- Dr. Lalit Chawla
E#35: Nervous Talking about Sex?
In this weeks episode I'll share with you a friend's dilemma about sex talk.
(This is the core of the transcript from the podcast. The Intro has been removed and some areas improved for reading ease.)
This podcast episode is about the topic of sex, and I may be saying something a bit controversial, but I think it's important to say and address this topic. Several months ago, I had a call from a friend of mine, and he would clearly admit that he's an introvert. He is also a doctor, by the way, and the reason I mention this is because it does have some context in the story I'm going to share with you.
Now his son, who is 17 years old, was starting university. His son is in a relationship with a girl, and they've been together for several months.
My friend, like most parents, was not quite sure about their intimacy level. In other words, he didn't know if they were having intercourse or not. A topic that never really came up at the dinner table. And I don't think he's alone in that respect. People, especially children, don't volunteer their sexual activities with their parents.
Learning how to talk about sex, and all its complexities is not something we learn a whole lot about in medical school
Now, keep in mind, my friend and his son have an excellent relationship. They do many things together on a regular weekly basis, and they have a very healthy and admirable relationship as father and son. Talking about sex, with his son, wasn't something my friend was very comfortable with doing, even though he's a doctor, and he's dealt with many uncomfortable situations in the medical setting.
Learning how to talk about sex, and all its complexities is not something we learn a whole lot about in medical school. If we did, we might not use it very often, especially if you are not in family practice or obstetrics and gynecology.
So his dilemma was that his son was going off to university, and his girlfriend more than likely would be visiting him. And the big question in the father's mind was, "would they have sex, unprotected sex? Did they talk about sexually transmitted infections, the chance of pregnancy, mutual consent, etc.?"
"would they have sex, unprotected sex? Did they talk about sexually transmitted infections, the chance of pregnancy, mutual consent, etc.?"
So he wasn't sure what to say or what to do as a responsible father. Should he give his son condoms or not? Was that giving him the green light to go ahead and have sex? A whole lot of uncertainty about an area of discussion, coming from a guy who is highly intelligent and actually a phenomenal communicator. Ironically, he may have been able to talk with a patient about it, but sometimes, as you might suspect, when it comes to our children, we get tongue-tied or shy away from this. So what was he to do? I'll tell you what I suggested when he asked me, but first, I want to ask an important question?
Should he give his son condoms or not?
How and where are young people, and even not so young people, getting their information about sex? With access to social media, access to the internet, friends and peers, it will come as no surprise, whether we want to believe it or not, that information about sex is easily accessible. Thirty years ago, and before that, information about sex was so much harder to access, and that may not have been the best scenario either.
where are people getting their information about sex?
Today with easy access to the internet, we have access to so much information and now have different issues such as porn addiction. The average age a person is exposed to pornography is age 11. One out of ten Americans admits to having an addiction to pornography, so that probably is similar to other parts of the world, and it is estimated that before age 18, every adult will have been exposed to pornography. Just to put it into context, 0.6% of Americans are addicted to cocaine, compared to 10% who are addicted to pornography.
As a refresher, the definition of addiction, according to the DSM5 criteria, is a maladaptive pattern of substance use leading to clinically significant impairment or distress. Or another definition is a chronic, relapsing disorder characterized by a compulsive behaviour that continues despite harmful consequences and has long-lasting changes in the brain.
It's a complicated issue, but we know that pornography can create a distorted reality of what constitutes a healthy and consensual relationship. Plus other issues in terms of one's own body image etc.
"If I don't talk about it or think about it, the problem or topic or issue doesn't exist.
To add more complexities into the mix, with different cultures, beliefs, traditions, restrictions, gender identity, it can become increasingly harder to approach the subject with a child or a patient without preconceived ideas, misinformation and judgements. As clinicians, it may be somewhat more comfortable or open to talking about it with our patients, but as parents, we may hesitate.
Even as clinicians, it can be challenging to bring up the subject with young people, but I think sexual health is an essential aspect of a person's overall health. Whether we want to talk about it or address it with them, is not a simple matter of avoidance by putting our head in the sand and thinking, "If I don't talk about it or think about it, the problem or topic or issue doesn't exist." It does, though.
For example, we may be uncomfortable with telling someone that they have a terminal illness. Still, we tell them because we know that it is our responsibility as competent and compassionate communicators.
As a responsible adult, we can't be introverted about this topic. We can't be afraid to talk about difficult topics but rather create a safe place to engage in a conversation.
You know, if we as adults, have a hard time or are reserved to talk about this topic to our young people, or even our peers, or patients, how in the world will a 15-year-old come to us and break the ice. It just doesn't happen that easily.
As a physician, or individual, your job is to simply state the question, how they react is their job.
I'm always impressed when a parent comes in with their teenage child wanting to talk or ask about birth control. That takes a certain level of dialogue and interaction between the parent and child. That's being very proactive.
So how do you engage in the topic and overcome your reservations or hesitancy?
Is your hesitancy because you might offend them or not being eloquent enough?
Ask yourself, why are you uncomfortable?
So, What's a good opener, or how would you talk about it in the clinical setting?
Well, firstly, it's difficult to dive into the discussion without building rapport and especially in the clinical setting, to ensure confidentiality. A useful resource is the H.E.A.D.S.S assessment guide, which is available on the web. One key element is to normalize it. Start with an open-ended question and ask about how things are at home? How is school? And exploring those areas.
In the clinical setting, I'll start by saying, "you know, this next subject may be a bit awkward to talk about, but I feel it's important to discuss, and I discuss this with most of my patients. I want to be able to ask about sex, drugs, your home life…."
Say it as a matter of fact and as objectively as you can. The tone is very important because when you are uncomfortable, that will come across in your tone and pace. You'll hesitate, you'll look up and down, and they will pick up on that which in turn will make them uncomfortable. But if you simply say it without emotion, as objective as possible they receive it well. So the exact wording may not be so important, but rather the tone and style with which we say it.
I have to say, in my opinion, that the tone and inflection should be kind of monotone.
As a physician, or individual, your job is to simply state the question, how they react is their job. The onus is on them. Now with my experience, I've been surprised how open young people are and that they are quite open to talking about it or any other topic you ask them on. They actually can be good conversationalists. Also it is useful to remember that if they don't talk about it on that occasion, they know that they have an ally with whom they can bring it up later.
When you bring up the topic of sex, it opens the door, and you get them thinking about it.
When you bring up the topic of sex, it opens the door, and you get them thinking about it. You let them know that you are receptive to discussing this topic with them. And the fact that you can bring it up is key, and if you can do it without prejudice or judgement, that really is the key.
So get them involved in the decision process. If they ask you for your opinion, let them know there are options. As clinicians, we can easily talk about the benefits of a medication or a treatment, and we also educate the patient about the side effects too. This should be no different when we talk about the subject of sex.
If, as a parent, you are having a conversation with your child, and you say, "you know I believe that having intercourse as a teenager is too young, explain WHY.
You might say "because the risk of getting pregnant is higher, you don't know the kind of person you truly are dealing with, the chance of getting a sexually transmitted disease is there, you or other person may not be emotionally ready, trust is important, and they can violate that and so on."
Give reasons, merely stating "don't have sex because I said so" just leaves the listener confused as to why? It also adds curiosity as to "why shouldn't I?" and the very thing you didn't want ends up happening, because curiosity creates intrigue. After all, it's mysterious and people are explorers. So as Simon Sinek, a thought leader would say, Start with Why.
So what about my friend and his son? Condoms or no condoms? Talk or no talk?
So I asked him, what would you want him to know if he wasn't your son but a young man you saw in your clinic or someone you didn't care to offend or were comfortable with? Or, as I said in the one podcast on "Turning the Table" which was episode 18, what would you advise me to say if I were to talk to my son.
He told me that he wanted to ask him if his son and his girlfriend talked about sex? He'd say, "you don't have to tell me, but you should know the risks, side effects, of doing it. And if you do decide to engage in intercourse, you should make sure she is ready and that you use a condom. Consent is essential and that there are risks for getting pregnant.
If he asked me about intercourse, maybe even if he didn't, I'd share with him my opinion that perhaps he should wait to have sex, and I would see what my son would say. I'd also buy him some condoms, because he may be too nervous about buying them and if they are getting it on and things are getting heavy, then he should definitely be getting it on if you know what I mean?
I'd ask him if he has brought it up with his girlfriend and give him some suggestions on how to bring up the subject such as saying:" A friend of mine talked with his girlfriend about this and I wanted to ask you about it…"
By the way, young people are further along and more than likely have talked about certain aspects of sex, and we as adults need to get beyond your comfort or unease about it so good sex health conversation matters.
So in summary,
-Sexual health is an intricate part of people's health. Whether we are comfortable or not to talk about it, it is something we should be more extroverted in making sure we engage in a healthy conversation about. Our job is to talk about it without judgement or anxiety. When we get anxious, it shows we are unsure and uncomfortable. So talk, practice and role play with a friend if you need to.
-If you're uncomfortable about talking about it, ask yourself why?
- Remember, as a clinician or parent, our job is to ask, explain and educate. Their job is to interpret and expand on the information.
When you think of things in those terms, it makes it easier to expand your ability to connect with people. Remember many aspects of it will not be brought up by the other individual because they may be uncomfortable about it, or they may not know how comfortable you are about talking about it. Be approachable, open that door to better conversations; it may change a person's life for the better.
Thank you for listening.
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I'm Dr. Lalit Chawla and thank you so much for listening. Let's together make a greater, more effective community so that you live with greater passion, harmony and magic in your life and help others do the same.
Have a fantastic weekend!
I would love to hear any comments about this podcast and what would you like to hear in future episodes?