Let's Talk About Sex ... and Patient Education
It's the Halloween season (enjoy that office candy this week!). So the time is right to consider one of the scariest topics for many writers: how to discuss sex and other body functions in consumer writing.
Is sex always intimate?
Many diseases and disorders affect sexual function. But this common issue can be difficult for patients to discuss with providers, whether for cultural reasons or uncertainty about what words to use. People with dire conditions might also feel sexual problems are trivial compared to, say, bone metastases. Finally, patients who do not have partners may hesitate to share sexual concerns. Many books and articles -- for example, on sex and intimacy after prostate treatment -- are addressed to couples.
This article won't give you the perfect words for every patient. But I hope it inspires you to think carefully about the words you choose.
Let's look at an example. What's the difference between the statements below?
- Check the box if you have problems with intimacy.
- Check the box if you have sexual problems.
Simple, right? Don't "sex" and "intimacy" mean the same thing? And "intimacy" sounds much more polite. Less embarrassing or distressing perhaps ... but what does it mean? The word is a euphemism for sex, but it can also cover the whole relationship. And what if a patient has erectile dysfunction (or, in plain language, "difficulty getting an erection") but no current partner? The lack of a partner doesn't negate the problem. But the first statement leaves this patient out of the picture. He might feel unimportant or even, depending on cultural conditioning, transgressive for caring about a sexual problem. No partner, no reason for concern, right? But with 45 percent of all U.S. residents now single, it's time to make sure our language is inclusive, even in situations where we tend to assume people have company.
Some options for writing about sex
Being as precise as possible makes writing better. So if you're writing about partner sex, feel free to write "intimacy (sex) with your partner." Though parentheses aren't perfect, I've used them around the plain-language term here because readers respond faster and more accurately to familiar words than less familiar ones. This is called the word frequency effect.
If you're writing about sexuality in general, there's no need to raise the issue of a partner. You can write:
- Sex and intimacy -- Covers all types of sexual activity, including partnered activity.
- Sexual activity -- Covers it all.
- Sexuality -- Even broader.
- Sex -- As in "problems with" or "changes in."
Taboo or not taboo? Words for waste
If you write for patients, sooner or later you describe the body functions that help fluids and semi-solids make an exit. You have choices:
- Use the medical term you feel comfortable with. After all, "defecation" is correct.
- Use a middle-of-the-road term.
- Use a vernacular word, one patients probably use in everyday speech, but that looks too plain and way too casual in a document for the public.
For example, perhaps you're writing on constipation. What should you call the product of constipation relief? Your choices are:
- Feces or stool - medical terms.
- Bowel movement - middle-of-the-road.
- Poop - A nursery word some patients may find too casual or even shocking, although the government of Malaysia had no problem. (If the word bothers you, don't check out this outstanding health infographic on what you can learn from ... you know.)
The right word depends on two things: 1) context, and 2) audience. It's time to set aside sqeamishness for a moment and consider your main purpose: writing information in language patients can understand and use. Not language that repels or offends them, but also not language that confuses them. If the stakes are high, it could be a good time for a focus group (five to 10 people is all you need).
Again, there's no perfect answer. But your answer should be reasoned. Medical terms are perfect for medical audiences, and none of the terms above is perfect for every audience. For example ...
- The term "stool" may confuse low literacy readers or non-native English readers because it is a lookalike, sound-alike term for a piece of furniture.
- "Feces" is Latin. Adults without strong reading skills may not recognize it, so they might skip it entirely.
- "Bowel movement" describes a physiologic event. It's not offensive to most. And most English readers likely recognize the word "bowel," when they hear it. But they may spell it "bowl" because that's how it often sounds.
- Most adults and children recognize "poop" and "poo." In cultural context, however, these words are mainly used with children and pets. The language level, also called the register, is extremely informal. You might be comfortable using these words in a more freewheeling context, like the Malaysian infographic, but not in writing about colorectal cancer.
If someone in your office cares more about propriety than patient comprehension, you might choose to compromise. For example, you might write "stool (poop)," with the plain-language term in parentheses. Not ideal, but better than using a potentially misunderstood word by itself.
If the piece is informal - written for a young audience, used as an internal handout for patient families -- you might be able to use "poop." If you must use "feces," consider including a graphic to show patients what the word means.
Medical discussions touch on topics we don't usually bring into public discourse. But these topics bother patients as much or more than others, and they deserve to be addressed just as clearly. Whatever makes patients feel informed and included, whether it's using the terms they recognize fastest or speaking to the realities of their lives, is the best choice.
I'm always happy to discuss medical words, including for awkward or sensitive topics. Email me or call (503) 734-6853 to chat.
Fall and Holiday Schedule
November 18-24 - Out of office
November 26-27 - Thanksgiving holiday
December 23 - 25 - Christmas holiday
Charts that say what they should
Love data? Care how it looks on the page? Then The Visual Display of Quantitative Information (2nd ed.), by the dean of "visual reasoning," Edward R. Tufte, is for you. Tufte's principles are similar to those for effectively communicating health information: show the data, erase "non-data ink," erase "redundant data-ink," revise, and edit. As we say in patient education, include the need-to-know, leave out the nice to know, and edit (and test) your document.
Color illustrations of the worst graphics ever - "chartjunk," as Tufte calls it, are a lot of fun ... until you cringe. Bonus: beautifully printed and bound, this isn't just informative and entertaining, it's a great coffee-table book.
You're normal, she's normal, we're all normal
Emily Nagoski's Come as You Are is a bestselling book about women's sexuality. It's popular for a good reason: Nagoski does an outstanding job of explaining physiology, cultural contexts, relationship dynamics and much more with wit and compassion. Plus, each chapter has a "tl:dr" ("too long; didn't read") summary at the end.
Even if you've read plenty of sex and relationship books, or think you've heard it all because you work in health care, this book is worth picking up. Not just for women. Couples and men seeking enlightenment will likely benefit, too.
Genevieve J. Long, Ph.D., writes and edits for patients and health care providers. As the business owner, I specialize in patient education, plain language, and health literacy as well as marketing communications.
I belong to the American Medical Writers Association, the Plain Language Association International, and the National Association of Science Writers. In my spare time, I fly fish, walk my black Labs, do yoga, and read consumer health books and mysteries.
Email me or call (503) 734-6853 to discuss your project. I'm always happy to hear from you!
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