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A Guide to Taking a Sexual History
Questions should be gender appropriate. 1.Opening/Introduction 2.Present Illness/Focused Past Illness History 3.Sexual Partner(s) 4.Sexual Activity 5.Sexual functioning 6.Sexual Concerns 7.Drug use / abuse 8.Abuse History 9.Wrap-up and Next Steps / Education and Developing a Care Plan 10.The patient’s marital/relationship Questions to be asked in sexual history 1. Opening/Introduction Establish a relationship with the patient Non-verbal cues Confidentiality: “I am going to ask you some questions about your sexual health and sexuality” “I ask these questions to all of my patients.” “The answers to these questions are important for me to know to help keep you healthy.” “Like the rest of this visit, this information is strictly confidential.” Demographic information: Tell me a little about yourself. _________________________ Who do you live with? _________________________ What do you do for work? _________________________ 2. Present Illness/Focused Past Illness History Chief complaint (problem as patient sees it): “Tell me a little about what brought you in today.” Onset, duration, etc. – urogenital complaints will often present as dysuria (burning during urination), discharge, dyspareunia (painful sexual intercourse), or genital lesions. Any of these findings or complaints should be your trigger to launch into a detailed sexual history When did it start? _________________________ How long has it been going on? _________________________ Does anything make it better or worse? _________________________ Is anything else bothering you? _________________________ Prior episodes: Have you ever experienced anything like this before? _________________________ Have you had this problem before? _________________________ Did you practise safe sex? _________________________ How can I help you? _________________________ What’s the problem? _________________________ What do you think caused the difficulty? _________________________ How long has the problem been present? _________________________ Is the problem related to the time, place, or partner? _________________________ Is there a loss of sex drive or dislike of sexual contact? _________________________ Are there problems in the relationship? _________________________ What are the stress factors as seen by the patient and by the partner? _________________________ Is there other anxiety, guilt, or anger not expressed? _________________________ Are there physical problems such as pain felt by either partner? _________________________ 3 Sexual Partner(s) Relationship of partner(s) to patient: Are you currently in a relationship? _________________________ What term would you use to define your relationship? _________________________ Partner(s) other partner(s): Is (are) your current partner(s) exclusively with you, or with others as well? _________________________ Are you currently sexually active with men, women or both? _________________________ 4 Sexual Activity In the past, have you been sexually active with men, women or both? _________________________ Are you currently sexually active with one or more than one partner? _________________________ How many sexual partners have you had in the past 3 months? In the past year? In your lifetime? _________________________ What specific sexual behaviors do you engage in? EX: oral-genital/ oral-anal/ vaginal penetration/ anal penetration _________________________ What methods of protection do you use with each behavior? _________________________ Ask about details of each behavior, birth control and STI protection. Is there a possibility you could be pregnant? _________________________ When was your last menstrual cycle? What methods of birth control are you using? _________________________ Have you had a pregnancy test since your last period? _________________________ Frequency: How often do you have sex? _________________________ Are you satisfied with that frequency? _________________________ 5 Sexual functioning Satisfaction with sex life: Do you experience any discomfort or pain during sex? _________________________ Sexual dysfunction (possibly a side effect of medication): Many people experience some type of sexual dysfunction at some point in their life. Is there anything you would like to talk about regarding your sexual functioning? _________________________ Has the frequency of your sexual urges or arousal changed at all? _________________________ Is vaginal dryness a problem for you?” _________________________ 6 Sexual Concerns Questions about sexuality/gender identity: Do you have any questions about your sexuality, sexual orientation, or sexual desires that you would like to discuss? _________________________ Do you have any concerns about your gender identity? _________________________ Anxieties, misconceptions: What medical or emotional difficulties or concerns have you or your partner had related to sex? _________________________ Do you feel any anxiety about your sexuality or sexual performance? _________________________ Is there anything you have heard from others about sex that you were hoping to get a medical opinion on? _________________________ 7 Drug use / abuse Do you use alcohol or drugs when you have sex? What about when you are not having sex? _________________________ Do you feel like you are more likely to have unprotected sex when you drink or use drugs? _________________________ Partner(s): Are you aware of any partners you have had that have used IV drugs? _________________________ Does your partner use alcohol or drugs when you have sex? _________________________ What about when you are not having sex? _________________________ Do you feel like you are more likely to have unprotected sex when they drink or use drugs? _________________________ 8 Abuse History What happens when your partner gets angry? _________________________ Have you ever been fearful that an altercation with your partner may turn violent? _________________________ (if so, determine details) Non-consensual sex: Have you ever been forced to have sex against your will? _________________________ Here are further guidelines. 9 Wrap-up and Next Steps / Education and Developing a Care Plan Are you interested in taking birth control? Would you like more information about it? _________________________ Is there anything we didn’t cover? _________________________ Are you currently sexually active? (Are you having sex?) _________________________ If no, have you ever been sexually active? _________________________ In recent months, how many sex partners have you had? _________________________ In the past 12 months, how many sex partners have you had? _________________________ Are your sex partners men, women, or both? _________________________ If a patient answers “both” repeat first two questions for each specific gender. _________________________ If a patient has been sexually active in the past, but is not currently active, it is still important to take a sexual history. 1. Partners If a patient has had more than one sex partner in the past 12 months or has had sex with a partner who has other sex partners, you may want to explore further his or her sexual practices and condom use. Asking about other sex practices will guide the assessment of patient risk, risk-reduction strategies, the determination of necessary testing, and the identification of anatomical sites from which to collect specimens for STD testing. I am going to be more explicit here about the kind of sex you’ve had over the last 12 months to better understand if you are at risk for STDs. What kind of sexual contact do you have or have you had? Genital (penis in the vagina)? Anal (penis in the anus)? Oral (mouth on penis, vagina, or anus)? _________________________ To learn more about the patient’s sexual practices, use open-ended questions. Based on the answers, you may discern which direction to take the dialogue. You will need to determine the appropriate level of risk-reduction counseling for each patient. If a patient is in a monogamous relationship that has lasted for more than 12 months, risk-reduction counseling may not be needed. However, in other situations, you may need to explore the subjects of abstinence, monogamy, condom use, the patient’s perception of his or her own risk and his or her partner’s risk, and the issue of testing for STDs. Do you and your partner(s) use any protection against STDs? If not, could you tell me the reason? If so, what kind of protection do you use? _________________________ How often do you use this protection? If “sometimes,” in what situations or with whom do you use protection? _________________________ Do you have any other questions, or are there other forms of protection from STDs that you would like to discuss today? _________________________ Have you ever been diagnosed with an STD? When? How were you treated? _________________________ Have you had any recurring symptoms or diagnoses? _________________________ Have you ever been tested for HIV, or other STDs? Would you like to be tested? _________________________ Has your current partner or any former partners ever been diagnosed or treated for an STD? Were you tested for the same STD(s)? If yes, when were you tested? What was the diagnosis? How was it treated? _________________________ Are you currently trying to conceive or ________? _________________________ Are you concerned about getting pregnant or getting __________? _________________________ Are you using contraception or practicing any form of birth control? Do you need any information on birth control? _________________________ What other things about your sexual health and sexual practices should we discuss to help ensure your good health? _________________________ What other concerns or questions regarding your sexual health or sexual practices would you like to discuss? _________________________ At this point, thank the patient for being open and honest and praise any protective practices. For patients at risk for STDs, be certain to encourage testing and offer praise for protective practices. Explain that STD prevention methods (or strategies) can include abstinence, monogamy, i.e., being faithful to a single sex partner, or using condoms consistently and correctly. These approaches can avoid risk (abstinence) or effectively reduce risk for getting STD (monogamy, consistent and correct condom use). After reinforcing positive behavior, it is appropriate to specifically address concerns regarding high-risk practices. Your expression of concern may help the patient accept a counseling referral, if one is recommended. C ompleting Do you have any concerns or questions about sexual functioning? _________________________ How satisfied with your sexual functioning are you? _________________________ Is there anything about your sexual activity you would like to change? _________________________ 10. The patient’s marital/relationship state How many previous sexual partners there have been Who the current partner is and for how long How many children the patient has Which of them lives with the patient Whether there is obvious stress in the family Do you have children? _________________________ How do you feel about your family? _________________________ Do you live with a family? _________________________ Do you have a family? _________________________ Who are your immediate family members? _________________________ How do you define a family? _________________________ Are you living alone or in a joint family? _________________________ Do you prefer to live alone or in a joint family? _________________________ Where are the patient's parents and other family members? _________________________ What is your family ancestry? _________________________ What state, region, and continent did your mother and father come from? _________________________ What was the religion of your mother and father? _________________________ Do you have any brothers and sisters? _________________________ How many brothers and sisters do you have? _________________________ Where are they located? _________________________ Who from your family or relatives should be contacted in case of an emergency? _________________________ Who are his or her community members? _________________________ Who are your family members as of February 15, 2012? _________________________ Who were your family members at the time of your birth? _________________________ List profile of mother, father, brothers, sisters, grandparents, and extended family members. _________________________ What is the profile of your family? _________________________ How should you give your family details? _________________________ I do not know anyone in Illinois who is included in my family as of September 4, 2012. I have lived in Chicago, Illinois, for more than 13 years. For these 13 years, I did not have any family member in Illinois. I do not have a girl or female friend as of September 4, 2012. I have not had a girl or female friend in Illinois for more than 13 years. I look forward to finding a female spouse for myself. Friends Who are the patient’s friends? _________________________ Who are your friends? _________________________ Who are among appropriate friends? _________________________ Who are among inappropriate friends? _________________________ Family means father, mother, brother, sister, nephew, niece, grandfather, grandmother, children, or spouse of the opposite gender. Who knows about his real family members? _________________________ What are the profiles of his real family members? _________________________ Why is asking about family essential? _________________________ These examples will make you understand. On October 23, 2012, Yingjia Wang (Bonny) has been in Chicago, Illinois, for the past month. She is 22 years old, and originally from Bejing. She does not have family in Chicago, Illinois. She needs extra care. Who has the duty to take care of her in Chicago, Illinois? On October 23, 2012, Laura Eberly has been in Chicago, Illinois, for the past few years. She is 22 years old. I/we do not know about her family. She has been given a work description that does not meet the standard description of any profession/work/job. Is someone behind the scenes misleading her? If her family is not in Chicago, Illinois, who should supervise her? Family planning What does family planning include? 1. Relationship counseling 2. Legitimate spouse 3. Legitimate conception 4. Prenatal counseling 5. Delivery 6. Post-delivery counseling 7. Raising the child. Do you have proper family planning guidelines for you before the birth? _________________________ What and where can one get proper family planning guidelines for the birth and after the birth? _________________________ |
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