Physician Jennifer Gunter was startled by a post she read on Reddit “from a woman whose fiancé insisted she have some kind of premarital exam.”
“So, I Googled ‘premarital exam,’ wondering what a woman might find,” Gunter said in a Sept. 9 blog post. The first result was University of Utah Health. “I just about fell off my chair.”
Gunter was troubled by some of what she read. One section was about keeping antibiotics on hand in case a bride gets a urinary tract infection from having sex during her honeymoon. Another talked about having an exam to “confirm that her body is ready for sex and take steps to reduce discomfort and frustration associated with the first few times,” such as by using sterile dilators.
Such uses of antibiotics and dilators are not considered standard or evidence-based, Gunter said. She also questioned why premarital exam information was only directed toward women. “Is the implication here from the University of Utah that heterosexual men are naturally informed about sex?” she wrote.
University of Utah Health understands that premarital exam is “not the accurate medical term,” and that a better term is “sexual health visit,” said Kathy Wilets, director of public relations and content marketing. But after noticing patients specifically asking for that and searching for that term online, officials decided to meet people “where they are” to connect with and educate them, she said.
“A lot of our patients that come in for a visit prior to becoming sexually active … have misinformation and misconceptions,” said Tiffany Weber, a generalist OB-GYN at University Hospital.
The term “premarital exam” is unique to Utah, said Kristin Hodson, a sex therapist in Salt Lake City and founder and executive director of The Healing Group. Before moving to the state, Weber and Wilets said, they hadn’t heard of the practice.
Sometimes, these visits may be the only place where Utahns can learn about sexual health, Hodson said. There are restrictions on what’s allowed to be taught in public schools in Utah, where the predominant Latter-day Saint faith focuses on chastity when leaders speak about sex. Children may be encouraged to ask their parents for more information, Hodson said, but those parents may also not have been educated.
While Gunter — an OB-GYN and pain physician who has been called “Twitter’s resident gynecologist” and is often quoted by national media — is “all for education” and talking with a doctor, she wrote, a woman “doesn’t need her OB/GYN reinforcing patriarchal tropes” and providing what she described as incorrect information.
University of Utah Health and Intermountain Healthcare have started making changes to their websites on the topic. The university now calls it a “sexual health visit (often referred to as a premarital visit),” while Intermountain uses “premarital consultation.”
University of Utah Health was aware of Gunter’s post but had begun its conversation about updates earlier, Wilets said. Intermountain Healthcare didn’t comment on what prompted it to make changes.
But Intermountain recommends “that anyone of any gender who is considering becoming sexually active or has questions or concerns about sexual health have a visit with their health care provider,” Jean Millar, Intermountain’s executive clinical director of the women and newborns clinical program, said in a statement.
After noticing people searching more recently about male sexual health visits — something it hadn’t seen in the past — University of Utah Health plans to include “language for both men and women” on its website in the next few weeks, according to Wilets.
While the premarital visits have been directed toward females, there’s a need for males to have information about how to have safe, healthy sex, too, Hodson agreed. Sexually transmitted infections have increased in Salt Lake and Utah counties in recent years. “Everybody needs this information,” Hodson said.
University physicians started working on changes after “feedback and discussion within the department that the content that we had our website might be misinterpreted,” Wilets said.
The university has updated and removed sections about the dilators and antibiotics. Both providers suggest people talk to their doctors about contraception, practicing safe sex, the HPV vaccine and any other concerns they have.
Items listed on the website before, such as the dilators and advance prescriptions for antibiotics, were not “necessarily recommendations, but … things that you can potentially discuss with your physician,” Weber said.
“It is not the recommendation to use, to require antibiotics prior to sexual intercourse to prevent UTIs,” Weber said. The same goes for dilators.
Those are just things “that are commonly brought up, or patients commonly want to discuss, that are actually not evidence-based practices,” she said.
A physical exam needs to be done only if a patient has a particular symptom or concern, Weber said. What’s more important is “to make sure that they are safe as they start a sexual relationship.” She said she might use diagrams to review anatomy with patients who may not have been comfortable discussing sex with anyone in the past.
The original webpages were created a couple of years ago, when a university physician had “a lot of patients coming to her, asking for this premarital exam,” Wilets said. She “felt that enough people were asking about this that … she came to our team and asked us to prepare some content because she felt there was a real need.”
The information “was our second-highest performing content on our women’s health page,” Wilets said, and a 2017 blog post on the topic “was really broadly shared.”
These pages were “intended for a very specific group of people,” whom Wilets defined as “heterosexual women who have remained abstinent from sexual activity, are about to get married and who have questions/concerns about their first sexual experience.”
She added: “All content can’t appeal to everybody. We’re trying to reach a very specific audience. But the ultimate goal is to get them accurate information and get them the health information and health care that they need.”