Over 50% of the Abo­rig­i­nal and Tor­res Strait Islander pop­u­la­tion across Aus­tralia is young – less than 25 years old. There are high rates of sex­u­al­ly trans­mit­ted infec­tions (STIs) in young peo­ple right across Aus­tralia, but in very remote Aus­tralia there is lim­it­ed access to meth­ods of birth con­trol or spe­cial­ist ser­vices, and lim­it­ed knowl­edge of sex­u­al health. Remote com­mu­ni­ties rely on remote area nurs­es (RANs) for accu­rate infor­ma­tion, screen­ing and treatment. 

The most com­mon STIs, chlamy­dia, gon­or­rhoea, tri­chomonas and syphilis, have few or no symp­toms. All STIs in preg­nant women can have seri­ous con­se­quences both for the woman and her baby. 

Syphilis has sig­nif­i­cant­ly increased in Aus­tralia over the last ten years, now declared a Com­mu­ni­ca­ble Dis­ease Inci­dent of Nation­al Sig­nif­i­cance by Australia’s Chief Med­ical Offi­cer, and women of repro­duc­tive age are espe­cial­ly at risk. 

Explor­ing sex­u­al health mat­ters with young peo­ple pro­vides them with accu­rate infor­ma­tion about how their body works and how they can care for them­selves. Ear­ly detec­tion of STIs can pre­vent long-term health com­pli­ca­tions, such as infer­til­i­ty or chron­ic infections. 

Young peo­ple need to learn about puber­ty and the nor­mal changes occur­ring in their bod­ies, too.

Work­ing in very remote com­mu­ni­ties where Eng­lish is not the first lan­guage for many peo­ple, RANs become adept at sketch­ing anato­my dia­grams to illus­trate a con­cept and sourc­ing pic­to­r­i­al resources. 

Par­tic­i­pat­ing in a group health ses­sion organ­ised by the local youth work­ers, one RAN found that the grand­moth­ers, moth­ers and girls were all fas­ci­nat­ed by the men­stru­a­tion cycle sto­ry. Nor­mal­is­ing the sto­ry and offer­ing prac­ti­cal tips on how to man­age men­stru­al bleed­ing gave the women more con­trol over their bod­ies. Under­stand­ing fer­til­i­ty helped the women to under­stand con­cepts such as con­tra­cep­tion, STIs and cer­vi­cal screen­ing – often all lumped togeth­er under ​‘women’s health’ in remote clin­ic settings. 

Issues such as sex­u­al dys­func­tion, trau­ma, or abuse may not be revealed unless the RAN cre­ates a safe and sup­port­ive envi­ron­ment. Address­ing these con­cerns can improve qual­i­ty of life, enhance rela­tion­ships, and pre­vent fur­ther psy­cho­log­i­cal distress. 

A young man with a seri­ous men­tal ill­ness declined to take his anti-psy­chot­ic med­ica­tions. The RAN in his com­mu­ni­ty was atten­tive to his con­cerns and found the patient attrib­uted his impo­tence to the anti-psy­chot­ic med­ica­tion he was pre­scribed – a valid con­cern. He and his part­ner want­ed to have chil­dren. Work­ing with the psy­chi­a­try team, a suit­able alter­na­tive med­ica­tion was found. The young man remained men­tal­ly well, and he and his part­ner had a child a year later. 

Being skilled in this area of health is essen­tial to reduc­ing health dis­par­i­ties. It helps to ensure that all patients, regard­less of gen­der, ori­en­ta­tion, or back­ground, receive the same lev­el of atten­tive and non-judg­men­tal care. It fos­ters trust between patients and RANs, pro­mot­ing bet­ter health out­comes and patient satisfaction.

• Con­sid­er ter­mi­nol­o­gy. Think about the many rela­tion­ships peo­ple have and what it might mean to the patient if asked, ​“Are you in a sta­ble rela­tion­ship?” A sta­ble rela­tion­ship could be two part­ners, three part­ners, an occa­sion­al part­ner, pla­ton­ic or some oth­er vari­a­tion. Anoth­er exam­ple is ask­ing if some­one is mar­ried. They could answer yes and might be mar­ried but haven’t seen their mar­ried part­ner for many years, or be liv­ing with some­one dif­fer­ent. Using the words, ​“Are you sex­u­al­ly active?” means the RAN will need to explore what sex­u­al­ly active means to the patient; does it include pen­e­tra­tive vagi­nal, oral, anal sex, or kiss­ing and cuddling? 
• Com­mu­ni­ca­tion tech­niques. Use com­mu­ni­ca­tion tech­niques such as open and closed ques­tions, silence, clar­i­fy­ing, sum­maris­ing, and reflect­ing. Ques­tions that don’t have under­ly­ing assump­tions, are pre­cise and use­ful, and are under­stood by both patient and clin­i­cian, are the aim.
• Side­ways talk. Explain the issue with­out relat­ing it to the per­son, then bring the per­son in. For exam­ple, ask, ​“Have you seen the ads on TV for STI test­ing? Have you thought about hav­ing an STI test?” 
• Nor­malise. For exam­ple, say, ​“We offer this to everyone.” 
• Hook. For exam­ple, say, ​“Have you heard about the HPV vac­cine?” Alter­na­tive­ly, say, ​“Do you have one of those rods (Implanon con­tra­cep­tive) in your arm?”
• Incor­po­rate. For exam­ple, say, ​“While we are talk­ing about cer­vi­cal screen­ing, can I also talk about your sex­u­al health?” 
• Warn­ing shot. For exam­ple, state, ​“I am going to ask you some per­son­al ques­tions, these are all for a rea­son, and they are all con­fi­den­tial. Is that ok with you?” 
• Impor­tant­ly, nev­er apol­o­gise for ask­ing ques­tions relat­ed to sex­u­al health. Under­stand­ing a patient’s sex­u­al health enables RANs to iden­ti­fy poten­tial risks, pre­vent dis­eases, and offer more per­son­alised treat­ment options.