The magical mystery land of community health

I don't make this stuff up!…but I do change identifying information.

Is it my business? March 2, 2010

Filed under: Uncategorized — lesbonurse @ 4:21 am

Is it my business to counsel patients on what is clearly poor sexual technique?  Here’s the situation: A young male patient came in with a request for std testing.  He reported that a condom had broken during sex last week, and he was worried.  In these situations, I always inquire into the circumstances of the breakage.  Improper use of the condom?  Lack of lubrication?  Oil-based lubrication?  It turns out that this patient’s condom had broken at some point during 90 minutes of sexual intercourse.  I pointed out that condoms can get very dry during extended sexual intercourse, and inquired about whether or not he had used any lubricant.  “No,” he said, “But I think you’re probably right.  She kept saying ‘I”m so dry, I’m so dry.'”  Ok then, we have identified the problem.  I pointed out that using lubricant can prevent dryness and therefore prevent condom breakage, especially during long sexual encounters.  The patient seemed receptive.  I was close to pointing out that his lady friend would have no doubt been happier and more comfortable with some extra lubrication.  I was also close to asking him if he usually has a problem reaching orgasm.  Neither of these things were exactly relevant to the std testing situation, and neither of them are strictly medical (although the orgasm question can be a medical issue).  I settled for reinforcing the proper use of condoms and lubricant, as well as reviewing the different types of std’s and screening.  I decided against dispensing any more sex advice, but I couldn’t shake the feeling that I had passed up an opportunity to help this young man become a better partner.  But really, is that my job?  I don’t want to be inappropriate as a provider, but I also don’t want to encourage what sounded like a relatively unpleasant sexual encounter for his partner.

I’ll be seeing him again for his lab results, so if I can think of a professional-but-rapport-building approach to this issue, I’ll get another stab at it.  No pun intended.  ha.


5 Responses to “Is it my business?”

  1. john Says:

    Long time reader, first time caller. 🙂

    I’m an ex-nursing student who’s starting medical school in the fall, so have never been someone’s primary care provider. But for years, I was an HIV/STD test counselor. Thus, i found myself in situations sort of analogous to this like all the freakin’ time, but i was completely allowed to dispense advice.

    whose role (as my organization defined it, at least) was to be a useful, sex-positive guide for my clients, and to help them choose fun goodtime behaviors that minimized exposure to HIV and other STDs. It wasn’t a codified professional standard, but my mission was understood: I was there to help my clients find safer goodtime behaviors that *they would want to engage in*, and (ultimately) to provide a safe space to discuss sex. The pisser is that the advice I gave wasn’t medical, it was health education from one gay dude to another (or at least from gay dude to an MSM), and my role had nowhere near as much professional definition as being an FNP.

    That said, i think you’ve got an arguable point. Yeah, lube reduces risks of condom breakage as well as … um, partner breakage. But as a provider, why draw a line at addressing someone’s sexual wellness, when the rest of their wellness (self-care, nutrition, fitness, SES concerns — even spirituality, per a bunch of theoretical approaches I dimly remember from MSN school) is fair game?

    Then again, it’s also arguable that as health care providers, we should be like the government: out of the bedroom except when we’re requested to enter. He came in for STD screening, you discussed the source of his risk, and gave him useful, patient-centered advice on how to fix it.

    I’m really, really interested to see what others might think about this — as well as what you decide to do in the future. I dunno what I would have done: maybe I’d have mentioned his lady-caller would have a better time with lube, but I don’t know if I would have the ovaries to bring up (or sense to even consider!) what the length of time to orgasm might actually mean for his health, or well being.

    Anyway, you’re hilarious and smart and seem like an excellent provider, and I love the blog and totes recommend it to friends. Thanks for writing. And yikes, sorry for such a long comment!

  2. np2b Says:

    It sounds like you handled the situation really well. I feel that providers are able to counsel patients about “sexual technique” through counsel on safe-sex practices… “Lubricant is effective not only preventing dryness during intercourse that can cause condoms to break, but it also helps create a better overall experience for your female partner.”

  3. Beth Says:

    So funny because the day after reading this, I saw a patient who mentioned that “condoms always break” and we got into the “why lube is important” conversation. Very timely : )

  4. Eden Says:

    Well, in the interest of STI prevention, wellness promotion, and public health (aka his partner may be seeking care for vaginal irritation) I would probably broach the subject… framed as additional reasons to use lube.

  5. k. emvee Says:

    In one of my other incarnations, I work at our local feminist sex shop. We do a fair amount of collaboration with other health care providers and I have to say that from my vantage point, being able to offer advice about sex and sexuality could be absolutely life changing for a client. You can absolutely couch it in a discussion of anatomy and sexual response – or even just keep it related to STIs and sexual health (i.e. an unlubed vagina, especially one that has been experiencing 90 minutes of friction, is much more likely to pick up an STI than one that is lubed and supple and happy).

    I firmly think that the more we can educate people in this area, the happier and healthier they will be. Especially because so many people aren’t getting good information from other sources and almost certainly aren’t getting it from other health care providers, which is a shame.

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