- • Sexual history taking should be routine, nonjudgmental,
- • 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. ||Download (.pdf)
Table 31–1. Key Aspects of Obtaining a Useful Sexual History.
|Assure confidentiality and be nonjudgmental|
|Remind patients of why the information is clinically relevant|
|Be specific and use nonmedical terminology|
|Ask about sexually transmitted diseases as well as preventive and sexual risk behaviors, including type of sex, condom use, and number and types of partners|
|Make no assumptions based on patient characteristics|
|Explore situations that place individuals at increased risk (eg, alcohol or substance use) and, together, develop a concrete risk-reduction plan|
|Use direct questions such as, “Do you have sex with men, women or both?”; “How many partners have you had in the past 2 months, past 1 year”; and “How do you protect yourself from getting STDs?”|
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 ...