PLAB 2: Navigating Sexual Health Consultations with Confidence

As medical professionals, we frequently encounter patients presenting with concerns related to sexual health. For candidates preparing for the PLAB 2 exam, these scenarios are particularly high-yield and can be daunting due to their sensitive nature and the need for astute communication skills. Mastering sexual health consultations in PLAB 2 is not just about clinical knowledge; it's about demonstrating empathy, maintaining professionalism, and effectively navigating sensitive discussions.

Why Sexual Health Matters in PLAB 2

Sexual health stations often test a broad range of competencies, including:

• History Taking: Eliciting a comprehensive and sensitive sexual history, including presenting symptoms, past medical history, drug history, social history, and specifically, sexual activity (partners, practices, contraception, STI history).

• Clinical Knowledge: Understanding common sexually transmitted infections (STIs), contraceptive methods, and other sexual dysfunctions.

• Communication Skills: Building rapport, ensuring confidentiality, active listening, showing empathy, using non-judgmental language, explaining complex medical information clearly, and providing appropriate advice and safety-netting.

• Management Planning: Formulating an appropriate management plan including investigations, treatment, partner notification, and follow-up.

• Ethical and Legal Considerations: Confidentiality, consent, safeguarding, and local guidelines (e.g., Gillick competency for minors).

High-Yield Scenarios and How to Approach Them

1. Suspected Sexually Transmitted Infections (STIs)

This is a very common PLAB 2 scenario. Patients might present with discharge, dysuria, genital ulcers, or simply a request for an STI screen.

Approach:

• Introduction & Rapport: Introduce yourself clearly. Acknowledge the sensitive nature of the consultation and assure confidentiality. "I understand this might be a sensitive topic, but please be assured that everything we discuss today will remain strictly confidential."

• Open-Ended Questions: Start broad: "What brings you in today?" Then, gently delve into specific symptoms, their duration, severity, and any associated features.

• Sexual History: This is crucial. Ask about the number of partners, gender of partners, types of sexual activity (vaginal, anal, oral), consistent condom use, history of STIs, and vaccination status (e.g., HPV, Hepatitis B). Frame these questions non-judgmentally: "To help me understand your situation better, I need to ask some questions about your sexual history. This is routine, and all information is confidential."

• Examination: Explain the need for examination, ensure a chaperone is offered and present if required. "I would recommend an examination to help me find the cause of your symptoms. This would involve [explain what it involves]. We can arrange for a chaperone if you would like one."

• Investigations: Explain the necessary tests (e.g., swabs, urine tests, blood tests).

• Management:

  • Provisional Diagnosis: State what you suspect (e.g., "Based on what you've told me, I suspect you might have an infection called Chlamydia.").

  • Treatment: Discuss empirical or confirmed treatment. Explain the medication, dosage, side effects, and importance of adherence.

  • Partner Notification: Explain why this is important for public health and preventing re-infection. Discuss how this can be done (patient-led or clinic-assisted). "It's very important that any recent sexual partners are also tested and treated, even if they don't have symptoms, to prevent reinfection and further spread."

  • Abstinence: Advise abstaining from sexual activity until treatment is complete and symptoms have resolved.

  • Safety Netting: Advise on when to seek urgent medical attention (e.g., worsening symptoms, new symptoms).

  • Prevention: Discuss safer sex practices and regular STI screening if appropriate.

2. Contraception Counselling

Patients may present seeking advice on starting or changing contraception.

Approach:

• Explore Needs: Understand their lifestyle, relationship status, future family plans, and any personal preferences or concerns regarding contraception.

• Discuss Options: Briefly explain various methods (e.g., pills, implants, injections, IUDs, condoms) along with their efficacy, advantages, disadvantages, and potential side effects. Use visual aids if available.

• Risk vs. Benefit: Discuss risks and benefits specific to the patient (e.g., contraindications for hormonal methods).

• Empower Choice: Help the patient make an informed decision rather than dictating a method. "My role is to give you all the information so you can choose the method that best suits your needs and lifestyle."

• Follow-up: Explain how to start the chosen method and when to follow up.

Essential Communication Tips for Sensitive Topics

• Non-Judgmental Language: Avoid language that could imply judgment or blame. Use neutral terms.

• Confidentiality: Reiterate that the discussion is confidential, especially if a third party (e.g., parent, partner) is in the room.

• Empathy and Reassurance: Acknowledge their feelings. "It sounds like this has been a very worrying time for you." Reassure them that help is available.

• Active Listening: Pay attention to verbal and non-verbal cues. Summarize to ensure understanding.

• Clear Explanations: Use plain language, avoiding medical jargon. Check for understanding frequently: "Does that make sense?" or "Do you have any questions about what I've explained?"

• Signposting: Guide the patient through the consultation, letting them know what to expect next.

Practical PLAB 2 Tips

• Structure: Follow a clear OSCE structure: Introduction, History, Examination (offer/explain), Investigations, Management, Safety-netting, Conclusion.

• Time Management: Be efficient with your history taking but allocate enough time for sensitive questions and thorough explanations.

• Role Play: Practice these scenarios with a study partner, focusing specifically on how you phrase sensitive questions and deliver information. Get feedback on your non-verbal communication.

• Know UK Guidelines: Be familiar with common UK guidelines regarding STI management, contraception, and safeguarding.

Sexual health consultations in PLAB 2 are a true test of your clinical acumen and, crucially, your ability to communicate effectively and empathetically. By preparing thoroughly, practicing sensitive questioning, and demonstrating a non-judgmental approach, you can navigate these stations with confidence and excel in your exam. Good luck!