Sexual health is important for patients of all ages, not just those in their reproductive years. Sexual health is defined as a person’s physical, emotional, mental and social wellbeing in relation to sexuality. It is not merely the absence of disease, dysfunction or infirmity.1
Sexuality encompasses a person’s birth sex, gender, sexual orientation, eroticism, pleasure, intimacy and reproduction.1 While the majority of Australians identify as heterosexual and according to their birth sex, 3.6% of adult males and 3.4% of adult females in Australia identify as lesbian, gay, bisexual, pansexual, asexual or queer.2 Research into the adolescent population found that 2.3% of Australian senior school students identified as being transgender or gender diverse.3 Limitations exist on the data collected about Australia’s gender and sexually diverse populations.2 Additionally, further research is required for a more complete understanding of an individual’s experience, and the breadth of that experience, of gender, relationships, sexualities and lived experience.4
Sexuality is influenced by many factors, including a person’s culture, religion or spirituality, social, economic and psychological state.1 General practitioners (GPs) therefore need to take a holistic approach to all sexual health presentations and consider:5
- a person’s sexuality and gender
- attitudes of a person’s peers and society on sexuality and gender
- circumstances of the sexual relationships the person may be involved in.
GPs need to be comfortable discussing sex with a wide range of people including those of different ages, genders (eg male, female, transgender, intersex, Sistergirl and Brotherboy), sexualities, Aboriginal and Torres Strait Islander peoples, culturally and linguistically diverse people and people with disabilities. It is important to understand the intersectionality of overlapping forms of discrimination and marginalisation for individuals, particularly regarding ethnicity, gender and sexual orientation. Self-reflection and awareness by the GP on their attitude to sexual health, sexuality and gender diversity is vital. The avoidance of assumptions about a person’s sexuality or gender and using gender neutral language (eg ‘partner’ instead of ‘wife’, ’boyfriend’) is paramount in these conversations.6
Some of the more common sexual health presentations in general practice include sexually transmissible infections (STIs), blood-borne viruses (BBVs), pregnancy and patients wanting to prevent unwanted pregnancy through contraception.1,5 Taking a non-judgemental sexual history and identifying individuals at risk of STIs and blood-borne viruses is an important part of general practice. It is also vital for GPs to promote sexual safety and wellbeing through an understanding of the intricacies of sexual consent, safe sex practices and regular testing, particularly for young people and other individuals at increased risk of STIs and BBVs. It is essential for GPs to be well versed in their legislative and public health requirements, particularly regarding notifiable diseases, contact tracing, patient-delivered partner therapy guidelines and mandatory reporting of suspicions of child abuse.
GPs need to be proactive in sensitively raising sexual and reproductive health issues with patients, including:
- consensual sex and age of consent
- sexual assault and intimate partner violence
- prevention, screening and management of STIs and BBVs
- prevention and management of unwanted pregnancy (including contraception options for males, females and gender diverse patients, and appropriate counselling and referral for unwanted pregnancies).
GPs have a significant role to play in respecting and acknowledging those who are transgender and/or non-binary through the use of correct names and pronouns and providing gender-affirming healthcare. They also need to understand the barriers to patients in accessing contraception and sexual health services and advocate for inclusive and individually-appropriate healthcare to reduce social and health inequalities experienced by gender-diverse patients, Aboriginal and Torres Strait Islander peoples, patients from diverse cultural, linguistic and religious backgrounds, as well as those who live in rural and remote areas.