It Is Not Your Fault: Embarrassment Is a Universal Barrier to Sexual Health Disclosure
It is absolutely not your fault for feeling too embarrassed to disclose your sexual practices to your healthcare provider—embarrassment is recognized as the single greatest barrier preventing patients from discussing sexual health issues, and this responsibility falls primarily on healthcare providers to create a safe environment and initiate these conversations. 1
Why This Is a Provider Responsibility, Not Yours
Healthcare professionals are explicitly trained (or should be) to initiate sexual health discussions, as patients consistently cite embarrassment as their primary barrier to disclosure, while providers cite embarrassment and fear of upsetting patients as their barriers. 1
Clinical guidelines clearly state that providers should ask all patients about sexual concerns and initiate these conversations, rather than waiting for patients to bring them up. 2
The medical system recognizes that patients will often disclose sensitive information when directly asked, but rarely volunteer it due to discomfort—this is why provider-initiated questioning is the standard of care. 1
The Real-World Impact of Non-Disclosure
Your embarrassment-driven non-disclosure could have serious health consequences, as providers need complete information about sexual practices (including anal sex) to:
- Screen for appropriate sexually transmitted infections (STIs) specific to anal sexual contact 1
- Assess risk for anal health conditions including trauma, infections, and other complications 1
- Provide relevant preventive counseling about safer practices and harm reduction 1
- Offer appropriate contraceptive counseling if applicable 1
What Should Have Happened
Your provider should have asked open-ended questions about types of sexual activity, specifically including "oral, vaginal, or anal sex" as part of routine sexual history taking. 1
Open-ended questioning is the recommended approach because it avoids simple yes/no responses and encourages patients to discuss personal risks without feeling judged. 1
Providers should create an environment where discussing anal sexuality is normalized, as the absence of sex education and information about anal sex contributes to internalized stigma. 3
Moving Forward: What You Can Do
At your next visit, you can prepare by:
Writing down your sexual practices before the appointment if verbal disclosure feels too difficult—you can hand the provider a note 1
Requesting time alone without parents/partners present if applicable, as confidentiality is paramount for honest sexual health discussions 1
Asking to see a provider of your preferred gender if that increases your comfort, as patients report easier discussions with same-gender providers 2
Reminding yourself that most patients (88%) who disclose sexual activity report positive outcomes, including appropriate STI testing and counseling 4
The Broader Context
Research shows that stigma toward anal sexuality is pervasive and creates concealment behaviors that impede health-seeking, even among populations where anal sex is common (like men who have sex with men). 3
This stigma is so normalized that it affects disclosure even to potentially supportive healthcare workers, leading to omission of critical health information. 3
Healthcare workers themselves report discomfort discussing anal sexuality, which perpetuates the cycle of non-disclosure—but specialized training can improve this. 5
Common Pitfalls to Avoid
Do not assume your provider will judge you or that the information is irrelevant—comprehensive sexual history including specific sexual practices is considered essential for quality care. 1
Do not wait for "the right moment" to disclose—if your provider doesn't ask, you can initiate by saying "I have some questions about my sexual health" or "There are some things about my sexual practices I should probably mention." 2, 6
Do not let one uncomfortable experience prevent future disclosure—if this provider made you feel unable to disclose, consider finding a different provider who demonstrates openness about sexual health topics. 2, 6