Sexual Health Issues

Starting the sexual health conversation: Opening the door and establishing rapport

So, how do you lead into a discussion of sexuality related issues?

Almost everyone’s experience is that discussions work best when you have rapport and trust, and this is especially true of discussions surrounding sexual health. Does the young person perceive you as someone who is askable? Do you have a comfortable relationship with them? Does he or she trust you? Building rapport is a great way to start…and how you start to build rapport and segue toward a sexual health related will depend in large part on your relationship with the adolescent and your assessment of the trust in your relationship.  Then, careful consideration must be given to the context of the discussion. Do you know a lot about the client? Regularly speak to them? Has the adolescent indicated an interest in a discussion about sexuality? What safeguards are there for privacy and protection of confidentiality?

You are likely to encounter two types of situations:

  1. Someone will come to you to talk about a sexual health concern.
  2. You need to approach an young person about a sexual health related concern.

For the former, the place of the first discussion will be determined by the other person. The fact that they have approached you, indicates they perceive you as “askable.” They likely won’t start off talking about sex, sexuality, or sexual health and, unless you had concerns prior to the meeting, you may not be initially thinking in terms of sexual health either. In this case, the important thing is to be mindful of the possibility that your discussion may need to go in the direction of understanding possible sexual health related issues.

On the other hand, when you need to approach someone, or address a situation, your first decision is likely to be where and how you approach the person about whom you have concerns. Many times the easiest ways to do this is casually, during a walk or informal interaction at your community based organization; however, sometimes a phone call is the most private and least intrusive way of connecting with an adolescent or his or her parent. During this initial contact, you are simply affirming questions, and opening the door to a conversation. Depending on where the contact occurs, and the seriousness of the issue,  you  may continue it in  a more private or different location.

“Doorknob” questions

Doctors often refer to the underlying issue that a patient really wants to discuss but which the patient doesn’t bring up immediately as a “doorknob” question. “Doorknob” because the patient will often wait until the visit is almost done and you are reaching for the doorknob before they raise the ‘real’ problem. Adolescents who approach you first are quite likely to mimic this behavior. Putting off what they really want to talk about until you help them open up.

** Note, if where this conversation takes place is not public, then it’s advisable that you have another adult present.

For all cases, a key initial issue is how to building rapport. The initial rapport building stage of a discussion will likely not have anything to do with sexual health. Here is where you open the door: do your best to appear comfortable and open to taking your time, give some sense of why you are there, initially ask non-sensitive questions, and pay attention to signs of distrust or discomfort. Without rapport, people will be far less likely to open up about more intimate topics.

We establish rapport to put people at ease. Does this person trust you? What do they perceive your motivations to be in asking about them?

What do they feel you will do with the information if they do disclose sexual health related feelings, and behaviors? What do they think you will think of them (how will you “judge” them)? All of these factors influence when and how a client might disclose a sexual health concern, and may require patient, gentle support for the disclosure to emerge.

Relationships and rapport are built by simply showing up day after day and week after week. Indicate you are glad to see them and care about their well-being. Get to know what they enjoy, how important things like school are going, and who is part of their family.


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