Purpose: In spite of research showing that young people want their family doctors to help educate them about sexual health, clinicians are not likely to provide this type of counselling. Clinical conversations often emphasize the risks of sexual activity, and in many regards, this emphasis is well placed. However, research demonstrates that a singular focus on risks alone may not be effective in promoting sexual health. In addition, recent studies indicate that failing to address sexual pleasure in relationships may limit individuals’ abilities to negotiate safer sexual practices. One first step in developing new and more effective ways to talk about sex is to ask young people what they require in clinical encounters that move beyond risk, while at the same time taking into account clinicians’ perspectives.
Methods: This study employed the qualitative methods of critical ethnography. To listen to young people, while focusing on gender and social context as key concepts, we conducted individual interviews and focus groups with 48 young people between 16-19 years and with 22 sexual health clinicians in Victoria, British Columbia. The transcribed data were analyzed using a process of thematic analysis highlighting contexts and structures, including gender, that shaped young people’s and clinicians’ perspectives.
Results: Most young people indicated they required information about birth control and protection from sexually transmitted infections. However, they also wanted to discuss positive aspects of sexual health. For example, according to one participant, clinicians “should talk about how to make sex good”. Young people requested that clinicians ask questions about orgasm, desire, sexual behaviour, and relationship issues. Young women often described concerns about physical pleasure that they never mentioned in clinical consultations. Young men and women positively described clinicians who “treat them like an equal person”. Young people provided specific suggestions for clinical questions about sexual pleasure. In contrast, most clinicians highlighted their own knowledge and power, delivering content focused primarily on risk management: “this is a one time opportunity to get it into their heads that this is a big deal”. Accordingly, they tended to reserve conversations about pleasure for adult clients. Those who were preoccupied with sexual risk emphasized approaches whose goal was to control or reduce sexual behaviour, leaving little room on the clinical agenda for discussing pleasure.
Conclusions: Young people indicated it was important that clinicians addressed both the risks and the pleasures of sexual relationship, relating to their experiences. Clinicians had their own perspectives, often reflecting more negative attitudes about adolescent sexual health. Failing to include pleasure limited some clinicians’ abilities to initiate clinical conversations relevant to young people’s wants and needs. New clinical content and new attitudes towards sexual pleasure should be developed to support young people in making healthy and responsible sexual choices.
Sources of Support: The principal investigator was supported by the Fredrick Banting and Charles Best Canada Graduate Scholarships Doctoral Award from the Canadian Institute for Health Research.