Taking a sexual history is a mandatory skill that doctors need to learn. We also need to be aware of the social issues that may arise during the process of taking a sexual history.
To better guide the conversation with the patient, we can use “The 5Ps” to help us remember the main aspects of a sexual history.
STARTING THE SESSION
- Try to create a comfortable and private environment to start the conversation.
- If the patient came with someone else, try asking the patient is it fine to ask about personal issues with someone else in the room. Doctor may asked other person politely to leave the room for a while, or the patient sometimes feel more comfortable with someone else accompanying them.
- Ask for permission and apologize to the patient for asking private matters. Emphasize the patient to be honest and open as the informations will be crucial for diagnosing and lead to a better treatment.
- State that all the informations will be confidentials and only be written in the medical record.
- Remember: Never make assumptions about the patient’s sexual orientation or the gender identity of the patient or partners.
1. PARTNER
- Determine the number and gender of the patient’s sex partners.
- Ask about the partner’s risk factors, such as other concurrent partners, past sex partners or drug use.
- Dialogue with patient:
- “Have you ever had sex of any kind with another person?”
- “In recent months, how many sex partners have you had?”
- “What is/are the gender(s) of your sex partner(s)?” “Do you or your partner(s) currently have other sex partners?”
2. PRACTICES
- This will guide the patient risk assessment, risk-reduction strategies, determination of required testing, and the identification of anatomical sites for collecting specimens of STI testing.
- Dialogue with patient:
- “I need to ask some more specific questions about the kinds of sex you have had over the last 12 months to better understand if you are at risk for STIs. We have different tests that are used for the different body parts people use to have sex. Would that be OK?”
- “What kind of sexual contact do you have, or have you had? What parts of your body are involved when you have sex?”
- “Do you meet your partners online or through apps?”
- “Have you or any of your partners used drugs?”
- “Have you exchanged sex for your needs (money, housing, drugs, etc.)?”
3. PROTECTION FROM STIs
- We may need to explore the subjects of the abstinence, number of sex partners, condom use, the patient’s perception of their own risk and their partner’s risk, and STI testing. It is important not to assume risk or lack of risk for any patient.
- Dialogue with patient:
- “Do you and your partner(s) discuss STI prevention? “
- “If you use prevention tools, what methods do you use? (For example, external or internal condoms”
- “How often do you use this/these method(s)?”
- “Have you received HPV, hepatitis A, and/or hepatitis B shots?”
- “Are you aware of PrEP, a medicine that can prevent HIV? Have you ever used it or considered using it?”
4. PAST HISTORY OF STIs
- A history of prior STIs may place your patient at greater risk now.
- Dialogue with patient:
- “Have you ever been tested for STIs and HIV? Would you like to be tested?”
- “Have you been diagnosed with an STI in the past? When? Did you get treatment?”
- “Have you had any symptoms that keep coming back?”
- “Has your current partner or any former partners ever been diagnosed or treated for an STI? Were you tested for the same STI(s)? Do you know your partner(s) HIV status?”
5. PREGNANCY INTENTION
- Based on information from the prior session, we may determine that the patient or the patient’s partner(s) could become pregnant. Questions should be focused on determining pregnancy intention and what information they need.
- Dialogue with patient:
- “Do you think you would like to have (more) children at some point?”
- “When do you think that might be?”
- “How important is it to you to prevent pregnancy (until then)?”
- “Are you or your partner using contraception or practicing any form of birth control? Would you like to talk about ways to prevent pregnancy? Do you need any information on birth control?”
FINISHING THE SESSION
- By the end of the interview session, the patient may have come up with information or questions that they were not ready to discuss earlier.
- Dialogue with patient:
- “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?
Ask your patient about history of trauma, sexual abuse, or violence, as these are common, and patients may benefit from additional care.
- At this point, thank the patient for being open and honest. Encourage any protective practices.
- For patients at risk for STIs, be certain to encourage testing and give positive feedback about prevention methods that the patient is willing or able to use. Explain the STI/HIV prevention methods.
- These approaches can avoid or effectively reduce the likelihood of getting an STI/HIV through abstinence or mutual monogamy, proper condom use, and routine STI/HIV testing.
Note: the goal of the 5Ps is to improve patient health, not simply to solicit full disclosure of sexual practices, especially if patients are not comfortable.
REFERENCES
Kemenkes RI. Pedoman Nasional Penanganan Infeksi Menular Seksual. 2016.
Reno H, Park I, Workowski K, Machefsky A, Bachmann L. A guide to taking a sexual history. CDC. 2020.
UpToDate [Internet]. Uptodate.com. 2022 [cited 3 October 2022]. Available from: https://www.uptodate.com/contents/image?imageKey=ID%2F61677
Taking a Sexual History | History Taking | Sexual Health | Geeky Medics [Internet]. Geeky Medics. 2022 [cited 3 October 2022]. Available from: https:// geekymedics.com/sexual-history-taking/