Do ask, do tell: Bringing sexuality into reproductive health

Reproductive health is intertwined with sexuality. Effectively helping family planning clients prevent unplanned pregnancies and sexually transmitted infections involves discussion about sexuality, including sexual behaviors, sexual orientation, gender roles, pleasure and intimacy. Research has demonstrated that quality communication between providers and clients can improve sexual health, and that sexual pleasure and sexual risks are related. Across all cultures, staff members who feel comfortable talking about sexuality are more likely to put their clients at ease, and clients are more likely to give truthful information. However, extensive training provided by the Center for Health Training (CHT) has shown that clinic staff are hesitant to talk about sexuality — particularly sexual behaviors and sexual pleasure—with clients. Many staff state that they do not feel it is “any of their business.” Not only does staff's discomfort with sexuality make it difficult to conduct effective risk reduction counseling, but it sends the message that sex is taboo. In response, CHT has developed sexuality educational content, examining biases and values and delving into topics such as sexual pleasure, that is integrated it into all training conducted for reproductive health care staff. A more specific curriculum entitled, “Do Ask, Do Tell” has also been developed for agencies that request more intensive training regarding sexuality comfort and client counseling. A sexual history-taking guide and video is also being developed to teach staff which questions to ask to elicit accurate information from clients and demonstrate effective counseling.