Navigating Sexual Health with Tonya Chaffee, MD, MPH: From Screening to Open Conversations

The Centers for Disease Control and Prevention (CDC) states that a significant challenge in combating sexually transmitted infections (STIs) is the fact that most people who have them do not exhibit symptoms, making regular screening crucial. The shift from referring to these as sexually transmitted diseases (STDs) to STIs further emphasizes the importance of identifying infections early, even when symptoms are absent. Historically, STDs were only diagnosed when symptoms were present, but this approach overlooks the many asymptomatic infections that can lead to serious long-term health consequences, particularly for women, including pelvic inflammatory disease, chronic pelvic pain and infertility.

In an interview with The Educated Patient, Tonya Chaffee, MD, MPH, clinical professor of Pediatrics at the University of California, San Francisco, explains that despite the critical need for screening, societal stigma around sexual health continues to be a major obstacle. Many people avoid testing due to the negative connotations associated with discussing sexual behavior. Healthcare providers can also contribute to this stigma, which can lead to discomfort and reluctance to disclose important information. This stigma is not just a social issue; it directly impacts public health, as people who are reluctant to discuss their sexual health are less likely to seek out testing and treatment.

Opt-out screening is a way to reduce this stigma, particularly for adolescents and young adults. This approach means that instead of determining who is sexually active and only screening those individuals, healthcare providers screen everyone, regardless of disclosed sexual activity. This method, previously adopted in HIV testing, has been shown to lessen stigma and increase the detection of infections that might otherwise go unnoticed.

For parents, Chaffee says discussing sexual health with their children can be challenging, but it is essential. Conversations should go beyond just the risks of STIs and pregnancy to include broader topics like trust, intimacy and respect. Unfortunately, due to gaps in sexual education, in part exacerbated by the COVID-19 pandemic, many young people are turning to unreliable sources like pornography for information, which can lead to distorted views on sex and relationships.

Chaffee urges healthcare providers to create a supportive environment where young people feel comfortable discussing sexual health. It's also important for young people to know that they have the right to seek care and testing for STIs confidentially, without parental consent, which can help overcome potential barriers to accessing necessary health services. In this evolving landscape of sexual health, both accurate information and destigmatized, proactive care are key to preventing and managing STIs effectively.

Disclosures: Chaffee is a consultant for Hologic and trainer for Nexplanon through Organon.