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Have you taken a look at how you address the subject of noncoital sexual behavior — specifically oral sex — with your patients, particularly adolescents? While adding more questions to your written and oral histories might add time to patient exams, such effort is necessary, says Linda Dominguez, RNC, NP, assistant medical director of the Albuquerque-based Planned Parenthood of New Mexico.
"The pressures of time that dictate the clinician’s day compound the reasons the topic of oral sex may not be broached," observes Dominguez. "But would we short-shrift our patients by only listening to only one lung or examining only one breast, or in this case, ask only for part of the history?"
Include questions regarding sexual preference and sexual activity in the self-taken history to initiate the conversation with patients about oral sex, suggests Dominguez. The self-taken history then sets the stage for one-to-one conversation and clinical assessment regarding such risks.
Since the advent of HIV, an increasing number of clinicians, even those not in reproductive health, see the necessity and value in prompting discussion regarding the risks of sexually transmitted diseases (STDs), says Dominguez. However, the written interrogatories are not sufficient.
"The clinician must be willing to risk some discomfort by asking more specific questions regarding sexual activity," she states. "Admittedly, this is difficult, especially when the teen is accompanied by a parent, or the teen states she is virginal or abstinent."
Talk about it
Screening for oral sex risks includes a written and verbal assessment of sexual history and practices. The physical examination should include assessment of the oral and pharyngeal surfaces, and swab testing as needed by clinical finding or as indicated by history.
Engaging a patient in a verbal assessment is difficult, Dominguez admits. This is an area where "the art of healing meets the science," she notes.
• Use oblique statements.
Use statements such as: "Some of my teen patients have told me that they worry about infections and germs they might have caught from heavy petting or oral sex. Have you been worried or have questions or ever heard about problems about things like that?"
• Time your questions as you perform the physical exam.
Try using the following approach: "I am now going to look in your mouth for any sores or problems. Have you noticed anything unusual or have concerns regarding your mouth and throat that you want me to check out?"
Many teens (and adults) believe that if they or their partners have had a negative HIV test, then they are free of infection risk of any type, says Dominguez. Help patients to understand that the HIV test only gives information about one type of infection and risk.
"Patients will say to me, I feel safe with him because he had a negative test,’" Dominguez observes. "They are not considering the other entities in the alphabet soup of risk such as HSV, HPV, GC, or CT [genital herpes, human papillomavirus, gonorrhea, or chlamydia]."
According to information from the Atlanta-based Centers for Disease Control, the risk for HIV and other STDs from oral sex can be lowered by using latex condoms each time. For cunnilingus (oral/vaginal sex) or anilingus (oral/anal contact), plastic food wrap, a condom cut open, or a dental dam can serve as a physical barrier to prevent transmission of HIV and STDs.1
1. Centers for Disease Control and Prevention. Preventing the Sexual Transmission of HIV, the Virus that Causes AIDS. What You Should Know About Oral Sex. Atlanta; December 2000.