The Dreaded Sexual History

It’s one of the great mysteries of healthcare – the sexual history. Everyone dreads it. Some even avoid seeking medical care because of it. Yet few people can tell you what this infamous, knee-knocking interview actually entails.

From adolescence on, it may be necessary for a healthcare practitioner or therapist to conduct a sexual history. These interviews are necessary in making a diagnosis, in determining treatment, and in making appropriate referrals. But given that most professionals are not trained to conduct an adequate sexual history, they may not be inquiring about your sex life enough. So what should they be asking and just what exactly should you share?

Man sexually transmitted infections

When it comes to this kind of cross-examination, men tend to get off more easily simply because there are fewer opportunities to take their histories. It is for this reason that a man and his healthcare provider need to get busy about how he’s getting busy when he makes his cameo office appearance.

Given that a number of sexually transmitted infections (STIs) are asymptomatic – meaning they don’t present symptoms – any health issues he has may also need to be investigated more. His screening history should include inquiries about:

  • Urological complaints
  • Genital infections
  • STIs, primarily check-ups for such, your history of infection, untreated symptoms, partner history, and a partner’s STI risk
  • Bowel function
  • Relationship problems, e.g., the number of times you have sex, performance issues, enjoyment, and contraception practices
  • Male sexual dysfunction

Women medical and psychosocial history

Women, on the other hand, have more opportunities for a sexual history since our gynecological functioning and contraceptive practices are regulated so much more. A screening history for her should include a medical and psychosocial history around:

  • Menstruation, e.g., PMS history, regularity of menstrual cycle, or the onset of menopause
  • Pregnancy – the focus should be on medical problems, whether pregnancies are planned or not, miscarriages, terminations, etc.
  • Childbearing history
  • Gynecological problems
  • STIs
  • Genital infections
  • Pap smears
  • Relationship problems, e.g., history with current partner, what happened physically early on in the relationship, pleasuring, or how is relationship going
  • Female sexual dysfunctions

Beyond these gender differences, the questions asked of both males and females are quite similar. These may include:

  • When was the last time you engaged in sexual activity?
  • In the past, have you been sexual with men, women or both?
  • With approximately how many people have you been sexual in the past year? What type of sexual contact have you had?
  • How are things going for you sexually?
  • Do you protect yourself from unplanned pregnancy and STIs, including HIV?
  • Do you have any problems with sexual functioning?

When it comes to visiting with a therapist or counselor, females may get more detailed follow up questions regarding arousal, lubrication, and pain during sexual activity or orgasm. Questions for males may concern arousal, getting or maintaining erections, or problems with ejaculation or orgasm. Both may be asked about their intercourse pattern, sexual satisfaction, or masturbatory practices.

If there are sexual problems present, you may find yourself fielding questions meant to better assess the physical, mental, and relationship factors at place. Inquiries may focus on your intercourse history, including first time and later experiences, how sex feels or has felt, physical responses, the state of your union, or attitudes and behaviors around sex.

Sound easy enough? If you’re like most people, you’re shaking your head “no.” If it’s any comfort, know that these sexual histories are often no easier for your healthcare provider. In many ways, your health practitioner’s anxiety can be more nerve-wracking than the questions themselves. In lacking training, physicians and nurses will often project their anxiety onto a patient. This shuts down the process of information gathering and sharing. You may, in fact, not even get a sexual history at all.

Don’t be afraid to request a sexual history

So in looking out for your sexual and reproductive health, you need to be your own advocate. Don’t be afraid to request a sexual history, especially since a number of other factors also go into whether or not a sexual history takes place or if you get a screening versus full interview. These include:

  • Your reason for presentation supposedly having nothing to do with your sex life
  • Time pressure faced by service providers
  • Possibility for follow up
  • If you’re there alone or with your partner (or another)
  • Your age – the elderly are often assumed to be sexually inactive and thus not asked about their sex lives
  • Perceived confidentiality of history, e.g., an ER environment just isn’t going to work

In going to bat for yourself, don’t be afraid to reveal information related to any of the topics addressed above or whatever is your primary sex-related concern. In doing so, make sure that your comfort level is at its maximum. For example, your confidentiality should be assured. Request a same sex practitioner if that puts you at greater ease. Let your practitioner know that you’re uncomfortable with the situation – for example, “I’ll answer that as soon as I’m out of these stirrups.”

Finally, ask questions. A good sexual history concludes with time for questions and patient education. This is your time with your healthcare provider. You’re paying for it. You deserve to get the most out of it.

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