Insight Therapy

Psychologically informed reflections on how we interact.

Sexual Communication 2: Non-Bedroom Edition

Awkward--and harmful--silences about sex outside the bedroom

Last week’s post discussed the dismal state of sexual communication between sexual partners, be they one-time hookups or long-time spouses. The data suggest that these awkward bedroom silences come with a price. They are linked to less pleasurable and more risky sex and can have negative implications for relationships.

While much of the research on sexual communication has understandably focused on intimate romantic relationships, communication concerning issues of sexuality has important implications in other arenas as well. Sexual communication between parents and children, and between doctors and their patients, is just as important as it is between lovers--and just as difficult. 

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Research has shown quite consistently that parent-child sexual communication is among the predictors of sexual initiation, risk behavior, and contraception use among teens.

For example, open parent-child sexual communication was identified as one of the protective factors for children’s sexual and reproductive health in an extensive recent review of the literature between 1985-2007 by Christine Markham and her colleagues.

In addition, reviewing 15 studies on the topic, Madeline Sutton and her colleagues found last year that “Parent-child communication interventions that include parents of youth disproportionately affected by HIV/STIs can effectively reduce sexual risk for youth…and improve sexual health outcomes.”

Along similar lines, Megan Roberts and her colleagues at Dartmouth found that mother-daughter communication was an important predictor of HPV vaccination rates among young women.

Boston College researcher Katherine Hutchinson found that, “Early parent-adolescent sexual communication was associated with later age of sexual initiation, consistent condom use and, indirectly, less likelihood of sexually transmitted diseases. Mother-daughter communication about condoms was associated with consistent condom use.”

Overall, the research suggests strongly that positive and open parent-child communication about sex may help guide and protect young adolescents as they embark on their adult sexual paths. Lack of communication, on the other hand, may expose them to risk and contribute to poor decision-making.

And yet the data on the actual quality and rates of parent-child communication paint a dismal picture. For example, in a 2010 longitudinal study by Megan K. Beckett and colleagues of 141 parents and their adolescent children, 40% of the children had intercourse before they had any discussion with their parents about sexually transmitted disease, condom use, choosing birth control, or partner condom refusal. Laura Widman and her colleagues, in a recent study of 603 young adolescents (ages 12-15) found that 29% had not communicated with their parents at all about sexual topics such as condoms, birth control, sexually transmitted diseases, HIV/AIDS, pregnancy, and abstinence.

Reviewing 30 years of research on parent-child communication about the birds and the bees, E. Sandra Byers’s (2011) concluded that both parents and adolescents rate the quality of their sexual communication as poor. Parents, according to the data, do not provide detailed sexuality education to their children even when it comes to relatively noncontroversial topics like birth control, safe sex, and sexual decision-making.

Most parents, it turns out, want to provide their children with better sex education than they have received, but most fail to do so.

Now in fairness, parents’ difficulties are quite understandable in light of the emotionally charged terrain they must navigate and their haphazard preparation. All parents, after all, are amateur parents. They receive little training and no pay. However, this is not the case for health care professionals such as psychologists and physicians. One may reasonably argue that--since sexuality is an integral part of our overall mental and physical health--health professionals should be trained, skilled, and comfortable discussing sexual topics with their clients competently and dispassionately. Alas, this is not the case.

Byers’ review shows that health care professionals receive little to no training regarding how to approach and address clients’ sexual issues. For example, most practicing psychologists have not had a graduate level course on sexuality and their preparation for discussing the topic is, by their own reports, inadequate.

A 2011 review by Sharron Hinchliff and Merryn Gott of twenty-five articles from 1999 to 2010 found that older patients were more likely to seek help if their doctor inquired about sexual function during routine visits. However, according to the results, most doctors failed to inquire about sexual health and had limited knowledge of later-life sexuality issues. Because doctors don’t ask, patients don’t tell, jeopardizing their sexual well-being in the process.

A 2012 study by Stacy Tessler Lindau of the University of Chicago Medical Center revealed that even most OB-GYNs do not routinely ask their patients about sexual satisfaction, problems, and pleasure.

Patients appear to be quite aware of their doctors’ discomfort. Two-thirds of 500 patients surveyed by Charles Marwick in 1999 said they believed discussing their sexual concerns would embarrass their doctor.

Kathryn Flynn of Duke University and her colleagues, summarizing results from a study of sex-related communication among cancer patients and their doctors, concluded that, “Sexual health has yet to be fully integrated into oncology care, even for cancers involving sex organs.”

The lack of preparation and skill among health care professionals in dealing with sexual topics has several real world implications. At the very least, it constitutes a missed educational opportunity. For example, Stewart C. Alexander of Duke University Medical Center and his colleagues, analyzing 253 doctor-patient interactions, found that roughly “one-third of adolescents encounter no mention of sexuality issues during their annual health maintenance visit.” When doctors did initiate such talk, they routinely received little response and proceeded to drop the issue quickly, thus failing to establish the rapport and open dialogue that could help their patients.

Evidence suggests that dismal doctor-patient communication is potentially detrimental not only to patient morale, but to their health outcomes as well. For example, in 2007, Jaya K. Rao of the American College of Physicians in Philadelphia and her colleagues conducted a systematic review of over four decades of doctor-patient communication studies. They found that good communication predicts both patient satisfaction and more positive patient outcomes with conditions such as chronic headaches, diabetes, and hypertension.

In sum, the evidence to date supports quite clearly the notion that sexual communication between parents and their children, and between doctors and their patients, serves an important health function. Yet it also shows that, as things now stand, a young person cannot turn to her parents for sexual guidance, nor can she trust that her doctor will comfortably and proactively address her sexual health and satisfaction concerns, now or in the future.

When it comes to sexual communication, ignorance is not bliss, and silence is not golden.

What do we say to that? 

Noam Shpancer, Ph.D., is a professor of psychology at Otterbein College and a practicing clinical psychologist in Columbus, Ohio.

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