Women’s voices are finally being elevated on a national level to the prominence they deserve on workplace, political, and social issues.
But as a physician (and father of two adult daughters), I’m concerned that women may not feel empowered to use their voices for their own health care. A 2015 survey found that only 22 percent of women in the United States possess health literacy skills, although health literacy is critical to achieve optimal outcomes. Other research suggests women’s physical symptoms are more likely to be interpreted as due to psychological factors than are men’s.
Unfortunately, these barriers may materialize at an early age. We recently surveyed young women between the ages of 15-24 regarding their reproductive health, mothers of women in this age group, and physicians, to better understand factors that might be contributing to the high rates of sexually transmitted diseases (STDs). According to the Centers for Disease Control and Prevention (CDC), cases of STDs are at an all-time high, with more than two million cases of chlamydia, gonorrhea, and syphilis reported in the United States in 2016. Young people aged 15–24 years acquire half of all new STDs, and alarmingly, one in four sexually active adolescent females has an STD.
These rates may be impacted if clinicians encouraged positive, non-judgmental dialogue about young women’s health care. But our findings suggest that the medical community has much work to do to overcome communication obstacles and empower young women to take charge of their health care.
Young women aren’t well informed about sexual risk — and don’t feel empowered to communicate frankly and honestly with their clinician. Young women can’t safeguard their health if they don’t know what or who to ask – let alone what to do with the information. Even though most young women have some knowledge of sexually transmitted infection and disease, many don’t understand the risk of common STDs. Only about half of sexually active young women we polled say they have been tested for an STD – because they say they don’t see the need. About one-quarter of young women don’t feel comfortable talking about STDs to a doctor or nurse, and nearly one-third don’t tell the truth to their provider about sexual activity.
One-quarter of physicians are “uncomfortable” with young women’s reproductive health issues. One in four (24 percent) primary care physicians we polled agrees with the statement, “I am very uncomfortable discussing STD risk with my female patients.” That’s probably one of the key reasons that more young women say they learned about STDs in their sex ed and health classes at school than from their doctor.
Young women aren’t being screened according to medical guidelines. The worst possible result of young women not being empowered in their health care is that their care suffers for it. Half of the young women we surveyed claim their nurse or doctor has never asked if they want STD testing, despite medical guidelines that recommend testing all sexually active young women under age 25. And although many STDs do not cause any symptoms, only seven in ten doctors said they would order chlamydia or gonorrhea testing for a sexually active, asymptomatic young female patient.
Mothers may unintentionally quell communication between their daughters and physicians. Although parents (and especially mothers) play a vital role in health education and access to health care for minors and young adults, we found that mothers are sometimes a barrier to conversations on reproductive care for their daughters, at least when they are in the exam room together. Our survey found young women are far less likely to be truthful about sexual history or talk about STD testing when their mother is with them. Physicians must be attuned to this dynamic, discussing the need for STD testing separately with mothers, and requesting time alone with their patients for sensitive and honest conversations.
The most significant takeaway from our STD research is the importance of communication: through health education, in patient-physician interactions, and to ensure adherence to guideline-based care. It’s clear these takeaways are transferable across the health care spectrum for young women. When we empower women at an early age to use their voices – to ask questions about their health, communicate honestly and fearlessly about their needs, and demand the services they deserve — they will soar to greater health, and greater heights.
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