This blog brought to you in partnership with FemmePharma. Sexuality is a core component of who we are as humans and is one of the few things we all have in common. If you are human, you are sexual, you have sexuality. Yet, it is often a topic shrouded with shame and secrecy. The taboo aspect of sex, and therefore sexuality, has contributed to a limited view of what sexuality actually is, and subsequently limits our access to education about it. The additional layer of education through an evolved and holistic lens is even further out of reach to most of us.
Health care practitioners have to deal with the consequences of this reality. They hold both the consequences for one, inadequate education and support for their own personal sexuality journey, and two, for being the first person people go to to seek their own education and support. They’re at the front line of many individual’s health care, confronted with an array of sexual health questions, needs, variances, and desires lacking essential tools and concepts to be able to share with their patients and clients.
I have experienced this as well, as a human and as a mental health practitioner. I saw a great need to have a basic competency within the realms of sex, sexuality, and relationships (which has now turned into decades-long specialties), because I saw my clients presenting problems that I felt ill-equipped to support and manage through both my personal and professional education. Now, as a dual-certified therapist, sex educator, and thought leader within the sexuality space, I have identified core elements I offer to HCPs to learn and explore in order to feel supported and more sexually component in their practices. From ophthalmologists to podiatrists, health coaches to nutritionists, I believe we all deserve and require education in order to elevate the care of their patients and also themselves in the process.
Basic Tenets of Holistic Sexuality Competency
You may read these and judge them as obvious, or have a few “duh” moments. Many of these you likely know or already incorporate into your practice. I include them first, however, because they are integral to grasping the importance of sexuality in your daily practice and seeing this topic as crucial in your continuing education instead of an added bonus. This work isn’t a luxury, I believe it to be essential.
You are busy. You may be slammed with patient hours, insurance claims, and managing staff. And that’s only just your day job, we haven’t even included your personal life. You are fully and utterly busy. So if sexuality seems like a luxury, it becomes relegated to a topic that you don’t need to review or learn about when it doesn’t seem like it isn’t relevant to your practice or your life.
This view isn’t your fault and isn’t innately wrong. It is what we have all been taught and it is the mindset that is supported through every aspect of health care. But we can change this. I’ve committed my life to changing this. These basic beliefs are the key to that shift.
- Sexuality, understood holistically, is a necessity of the human experience.
Sexuality is not just sex acts and who we have sex with, it’s the core of who we are. Human sexuality is integral to all other aspects of medical care and extends well beyond our sex organs and genitalia. I have identified 10 pillars of sexuality that form an evolved, holistic perspective in which to observe and understand sexuality. When you understand each component’s complexities and how they are interconnected and woven together, you will see how sexuality should be infused into all aspects of health care, rather than sanctioned off and seen as unrelated to most aspects of ourselves and health. - Sexuality isn’t relegated to a certain phase of life. It begins when we are born and ceases when we die. It’s important to understand the entire spectrum and unique needs at each stage. Puberty, fertility, and general aging aspects like menopause get the big headlines for sexuality within the healthcare space. They are, indeed, heavy hitters but they are merely stops along the sexuality journey, not the only stops to learn and know – there’s a lifetime in between.
Sexuality is ever changing, it is fluid and interacting with each aspect of our lives, all the time. We aren’t sexual beings only when we are engaging in sex acts. We are sexual beings and ‘have sexuality’ from birth to death, every moment. Our sexuality presents itself in unexpected times and places like when you’re 80 years old in a nursing home and learning about STI’s, when you’re on life-saving medications that affect your sexual desire, when a surgery or physical injury has made you feel very different in your body. It is present when a child is exposed to porn at an early on the school bus home, it is present when a young adult experiences erectile dysfunction after trauma. The aspects of presentation are endless, throughout our lives, for all genders, for all people. - Sex-positive vs. Sex-negative. Not many people are going to self-identify as ‘sex-negative.’ Most people will be drawn to identify as ‘sex-positive,’ especially those who generally find sexuality topics important, and those who have a general sense that people have a variety of experiences and presentations of their sexuality. The vast majority of us fall somewhere on a spectrum, and many of us will also find that our ‘sex-positivity’ comes with many judgments, our own shame, and is littered with historic cultural beliefs.
Being sex positive means you make active and purposeful efforts and actions to remove shame and judgment from sex and sexuality, and anything adjacent to this space. It is the belief that we should all have the safety and room to embody, explore, and learn about sexuality without fear of harm, intimidation, or exclusion. This definition makes for a much smaller group of sex-positive folks.
Specifically and for example, it is about examining your language in talking to a patient like not assuming a female-identified patient is having sex with a cis-gendered male, and therefore needs the pill to prevent pregnancy if she identifies as sexually active. It means staying educated on the continuum of sexual acts so you are not shocked if a patient says the bruises you ask about to screen for physical violence is in fact from consensual impact play, a kink sex act that the patient enjoys. It means making an effort in your office to have inclusive images and symbols, and promoting the importance of inclusivity education for all staff.
- Practitioners play a vital role in supporting patients as they evolve. Patients need to be supported and encouraged to seek additional support, resources, and education for their sexual health and holistic sexuality. It takes a lot of courage for most patients to bring up a question, problem, or curiosity within the sexual wellness, health and behavior realms. Understanding the likelihood of the presence of patient shame, embarrassment, and fear is pivotal to setting up all direct and indirect contact with patients. Direct contact involves providing information proactively, bringing up general questions and specific ones. It means that practitioners not only keep up with the latest information in the sexuality space but it also means practitioners keep a robust referral network to sexuality specialists and inclusive, diverse and up-to-date education resources.
- The concept of pleasure is not benign. Being an evolved, holistic, sex-positive practitioner requires you to embrace the importance of pleasure and hold the belief that pleasure is a birthright, part of human existence and overall well-being. Not just something for the young, the “promiscuous”, or the indulgent. Many patients will present with shame, fear, and embarrassment for asking for support in seeking, enhancing, or expanding their pleasure. Many feel seeking pleasure is audacious, slutty, sinful, or impolite to mention. Being a frontline sexual defender, you have the opportunity to dispel those harmful messages. At a minimum, practitioners can support a patient’s interest in pleasure without shame nor judgment, but I challenge practitioners to go a step further and use language that validates and celebrates a patient wanting to experience the range of pleasure in their sexual journey. Make pleasure seem like a priority to one’s health, because it is!
- Anatomy. Understand that learning robust sexual anatomy requires an understanding of inclusivity. All genders, all ages, all races, all people deserve pleasure, health, and wellness. The respect of inclusive language when referring to them as a human, and their unique anatomy is a bare minimum. There is a lot of debate over the gender continuum and where you land on the topic personally is a different article, but for training purposes, it is imperative to understand the complexity of how much is missing from formal anatomy training. A few headlines: the vagina and penis are not the opposites we learned them to be – the clitoral system and penile system is. Know the clitoral system. Learn the correct sexual anatomical names, know the functional range of each part, and understand how each part works to contribute to pleasure. Understand how genitals respond to hormone blocks and aids in transgender transitions. Know that many anatomy models, drawings and photos are white-based, do not fairly represent racial variance, and cause damage to races not represented. In addition to anatomy training, seek out racially-diverse anatomy training and representation.
- Reproductive health. As with anatomy, it is impossible to hit the full range of what needs to be understood within this topic but I will touch on important ones that are not frequently mentioned. Reproductive health is complicated for everyone. It is seen in political, religious, government, school, and community spaces. Everyone has an opinion and there is rarely a gray area as it is loaded for most people. Therefore, many practitioners don’t want to offend a patient or poke the bear of controversy. With the assumption of leaving personal beliefs at the patient door, practitioners must step into this space with a well-rounded knowledge of current and safer-sex practices, as well as the full array of birth control options. You must also deeply understand that there is a lot of fear, outrage, anger and trauma surrounding reproductive rights. This is in response to experiences with things like change of access, past experiences, the political climate, intersections with insurance, and more. Consider asking individuals if there are negative or positive experiences present when it comes to reproductive rights if appropriate.
- Trauma repercussions. We need to be trauma-informed practitioners. If you take one workshop after reading this article, please let it be training that helps you to become a trauma-informed practitioner. The amount of stories I have gathered from clients, followers, and speaking event attendees is astounding. The traumas caused by well-meaning, good-hearted practitioners who did not understand what they said, how they said it, what they didn’t say, what was done or not done in an appointment, and what was asked and not asked have life-long effects. Please know that many survivors of sexual violence, on all points of the continuum, do not report, let alone feel comfortable writing down that experience on a form. Many survivors will not answer truthfully if asked directly even with the best of intentions from a practitioner. Therefore, you must be a trauma-informed practitioner with every single patient. Also, know this extends to your full staff. Any one who could come in contact with a patient needs formal training. You want to be known for being a trauma-informed practice from start to finish.
- Continuums matter. Many continuums exist within sexuality. Gender, orientation, pleasure, and desires are the most well known and I’ve identified a few above. Gender, identity, and orientation continuums have grown exponentially in the last few years and terms are being added often. Prioritizing learning the most up-to-date terms is best practice, but also embrace learning from individuals, validating people’s preferences and desires. There is also a continuum within sex acts, interests, kinks and fetishes. Keep yourself up-to-date with the terms of sexual acts to understand terms mentioned by patients, and ask when you don’t know. Pleasure continuums need to include self-pleasure as an integral aspect of pleasure, and orgasm cannot be the pinnacle and gold star of human pleasure. That’s a continuum too.
Priority Practices for Your Practice
- The value of a sex-positive / sex-safe audit. In order to do an audit of current practices when creating a sex-positive and sex-safe practice, look at office decor, free literature provided, visible posters, etc. What a patient sees, matters. Train the front office to use and understand inclusive language. Include in your office audit a review of how your practice acknowledges the various intersections of race, religion, orientation, etc. as it all relates explicitly to sexuality. Finally, focus on your demographic and intake forms. I want you to ignore complaints about length of forms. For every person who is annoyed by the amount of ‘irrelevant’ questions, there will be five who are grateful for the care and priority. Seeing the questions and validation is healing, helpful, normalizing, life- and culture-changing. I have a number of clients who will tell me they were so relieved their intake form asked a certain question when seeking medical support. Trust me, the effort is noted. And the absence of it is noted too. I also want you to ignore people who are annoyed by ‘all the choices’ of gender, orientation, race, etc. I am going to assert this: They will be okay and are not harmed by the additions to options that are listed. You know who is harmed? The people who fall into those identities who feel invisible, unwelcomed, and misunderstood by their trusted medical providers. Be the provider who has such an up-to-date form, you impress clients of mine who tell me. The effort is worth it and necessary for change.
- Sexual history do’s and don’ts. Sexual history records need to be received free from bias, judgment, overt, and subtle discrimination. We must support honest reporting and safety for curiosity and questioning. This is accomplished in written documents by using inclusive language. It is also important to explicitly state who has / who doesn’t have access to their answers (for instance an online version that goes straight to the medical practitioner vs. a paper version filled out in the waiting room and handed to a receptionist – those differences matter.
When it comes to the questions themselves, providing explanations as to why the information is relevant to their care and how it will be used to help support their sexual wellness creates trust and safety. For example, “we ask about current sexual activity to ensure we are able to give you the most accurate, supportive, and individualized education and support you deserve. We understand sexuality experiences and needs vary for each patient.”
For those who may receive sexual histories verbally, make sure to have a similar explanation about why sexual questions matter to you as a practitioner, and to the patient’s sexual wellness. For example, “we care here about your sexual wellness so we will ask questions to make sure we are providing the right level of care for your needs. I want you to feel safe to answer honestly and I want to know if you need me to change my language at any point or if I should be asking something differently. Most of your answers will not go in my notes so your answers will be between us only.” Of course, only say what is true and only make claims that you will be able to support.
Priority Practices for You as an Individual
You are a human being as well which means you are a sexual being with your own sexual journey. Your experiences, positive and negative, your beliefs, your values, and your current relationship with your own sexuality will matter greatly as you show up for your patients and their sexual wellness. Don’t be the stereotypical medical provider who doesn’t prioritize their own health. Place value in your sexual wellness and seek support as well. You can be an expert in your practice and still need support and have questions from an expert outside of your practice. In fact, I suggest that you seek outside of your professional circle in most cases. Also, you were most likely not properly sex educated like the majority of us, so seek personally-driven sexuality education that will help heal any negative experiences in your sexual past and current life. Here are some places to focus on your own personal (s)exploration.
- Sexual agency. Learn this concept and live this concept. Although complicated in explanation, in short agency is about learning your yeses and nos within the holistic lens of sexuality, and then living them in relationships and communities that support your sexual terms, needs, wants and values. For more on sexual agency, I invite you to watch my TEDx Talk.
- Clean up your past sexual messages. We all have biases, opinions, and beliefs within the sexuality world. Some of those were given to us and we’ve never taken time to purposefully and intentionally examine if they actually reflect the truth of who we are. Take the time required to give that gift to yourself. Look at sexual messages like you would clean house clutter – What do you need to keep because it still works for you? What do you need to recycle because some of it aligns still but not 100%? What do you need to toss out because that was an old life? What is an old belief that you no longer subscribe to?
- Self reflection and self development. So often in “helping professions” the practitioners give and give all day and find such value in helping others. This is wonderful inherently, but what’s left for you at the end of the day? Did you retain enough energy and space to receive help yourself? Invest in therapy, restorative retreats, courses, and resources that support YOU. Not you as a practitioner, but you as a human being, a sexual being. You are worth the time and effort.
- This is just the beginning. And lastly, know that this is just the beginning. If after reading this article, you are inspired to seek further training, I would love to hear what topics you would like to learn more about, have seen presented clinically but didn’t receive training in, and what trends in your practice come up that you feel you need more tools to address. Please write to me at drjulianahauser@gmail.com and I will be gathering the list for further articles and data for targeted training that you can have easy access to.
May this article inspire you to take the next step for your professional work, your practice, and your personal life. Sexuality unites each and every one of us and it’s time we pay attention to all the ways sexuality intersects with our whole health as individuals and communities. I hope that you’ve taken at least one thing from these various offerings that will support you in continuing to develop as a practitioner and person.
Looking for a related blog? Check out Part 1 here!