In the United States, both black and white women discuss sexual health with their healthcare providers, but the frequency and content of those discussions differ by race, according to a recent Journal of Sexual Medicine paper.
Compared to white women, black women were more likely to have had a healthcare appointment during the previous year. They were also more likely to have discussions of sexual health.
The study involved 1,654 women (575 African American/black and 1,079 white, non-Hispanic) between the ages of 18 and 49. Their average age was 35 years. Just over half were married or had been married previously. Almost 80% had attended college or earned at least a Bachelor’s degree.
All of the women were participants in the larger 2018 National Survey of Sexual Health and Behavior (NSSHB). Because the researchers were focusing on differences specific to black and white women, biracial and multiracial women were not included.
Almost 90% of the women had seen their doctor in the past year, and 57% said they’d discussed sexual health during the visit. The most frequent topics for the group overall were sexual activity, birth control, and condom use.
When results were analyzed by race, the researchers found that 91% of the black women had seen their doctor; the rate for white women was 87%. Sixty percent of black women and 55% of white women had discussed sexual health.
Topic discussions also differed between black and white women:
| Topic | Black Women Reporting | White Women Reporting |
| Asked if sexually active | 68% | 57% |
| Asked if sex was painful | 36% | 29% |
| Asked about number of sex partners | 37% | 27% |
| Asked about condom use | 59% | 35% |
| Shown correct condom use | 15% | 5% |
| Provided with condoms for future use | 27% | 10% |
| Offered an STD test | 47% | 23% |
Rates for discussions of birth control were similar for both black and white women.
The researchers pointed out that STD rates have been higher for black women. Providers might have asked black women about condom use and STD testing more often than white women because of this situation.
In addition, black women were more likely to discuss their number of partners and their experiences with painful sex, and it’s possible these conversations were in the context of STDs.
However, the authors were concerned that black women might be “targeted” for sex health discussions. And while such discussions can boost knowledge and comfort level, there could be negative repercussions for black women. Providers may be “reinforcing stereotypes about black sexuality,” causing racism and discrimination to “become an upstream factor” for sex health outcomes.
“This is an opportunity for healthcare providers to become more aware and sensitive to the role they play in perpetuating stereotypes,” the authors wrote.
Providers should reflect on their own biases, receive appropriate training, and work toward policy changes that move toward equality in healthcare, they noted, calling for similar research including women of other races and ethnicities, sexual orientations, and gender identities. Studies of men are also warranted, they said.
It was unknown who initiated the sex health conversations, and this was an acknowledged limitation to the research. While providers might have been targeting black patients, it’s also possible that black women were more likely than white women to start these conversations themselves.
Resources
The Journal of Sexual Medicine
Townes, Ashley, PhD, MPH, et al.
“Inequitable Experiences Between Black and White Women Discussing Sexual Health With Healthcare Providers: Findings From a U.S. Probability Sample”
(Full-text. Published: July 2, 2020)
https://www.jsm.jsexmed.org/article/S1743-6095(20)30642-1/fulltext#%20