan and Carey Jewitt (eds)
Radcliffe Medical Press, 1995, £15.00

This is an excellent short text of about 100 pages packed with everything you wanted to know (but never dared ask) about engaging patients in consultation about sexual health matters.

The layout encourages the reader to dip in for ideas, but it can also be read cover-to-cover. It is unusual to find a book which targets its audience so effectively. The authors acknowledge the experience many of their readers will undoubtedly have in the consulting room, but they illustrate how even the most experienced will benefit from taking a closer look at how they handle sexual health promotion.

The authors explore ways in which the subject of sexual health can be introduced into the consultation in naturally, such as asking the patient to comment on promotional material in the surgery. They even suggest the ‘because it’s Christmas/Valentine’s day/holiday time’ approach if stuck for reasons to mention sexual behaviour to patients.

It is generally accepted that most healthcare professional are not very comfortable discussing sexual matters with patients. But the research evidence suggests that patients do expect to be questioned about their sexual history in certain situations, for example, when prescribing medication which may affect sexual function or interact with contraception.

The authors quote the startling statistic that condom distribution for sexual health (rather than contraceptive) purposes is overwhelmingly to young women (72-90 per cent). This highlights the problem of reaching those groups most at risk from high risk sexual activity — young men, both heterosexual and homosexual. Many strategies are explored which may go some way to redressing the balance. These include ‘birthday card’ visits — an invitation to attend the surgery for a ‘health check’ at age 16, and free condoms available in the practice, although the authors are aware that this can be fraught with difficulties and warrants a chapter to itself.

The chapter on how to talk about sex and keep the consultation going are salutary reminders of how easy it is, in such situations, to phrase a question which sounds judgmental. Good advice includes keeping questions simple when taking a sexual history and avoiding the risky ‘have you ever...?’

The last chapter deals with those in practice who wish to expand their skills and undertake a psychotherapeutic approach with patients, and gives details of available courses.

Finally, no current work would be complete without mentioning evaluation and audit. There is a useful section on outcome measures which could be used and the benefits that the knowledge would bring to service provision.