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Published in: Journal of General Internal Medicine 4/2009

01-04-2009 | Original Article

Patient–Provider Communication About Sexual Health Among Unmarried Middle-aged and Older Women

Authors: Mary C. Politi, PhD., Melissa A. Clark, PhD, Gene Armstrong, BA, Kelly A. McGarry, MD, Christopher N. Sciamanna, MD, MPH

Published in: Journal of General Internal Medicine | Issue 4/2009

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Abstract

BACKGROUND

Although past studies have highlighted the importance of patient–provider communication about sexual health and intimate relationships (SHIR), much of the research has focused on young women’s or married women’s experiences when discussing SHIR with their providers.

OBJECTIVE

To describe experiences of unmarried, middle-aged and older women in communicating about SHIR with their health care providers.

DESIGN AND PARTICIPANTS

Qualitative interviews were conducted with 40 unmarried women aged 40–75 years. We compared the responses of 19 sexual minority (lesbian and bisexual) women and 21 heterosexual women.

RESULTS

Women varied in their definitions of intimate relationships. Not all women thought providers should ask about SHIR unless questions were directly related to a health problem, and most were not satisfied with questions about SHIR on medical intake forms. However, the themes women considered to be important in communication about SHIR were remarkably consistent across subgroups (e.g. previously married or never married; sexual minority or heterosexual). Sexual minority women were more hesitant to share information about SHIR because they had had prior negative experiences when disclosing their sexual orientation or perceived that clinicians were not informed about relevant issues.

CONCLUSIONS

Some women felt that providers should ask about SHIR only if questions relate to an associated health problem (e.g. sexually transmitted infection). When providers do ask questions about SHIR, they should do so in ways that can be answered by all women regardless of partnering status, and follow questions with non-judgmental discussions.
Literature
1.
go back to reference Green MG, Adelman RD, Friedmann E, Charon R. Older patient satisfaction with communication during an initial medical encounter. Soc Sci Med. 1994;38(9):1279–88.CrossRef Green MG, Adelman RD, Friedmann E, Charon R. Older patient satisfaction with communication during an initial medical encounter. Soc Sci Med. 1994;38(9):1279–88.CrossRef
2.
go back to reference Stewart MA. Effective physician-patient communication and health outcomes: a review. CMJ. 1995;152(9):1423–33. Stewart MA. Effective physician-patient communication and health outcomes: a review. CMJ. 1995;152(9):1423–33.
3.
go back to reference Beck RS, Daughtridge R, Sloane PD. Physician-patient communication in the primary care office: A systematic review. J Am Board Family Pract. 2002;15(1):25–38. Beck RS, Daughtridge R, Sloane PD. Physician-patient communication in the primary care office: A systematic review. J Am Board Family Pract. 2002;15(1):25–38.
4.
go back to reference Keating NL, Green DC, Kao AC, Gazmararian JA, Wu VY, Cleary PD. How are patients’ specific ambulatory care experiences related to trust, satisfaction, and considering changing physicians? J Gen Intern Med. 2002;17(1):29–39.PubMedCrossRef Keating NL, Green DC, Kao AC, Gazmararian JA, Wu VY, Cleary PD. How are patients’ specific ambulatory care experiences related to trust, satisfaction, and considering changing physicians? J Gen Intern Med. 2002;17(1):29–39.PubMedCrossRef
5.
go back to reference Harrington J, Noble LM, Newman SP. Improving patients’ communication with doctors: a systematic review of intervention studies. Patient Educ Counsel. 2004;52(1):7–16.CrossRef Harrington J, Noble LM, Newman SP. Improving patients’ communication with doctors: a systematic review of intervention studies. Patient Educ Counsel. 2004;52(1):7–16.CrossRef
6.
go back to reference Street RL, Street RL, Piziak VK, Carpentier WS, Herzog J, Hejl J, Skinner G, McLellan L. Provider-patient communication and metabolic control. Diabetes Care. 1993;16(5):714–21.PubMedCrossRef Street RL, Street RL, Piziak VK, Carpentier WS, Herzog J, Hejl J, Skinner G, McLellan L. Provider-patient communication and metabolic control. Diabetes Care. 1993;16(5):714–21.PubMedCrossRef
7.
go back to reference Lewis CE. Sexual practices: are physicians addressing the issues? J Gen Intern Med. 1990;5(Suppl 5):S78–S81.PubMedCrossRef Lewis CE. Sexual practices: are physicians addressing the issues? J Gen Intern Med. 1990;5(Suppl 5):S78–S81.PubMedCrossRef
8.
go back to reference Andrews WC. Approaches to taking a sexual history. J Women’s Health Gender Based Med. 2000;9(Suppl 1):S21–S24.CrossRef Andrews WC. Approaches to taking a sexual history. J Women’s Health Gender Based Med. 2000;9(Suppl 1):S21–S24.CrossRef
9.
go back to reference Gelfand MM. Sexuality among older women. J Women’s Health Gender Based Med. 2000;9(Suppl 1):S15–S20.CrossRef Gelfand MM. Sexuality among older women. J Women’s Health Gender Based Med. 2000;9(Suppl 1):S15–S20.CrossRef
10.
go back to reference Politi MC, Clark MA, Rogers ML, McGarry K, Sciamanna CN. Patient-provider communication and cancer screening among unmarried women. Patient Educ Counsel. 2008;73:251–55.CrossRef Politi MC, Clark MA, Rogers ML, McGarry K, Sciamanna CN. Patient-provider communication and cancer screening among unmarried women. Patient Educ Counsel. 2008;73:251–55.CrossRef
11.
go back to reference Clark MA, Bonacore L, Wright SJ, Armstrong G, Rakowski W. The cancer screening project for women: Experiences of women who partner with women and women who partner with men. Women Health. 2003;38(2):19–33.PubMedCrossRef Clark MA, Bonacore L, Wright SJ, Armstrong G, Rakowski W. The cancer screening project for women: Experiences of women who partner with women and women who partner with men. Women Health. 2003;38(2):19–33.PubMedCrossRef
12.
go back to reference Merrill JM, Laux LF, Thornby JI. Why doctors have difficulty with sex histories. South Med J. 1990;83(6):613–7.PubMedCrossRef Merrill JM, Laux LF, Thornby JI. Why doctors have difficulty with sex histories. South Med J. 1990;83(6):613–7.PubMedCrossRef
13.
go back to reference Boehmer U, Case P. Physicians don’t ask, sometimes patients tell: Disclosure of sexual orientation among women with breast carcinoma. Cancer. 2004;101(8):1882–9.PubMedCrossRef Boehmer U, Case P. Physicians don’t ask, sometimes patients tell: Disclosure of sexual orientation among women with breast carcinoma. Cancer. 2004;101(8):1882–9.PubMedCrossRef
14.
go back to reference Bonvicini KA, Perlin MJ. The same but different: clinician-patient communication with gay and lesbian patients. Patient Educ Counsel. 2003;51(2):115–22.CrossRef Bonvicini KA, Perlin MJ. The same but different: clinician-patient communication with gay and lesbian patients. Patient Educ Counsel. 2003;51(2):115–22.CrossRef
15.
go back to reference Gott M, Hinchliff S, Galena E. General practitioner attitudes to discussing sexual health issues with older people. Soc Sci Med. 2004;58(11):2093–103.PubMedCrossRef Gott M, Hinchliff S, Galena E. General practitioner attitudes to discussing sexual health issues with older people. Soc Sci Med. 2004;58(11):2093–103.PubMedCrossRef
16.
go back to reference Gott M, Galena E, Hinchliff S, Elford H. “Opening a can of worms”: GP and practice nurse barriers to talking about sexual health in primary care. Family Practice. 2004;21(5):528–36.PubMedCrossRef Gott M, Galena E, Hinchliff S, Elford H. “Opening a can of worms”: GP and practice nurse barriers to talking about sexual health in primary care. Family Practice. 2004;21(5):528–36.PubMedCrossRef
17.
go back to reference Westerstahl A, Segesten K, Bjorkelund C. GPs and lesbian women in the consultation: Issues of awareness and knowledge. Scand J Primary Health Care. 2002;20(4):203–07.CrossRef Westerstahl A, Segesten K, Bjorkelund C. GPs and lesbian women in the consultation: Issues of awareness and knowledge. Scand J Primary Health Care. 2002;20(4):203–07.CrossRef
18.
go back to reference Ginsburg TB, Pomerantz SC, Kramer-Feeley V. Sexuality in older adults: behaviours and preferences. Age Ageing. 2005;34(5):475–80.CrossRef Ginsburg TB, Pomerantz SC, Kramer-Feeley V. Sexuality in older adults: behaviours and preferences. Age Ageing. 2005;34(5):475–80.CrossRef
19.
go back to reference Patel D, Gillespie B, Foxman B. Sexual behavior of older women: results of a random digit dialing survey of 2000 women in the U.S. Sex Transm Dis. 2003;30(3):216–20.PubMedCrossRef Patel D, Gillespie B, Foxman B. Sexual behavior of older women: results of a random digit dialing survey of 2000 women in the U.S. Sex Transm Dis. 2003;30(3):216–20.PubMedCrossRef
20.
go back to reference Gott M, Hinchliff S. How important is sex later in life? The views of older people. Soc Sci Med. 2003;56(8):1617–28.PubMedCrossRef Gott M, Hinchliff S. How important is sex later in life? The views of older people. Soc Sci Med. 2003;56(8):1617–28.PubMedCrossRef
21.
go back to reference Gott M, Hinchliff S. Barriers to seeking treatment for sexual problems in primary care: a qualitative study with older people. Family Practice. 2003;20(6):690–5.PubMedCrossRef Gott M, Hinchliff S. Barriers to seeking treatment for sexual problems in primary care: a qualitative study with older people. Family Practice. 2003;20(6):690–5.PubMedCrossRef
22.
go back to reference Spence D. Trends in HIV, gonorrhea, and syphilis. Sexual health services in general practice can be improved. BMJ. 2002;325(7362):494.PubMedCrossRef Spence D. Trends in HIV, gonorrhea, and syphilis. Sexual health services in general practice can be improved. BMJ. 2002;325(7362):494.PubMedCrossRef
23.
go back to reference Adler MW. Sexual health is an important part of people’s lives and doctors need to understand its variety. BMJ. 1998;317(7171):1470.PubMed Adler MW. Sexual health is an important part of people’s lives and doctors need to understand its variety. BMJ. 1998;317(7171):1470.PubMed
24.
go back to reference Verhoeven V, et al. Discussing STIs: Doctors are from Mars, patients from Venus. Family Practice. 2003;20(1):11–5.PubMedCrossRef Verhoeven V, et al. Discussing STIs: Doctors are from Mars, patients from Venus. Family Practice. 2003;20(1):11–5.PubMedCrossRef
25.
go back to reference Zablotsky D, Kennedy M. Risk factors and HIV transmission to midlife and older women: Knowledge, options, and the initiation of safer sex practices. J Acquir Immune Defic Syndr. 2003;33(Suppl 2):S122–S130.PubMed Zablotsky D, Kennedy M. Risk factors and HIV transmission to midlife and older women: Knowledge, options, and the initiation of safer sex practices. J Acquir Immune Defic Syndr. 2003;33(Suppl 2):S122–S130.PubMed
26.
go back to reference Stevens PE. Structural and interpersonal impact of heterosexual assumptions on lesbian health care clients. Nurs Res. 1995;44(1):25–30.PubMedCrossRef Stevens PE. Structural and interpersonal impact of heterosexual assumptions on lesbian health care clients. Nurs Res. 1995;44(1):25–30.PubMedCrossRef
27.
go back to reference White JC, Dull VT. Health risk factors and health-seeking behavior in lesbians. J Women’s Health. 1997;6(1):103–12. White JC, Dull VT. Health risk factors and health-seeking behavior in lesbians. J Women’s Health. 1997;6(1):103–12.
28.
go back to reference Lehmann JB, Lehmann CU, Kelly PJ. Development and health care needs of lesbians. J Women’s Health. 1998;7(3):379–87. Lehmann JB, Lehmann CU, Kelly PJ. Development and health care needs of lesbians. J Women’s Health. 1998;7(3):379–87.
29.
go back to reference Stevens PE. Lesbian health care research: a review of the literature from 1970 to 1990. Health Care Women Int. 1992;13(2):91–120.PubMed Stevens PE. Lesbian health care research: a review of the literature from 1970 to 1990. Health Care Women Int. 1992;13(2):91–120.PubMed
30.
go back to reference Trippet SE, Bain J. Reasons American lesbians fail to seek traditional health care. Health Care Women Int. 1992;13(2):145–53.PubMedCrossRef Trippet SE, Bain J. Reasons American lesbians fail to seek traditional health care. Health Care Women Int. 1992;13(2):145–53.PubMedCrossRef
31.
go back to reference Stevens PE. Protective strategies of lesbian clients in health care environments. Res Nurs Health. 1994;17(3):217–29.PubMedCrossRef Stevens PE. Protective strategies of lesbian clients in health care environments. Res Nurs Health. 1994;17(3):217–29.PubMedCrossRef
32.
go back to reference Valanis BG, Bowen DJ, Bassford T, Whitlock E, Charney P, Carter RA. Sexual orientation and health: comparisons in the Women’s Health Initiative sample. Arch Family Med. 2000;9(9):843–53.CrossRef Valanis BG, Bowen DJ, Bassford T, Whitlock E, Charney P, Carter RA. Sexual orientation and health: comparisons in the Women’s Health Initiative sample. Arch Family Med. 2000;9(9):843–53.CrossRef
33.
go back to reference Diamant AL, Wold C, Spritzer K, Gelberg L. Health behaviors, health status, and access to and use of health care: a population-based study of lesbian, bisexual, and heterosexual women. Arch Family Med. 2000;9(10):1043–51.CrossRef Diamant AL, Wold C, Spritzer K, Gelberg L. Health behaviors, health status, and access to and use of health care: a population-based study of lesbian, bisexual, and heterosexual women. Arch Family Med. 2000;9(10):1043–51.CrossRef
34.
go back to reference U.S. Census Bureau, Marital status of the population 15 years old and over, by sex and race: 1950 to present. 2003. U.S. Census Bureau, Marital status of the population 15 years old and over, by sex and race: 1950 to present. 2003.
35.
go back to reference Nusbaum MR, Hamilton CD. The proactive sexual health history. Am Family Phys. 2002;66(9):1705–12. Nusbaum MR, Hamilton CD. The proactive sexual health history. Am Family Phys. 2002;66(9):1705–12.
36.
go back to reference Cooper-Patrick L, Gallo JJ, Gonzales JJ, Vu HT, Powe NR, Nelson C, Ford DE. Race, gender, and partnership in the patient-physician relationship. J Am Med Assoc. 1999;182(6):583–9.CrossRef Cooper-Patrick L, Gallo JJ, Gonzales JJ, Vu HT, Powe NR, Nelson C, Ford DE. Race, gender, and partnership in the patient-physician relationship. J Am Med Assoc. 1999;182(6):583–9.CrossRef
37.
go back to reference Torkko KC, Gershman K, Crane LA, Hamman R, Barón A. Testing for chlamydia and sexual history taking in adolescent females: results from a statewide survey of Colorado primary care providers. Pediatrics. 2000;106(3):e32–e40.PubMedCrossRef Torkko KC, Gershman K, Crane LA, Hamman R, Barón A. Testing for chlamydia and sexual history taking in adolescent females: results from a statewide survey of Colorado primary care providers. Pediatrics. 2000;106(3):e32–e40.PubMedCrossRef
38.
go back to reference Lurie N, Margolis K, McGovern PG, Mink P. Physician self-report of comfort and skill in providing preventive care to patients of the opposite sex. Arch Family Med. 1998;7:134–7.CrossRef Lurie N, Margolis K, McGovern PG, Mink P. Physician self-report of comfort and skill in providing preventive care to patients of the opposite sex. Arch Family Med. 1998;7:134–7.CrossRef
39.
go back to reference Lindau ST, Schumm LP, Laumann EO, Levinson W, O’Muircheartaigh CA, Waite LJ. A study of sexuality and health among older adults in the United States. N Engl J Med. 2007;357:762–74.PubMedCrossRef Lindau ST, Schumm LP, Laumann EO, Levinson W, O’Muircheartaigh CA, Waite LJ. A study of sexuality and health among older adults in the United States. N Engl J Med. 2007;357:762–74.PubMedCrossRef
40.
go back to reference Cooper LA, Roter DL. Patient-provider communication: the effect of race and ethnicity on process and outcomes of health care. In: Smedly BD, Stith AY, Nelson AR, eds. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. National Academies Press: Washington, D.C.;2003:552–94. Cooper LA, Roter DL. Patient-provider communication: the effect of race and ethnicity on process and outcomes of health care. In: Smedly BD, Stith AY, Nelson AR, eds. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. National Academies Press: Washington, D.C.;2003:552–94.
41.
go back to reference Haist SA, Griffith CH, Hoellein AR, Talente G, Montgomery T, Wilson JF. Improving students’ sexual history inquiry and HIV counseling with an interactive workshop using standardized patients. J Gen Intern Med. 2004;19(5 p 2):549–53.PubMedCrossRef Haist SA, Griffith CH, Hoellein AR, Talente G, Montgomery T, Wilson JF. Improving students’ sexual history inquiry and HIV counseling with an interactive workshop using standardized patients. J Gen Intern Med. 2004;19(5 p 2):549–53.PubMedCrossRef
42.
go back to reference FitzGerald M, Crowly T, Greenhouse P, Probert C, Horner P. Teaching sexual history taking to medical students and examining it: experience in one medical school and a national survey. Med Educ. 2003;37(2):94–8.PubMedCrossRef FitzGerald M, Crowly T, Greenhouse P, Probert C, Horner P. Teaching sexual history taking to medical students and examining it: experience in one medical school and a national survey. Med Educ. 2003;37(2):94–8.PubMedCrossRef
43.
go back to reference Epstein RM, Morse DS, Frankel RM, Frarey L, Anderson K, Beckman HB. Awkward moments in patient-physician communication about HIV risk. Ann Intern Med. 1998;128:435–42.PubMed Epstein RM, Morse DS, Frankel RM, Frarey L, Anderson K, Beckman HB. Awkward moments in patient-physician communication about HIV risk. Ann Intern Med. 1998;128:435–42.PubMed
Metadata
Title
Patient–Provider Communication About Sexual Health Among Unmarried Middle-aged and Older Women
Authors
Mary C. Politi, PhD.
Melissa A. Clark, PhD
Gene Armstrong, BA
Kelly A. McGarry, MD
Christopher N. Sciamanna, MD, MPH
Publication date
01-04-2009
Publisher
Springer-Verlag
Published in
Journal of General Internal Medicine / Issue 4/2009
Print ISSN: 0884-8734
Electronic ISSN: 1525-1497
DOI
https://doi.org/10.1007/s11606-009-0930-z

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