We have to do standardized CLIPP (Computer-assisted Learning in Pediatrics Program) cases for our pediatric rotation. I was very impressed by the case I did tonight as I've often found my medical education to be awkward on how to do a culturally appropriate and comprehensive sexual health interview.
I appreciate that they use an open question as an example instead of the simple, and awkward "do you sleep with men, women, or both?". My actual replies to "do you sleep with men, women or both?" in the past have included "this week?" and "why are those my only two options?" The other issue with being trained to use the both question, is how does the provider follow the response? In the past when I, as a female, answer women, my doctor immediately and uncomfortably plowed forward without performing a comprehensive sexual exam. She assumed that I sleep with women = she's a gold star lesbian, therefor she can not be as risk for pregnancy, STIs, sexual violence, and the many other things they should be screening for. [PSA: STIs CAN be passed between female partners, and same-gender relationship violence DOES occur.] Basically, I believe the both question to be a stinky, outdated, question. I also appreciate that they clearly explain the purpose of such questions in a way that [nearly] any medical student can understand.
The text below is taken directly from the case. While not yet perfect, it is the best I've seen so far. Good work CLIPP! Way to educate medical students across the country!
"You thank Betsy for being comfortable with you enough to allow her to disclose her history of smoking and marijuana.
You now ask Betsy questions about possible sexual activity, "Are you going out with or dating anyone at the moment?"
You ask Betsy if it's getting more serious, and have they been thinking of or had sex yet? You find out that she's never been sexually active. Of course, in your initial discussion you correctly did not inquire if she had a "boyfriend" or make an assumption about Betsy's preferred gender of her sexual partners.
Using gender neutral terms is very important in allowing sexual minority youth to feel comfortable with you. If a teen is sexually active, asking “when you have sex, do you have it with girls, guys, or both” is very important. Sexual minority youth suffer from society’s pervasive homophobia and often have more difficulties during adolescence than heterosexual youth.
Click here to link a power point presentation that discusses adolescent friendly health services and obtaining a comprehensive sexual history."
Case 5 was written in August 11, 2002, by Kim Blake M.D., MRCP, FRCPC, Associate Professor of Pediatrics and Director, Pediatric Undergraduate Education, of Dalhousie University School of Medicine. The current case editor is Kirsten B. Hawkins, M.D., M.P.H., FAAP, Chief, Section of Adolescent Medicine, Assistant Professor of Pediatrics, Georgetown University School of Medicine. The section editor for the case is David Levine, M.D., Professor of Clinical Pediatrics, Morehouse School of Medicine.