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Providing care to patients who practice non-monogamy
Sep 21, 2016 by Jenn De Roo, MA, Registered Clinical Counsellor, and Lauren Goldman, RN(C), Clinic Educator, Clinical Prevention Services, BCCDC
What does non-monogamy actually mean?
People of all genders and sexual orientations have many different ways of being sexually active outside of monogamous relationships.
Some of the ways that people are sexually active include:
- Being single and sexually active, either intermittently or regularly, with one or more partners.
- Having multiple ongoing sexual and romantic relationships, such as polyamory or relationship anarchy.
- Being in one primary relationship and having sex together with others, such as group sex or swinging.
- Being in an emotionally monogamous relationship and having sex outside of it, with all partners’ knowledge.
- Being in a monogamous relationship and having sex outside of it, without all partners’ knowledge.
- Having anonymous sex encounters, where there may be no or minimal contact outside of the sexual encounter, such as cruising.
- Being in a monogamous relationship and having certain kinds of non-sexual or sexual kink play outside the relationship, such as BDSM, fetish, or leather.
- Doing sex work (as a provider).
- Purchasing sex (as a client).
People in any of these situations have different sexual decision-making styles and practices.
People may or may not be having the kinds of sex that carry the possibility of STI transmission or pregnancy. They may be using birth control and barriers (such as condoms, dental dams or gloves) with some or all partners, some or all of the time. They may or may not be getting regular STI testing. They may or may not feel safe and empowered to talk about safer sex and pregnancy prevention with their partners.
Providing informed care
When it comes to talking to a health care professional about their sexual practices, patients may be may be hesitant to disclose information if they perceive judgment from their health care provider. Remaining open and accepting can help patients feel more comfortable with these discussions.
As a health care professional, be aware of how your own social location and experiences affect your assumptions and biases.
In particular, it’s useful to explore your assumptions around risk. Non-monogamy is often listed as a risk factor for STI transmission, without consideration given to the types of sex that people are having, safer sex practices, STI testing, or education and communication about sexual health. In actuality, number of partners is only one factor of many when it comes to risk.
When talking to patients, use language that is welcoming and inclusive of non-monogamous sexual practices. Use open-ended questions whenever possible.
You don’t need to ask specific questions about number of partners. It’s more useful to know the types of sexual activities that patients are engaging in when screening for testing.
Here are some examples of how to frame questions that are inclusive of many types of sexual behaviour, including non-monogamy.
“I’m going to ask some questions that will help me identify what screening tests to offer you based on your sexual activities. People can have all kinds of intimate contact with each other, so please let me know if I have missed anything, or if you would like to add anything.”
- Are you sexually active? This includes any kind of activity where there is skin-to-skin contact between genitals, mouths or anuses, or contact with body fluids like blood, semen, vaginal or anal fluids.
- Do you have oral, vaginal or anal sex? Are you the giver, receiver or both?
- Do you use safer sex barriers such as condoms? If so, how often and during what kinds of activity?
- Do any of your partners ejaculate into the back of your throat, or the inside of your genitals or anus?
- Do you use sex toys with your partners? If yes, what kinds do you use? Do you share them between partners?
- Do you participate in any other activities where you have skin-to-skin contact with genitals, or where you come in contact with blood or genital fluids?
- Do you have any questions about other kinds of sexual activity that we have not yet discussed?
- Do you have questions about any other kinds of sexual practices?
Using inclusive language, being aware of assumptions, and learning more about non-monogamous sexual practices will help health care workers offer more informed and respectful care to all clients.
Categories: Current practice