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Must we go there? Discussing sexual history with dental patients

May 25, 2016
I remember being at the session on risk assessment at the 2015 RDH Under One Roof (UOR) conference, where all of us were squirming in our seats at the very idea of asking our dental patients about their sexual history.

By JoAnn Gurenlian, RDH, PhD

I must say I was overjoyed to see the article in the February issue of RDH addressing human papillomavirus (HPV) and oral sex by Catrice Opichka, RDH. I remember being at the session on risk assessment at the 2015 RDH Under One Roof (UOR) conference, where all of us were squirming in our seats at the very idea of asking our patients about their sexual history. But it's time we confront our discomfort with talking to our patients about HPV. Fortunately, there is hope for those who are not quite sure how to go about having "that" conversation with their patients.

The Centers for Disease Control and Prevention (CDC) has created "A Guide to Taking a Sexual History (CDC Publication: 99-8445 available at www.cdc.gov/std). The guide recognizes that sexual health can impact quality of life, and that health-care providers may need help determining the sexually transmitted disease (STD) risk among patients. Just as we may not be comfortable talking about this topic, our patients may not be at ease addressing the topic of their sexual history, sex partners, or sexual practices with their oral health professional either. The CDC guide was written for physicians, but it can easily be adapted for the dental practice. Dialogue samples are provided. For example, the following is an opening that you could use with your patients.

"We have learned that there is an important relationship between human papillomavirus, or HPV, and oral cancer. As part of your exam today, I will be looking for signs of any oral health problems. To update your health history, I am going to ask you a few questions about your sexual health and sexual practices. I understand that these questions are very personal, but they are important for your overall health and your oral (mouth) health. Just so you know, I ask these questions of all my adult patients, regardless of age, gender, or marital status. These questions are as important as the questions about other areas of your general health. Like the rest of our visit, this information is kept in strict confidence. Do you have any questions before we get started?"

The remainder of the guide focuses on five P's of sexual health. These stand for Partners, Practices, Protection from STDs, Past history of STDs, and Prevention of pregnancy. Some of the questions could easily be added directly to the health history; others might be best to ask in person. The important consideration is that you are opening a dialogue and having an honest conversation with your patient. This is an opportunity to provide education on a topic that might have been considered taboo both by you as the provider and by the patient. Granted, none of this experience is easy, and it will take practice to reach a point of comfort in having this conversation. Some patients will outright refuse to answer your questions. Others will be grateful that you took the time to help them understand that their sexual practices may influence changes in their mouth; changes they never envisioned could lead to cancer.

One thing I know is certain. We cannot just look at our patients and "know" their sexual history. That sweet-looking, grandmotherly type may have multiple sex partners and not use any protection. Don't assume and don't make judgments. Be positive, open, and supportive. Have resources available if your patient needs additional information.

We are forging into new territory for us, and it is going to take a little time to get used to the idea that we have a role to play in taking a sexual history. But years ago, we weren't using curettes or scaling subgingivally. We can adapt and grow, and our patients and practices will be better for it. In the end, we may even save a few lives. What could be better? RDH

JOANN R. GURENLIAN, RDH, PhD, is president of Gurenlian & Associates, and provides consulting services and continuing education programs to health-care providers. She is a professor and dental hygiene graduate program director at Idaho State University, and president of the International Federation of Dental Hygienists.