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Doctors, No Fear of Words, Please

Op-Med is a collection of original articles contributed by Doximity members.
Image: Pooja Pradhan for Doximity

Sexuality can be hard to talk about. I think this is true for adults far more than for children. Children are naturally curious and nonjudgmental. They just want to know: What is that, what’s it for, why are yours different from mine, and why does he have one of those and I don’t? It’s we adults who squirm and dodge, deflect and bolt. From a very early age, children learn that it’s not okay to talk about certain things because it makes the grown-ups uncomfortable. I want to change that.

My kids have known formal names of body parts forever — breast, vagina, penis, femur. They also know what the parts do, how they “go together,” etc. Anytime they ask a question, I try to answer as honestly as possible, in an age-appropriate way. For instance, I have had to clarify that babies do not come out of a woman’s “butt.”

First, I had to clarify the general use and meaning of “butt.” Then, I explained that men have two holes down there, and women have three, and the baby comes out of the middle one, between where pee and poop come out. Maybe it’s because my husband and I are both doctors and science nerds — we say these words all day long and never think twice. I think also it’s because I’m a terrible liar, and everybody can tell. It’s just not worth telling one story now, only to recant and revise later. Moreover, even if they don’t challenge the fib I’m telling today, their intuition that I’m not being fully forthright undermines my trustworthiness.

There are important parallels here for physicians and patients, too. In medical school, we learned how to take a sexual history. I think most of us handled it fine, but there was some blushing and gnashing of teeth at times. Again the key is repetition and getting comfortable with saying the words without embarrassment or judgment. “Are you sexually active? With men, women, or both? How many partners do you have now? How many in your whole life? Ever have anal sex? Receptive, insertive, or both? Do you use condoms? Every time?” It also applies to other aspects of the social history. “Do you or have you ever used recreational drugs, such as marijuana, cocaine, heroin? Acid, mushrooms, PCP, MDMA? Anything else?”

The underlying implication is: Tell me anything, I really want to know, and I will only judge the risks to your health, not you as a person.

Once I get to the end of these lists, patients can see and feel that I am comfortable talking about anything related to sex, drugs, and whatever else, and I make no assumptions. They are much more likely, then, to tell me honestly about their behaviors and experiences. I can then make a more accurate assessment of their health risks, and give more relevant advice. As a bonus, we often establish a deeper connection, because that sense of safety now likely extends to other things they may want to disclose. This is often when stories about sexual assault and relationship abuse surface.

I want my children and my patients ask me about sex, drugs, cancer, death, Alzheimer’s, depression, anxiety and all kinds of other things. All of these topics can render us deaf, dumb and blind so often, just by virtue of the acute discomfort they induce. But if we as parents and physicians cannot tolerate them, despite our responsibility in these relationships, how can we expect our children and patients to navigate them successfully? Yes, there is plethora of information on the internet. Much of it is actually accurate and helpful, and I Google as much as anyone. But when it comes to such personal and emotional topics as these, people need more context and interaction than a screen can provide. Google does not know your unique situation. It cannot help you sort through your emotions, your family dynamics, or the implications of your decisions today on your future and the future of your loved ones. We all need a human connection to do that — a safe, trusting and loving connection.

When parents and physicians share our knowledge and expertise freely, in words that children and patients can understand and apply to their own experiences, we empower them to make decisions in accordance with their core values and highest goals. We partner with them in service of their own self-determination. Our role is supportive, guiding, ancillary. We help demystify the process.

My goal is to help my children and patients be responsible, autonomous individuals who exercise good judgment for their own health and that of those they love. Since words are my primary mode of communication, I cannot afford to be afraid to use any of them.

Of note: My family and I recently discovered the book, It’s Perfectly Normal, by Robie H. Harris and Michael Emberley, and I (sing-song voice) love it! We own the 20th-anniversary edition updated to include information on sexuality for this digital, online, social media age. This book appeals to me because it totally demystifies the body and sexuality, and does so with objectivity, openness, inclusion, and good humor. We highly recommend it.

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