Written by Maria, RSEI Educator | Published August 30th, 2021
Sex education can cover a vast array of topics. In addition to topics more commonly associated with school sex ed, like STIs, birth control, and puberty, sex education also encompasses learning about healthy relationships, gender and sexuality, consent, pleasure, and media literacy. To be a sex educator means to provide information and skill-building in all of these areas so that students can make informed decisions for themselves. Making decisions to be sexually healthy can also involve accessing services we do not directly provide. Take STI testing for example. In a sex ed setting, we may talk to students about when they should seek testing. The testing itself, however, takes place outside of our scope of service. To get the sexual healthcare they need, young people not only need to know when to seek medical care but also how to seek medical care. Therefore, it’s important that our conversations about going to a health center or doctor’s office don’t start and end with, “You need to do it.”
There are numerous barriers and challenges that may exist for young people seeking sexual healthcare. Some of these barriers, like access to transportation, historical trauma, or cost, may apply to healthcare in general. Others may be more specific to sexual healthcare, like stigma or parental notification laws. As educators, we should be aware of all types of barriers when talking to students about seeking sexual healthcare. This is not to say that it’s our job to remove every barrier that exists for young people, as that’s not always possible nor appropriate. We can, however, support young people in navigating around these barriers in ways that make sense for them. When it comes to structural barriers, that may mean brainstorming ways to access transportation, researching visit costs, or finding out what the privacy laws are for minors receiving sexual healthcare. Beyond the logistical barriers of going to a health center, how can we support students in feeling like they’re able to get what they need out of the visit itself? One way to do this is to talk to young people about advocating for themselves at a medical visit.
When someone goes to a medical provider, there is already an imbalanced power dynamic. Providers have information that patients may not, and they make decisions about patient care. This power imbalance exists for everyone, but for young people, it may be especially pronounced. Oftentimes, young people have less experience going to medical visits on their own. They may be accustomed to the adults in their lives making some decisions for them or to following family or school rules. Young people may also have less information about sexual health or less experience talking about sexual health. There might even be laws or rules about what decisions they can make about their healthcare. All of this may contribute to young people feeling like they don’t have the autonomy that they deserve at a medical visit.
Healthcare, and sexual healthcare in particular, can feel very personal, so it’s important for people to preserve their autonomy at a medical visit in whatever ways they can. This can mean asking questions, voicing concerns, getting more information, communicating boundaries, getting a second opinion, and more. When teaching sex ed, we can center these practices of autonomy and talk about how to use them. Sometimes we may be teaching in group settings where we’re not able to provide one-on-one support for each student on how to advocate for themselves at a visit. But even in group settings, we can always provide information about what to expect. Let’s revisit that example of STI testing for a moment. Although we may not have time to go over each student’s potential concerns or questions, there is lots of information we can include about what an STI testing visit could look like. We can let students know that many STI tests are done through urine testing, which would mean that they would need to pee in a cup so that the provider can test their urine for signs of an STI. We can also make students aware of the other types of STI testing that could take place – like a finger prick, blood draw, swab, or visual exam. While we won’t always know exactly what kinds of testing someone will have at their visit, we can make people aware of the possibilities. We can also let people know that in order for their provider to help them figure out what kinds of tests might be right for them, they might ask questions about their sexual behavior – like what types of sex they have, who they have sex with, and how recently they last had sex. If people know ahead of time what to expect, they will have time to think about what questions or concerns they have. It can even be helpful for students to write down some of their questions and concerns to make it easier to ask their provider at the moment.
In addition to letting students know what they can expect, we can also talk to students about their rights at sexual health visits. Everyone has the right to privacy, to be listened to, to have their identities affirmed, and to have their boundaries respected. Young people often voice concerns about privacy in particular. As sex educators, we often recommend that young people reach out to a trusted adult for support around sexual health. Sometimes, young people will want to bring this trusted adult to their sexual healthcare visits with them. Sometimes, they will not. We may not know everyone’s situation when we are talking about sexual health visits, so it’s important to provide information about any special considerations or laws about minors. Privacy policies for minors may depend on the state, the health center location, the type of services they are receiving, and whether or not they are using a family members’ insurance. We often recommend that young people talk to their provider directly to learn more about their privacy policies.
When talking to students about their rights at a medical visit, it’s also valuable to emphasize consent. For many people, going to a medical visit can feel like giving up control. While it is true that there are certain things a provider needs to do for certain types of visits, consent is still an essential part of the process. For example, if someone is getting a breast exam or a testicular exam, it’s the provider’s job to feel their body for irregular lumps and bumps. Even though it’s their job, they still need to get consent from the patient to touch their body, and they should be explaining what they are about to do and why. And if a patient has questions about what they are doing or why, they always have the right to voice those questions or concerns, even if it requires the provider to pause what they are doing. A sexual health exam might be an unfamiliar experience or even a little awkward, but it still needs to be a respectful experience. Patients can ask for things that may make them feel more respected and comfortable during their visit, like for the provider to tell them when they’re about to start the exam or narrate what they are doing as they are doing it. Those requests can be especially helpful during exams like a pap smear when the patient may not be able to see exactly what the provider is doing. Patients are also not required to stay at an appointment where they feel uncomfortable or disrespected. A patient can leave their appointment at any time, and that is okay. While services like pap smears, testicular exams, or STI testing are important, it’s also important for a provider to do whatever they can to make their patient feel as comfortable as possible.
As mentioned previously, we may not be able to have conversations with each student about what might help them feel prepared to go to a sexual health appointment. We also may not know each student’s situation – their past experiences with sexual healthcare, their financial situation, or their particular concerns. What we can do is give students information and tools to prepare. This doesn’t always mean answering every question that students have about sexual health visits. Sometimes, it just means helping students identify what kinds of questions they might want to ask their provider, or giving them the knowledge to advocate for themselves. Part of our job as sex educators is to help students prepare to deal with situations they may encounter outside of an educational setting. Students deserve sex education that respects their autonomy in making informed sexual health decisions for themselves.
The Q Card is an informational card with places for youth to fill in information about their pronouns, sexual orientation, gender identity, and any concerns or questions they have for their provider. People can bring a Q Card to their medical visit and hand it to their provider during their visit. Q Cards also have a tear-off portion that can be left with a provider outlining tips for how to provide inclusive and informed healthcare for LGBTQ+ individuals.
The Planned Parenthood website features information about “Going To the Doctor,” with subtopics like “What should I talk to my doctor about?”, “What happens at a sexual health check-up?”, and “What If I Don’t Feel Safe at my appointment?”
This video from amaze.org features information about where young people can access sexual healthcare, what services are available to them, and how to find information about privacy policies.