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  • • Sexual history taking should be routine, nonjudgmental, and comprehensive.
  • • Patients should understand how an assessment of sexual behavior will help the clinician take care of the patient.

Collecting an accurate sexual history from patients is essential to the effective clinical management of patients with sexually transmitted diseases (STDs). Many clinicians, however, do not feel comfortable or well-trained in sexual history taking. A useful sexual history is collected in a nonjudgmental manner in which the patient shares personal information about sexual behaviors that might put him or her at risk for STDs. Such information not only guides further evaluation of patients but also may provide opportunities to introduce consideration or reflection about risk-reduction measures into the provider-patient discourse. Key aspects of obtaining a sexual history are summarized in Table 31–1.

Table 31–1. Key Aspects of Obtaining a Useful Sexual History.

The initiation of a sexual history requires that the patient feel comfortable and empowered. The interview should be in a private space with the patient in street clothes sitting at a level equal to or higher than the clinician. There should be no physical barrier (eg, table or desk) between the patient and clinician. The body language of the clinician should suggest openness and acceptance, with hands and legs uncrossed. The clinician should look directly at the patient, nodding encouragement, prompting, and offering periods of silence and reflection of statements.

Early in the session, the clinician should remind the patient that all the information collected during the interview is confidential and cannot be shared with others without the expressed permission of the patient. The clinician should articulate why the sexual history is valuable in a direct and noncondescending manner, using a statement such as the following: “In order for me to take better care of you, I need to ask a few personal questions about your history of sexually transmitted diseases and sexual behavior. Some of these questions may make you feel uncomfortable or may be embarrassing. That is normal and I assure you everything you tell me will stay in this room.” Similarly, many patients find it reassuring to be encouraged to ask questions ...

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