Sexual health is an important part of one’s overall health. A comprehensive sexual history can help a provider screen for sexually transmitted infections (STIs) and other sexual health conditions and share information about risk reduction and family planning when appropriate. However, it may be more difficult to broach a conversation with a patient regarding sexual health than it is to discuss other health topics. Though each patient’s situation is unique, the following guide provides an example of approaching and obtaining a patient’s sexual health history.
Introduce the topic and explain confidentiality.
It is a good idea to set the stage for the conversation before jumping into questions about a patient’s sexual health. You can help put a patient at ease by assuring them that obtaining a sexual health history is a routine part of a physical exam/medical visit and that everything shared will remain confidential. Here is a sample opener for a conversation on sexual health:
“Now, I’m going to ask you a few questions about your sexual health. This is a routine part of a medical exam/check-up, and I ask all my adult patients the same questions I’m about to ask you. I know these questions might be personal, but please keep in mind that everything you share with me will remain between us, strictly confidential.”
Address the five “P’s” of Sexual Health.
The Centers for Disease Control and Prevention (CDC), the AIDS Education & Training Center (AETC), and other established health organizations recommend addressing five key areas in a sexual health history, also known as the five “P’s”:
- Partners
- Practices
- Protection from STIs
- Past history of STIs
- Prevention of pregnancy
Keep in mind that you can never assume your patients’ sexual orientation, marital status, or family planning preferences. Use the questions below each key area to facilitate the conversation.
Partners:
- Are you currently sexually active?
- Have you ever been sexually active?
- Do you have sex with men, women, or both?
- How many sexual partners have you had in the last year?
- Have you had any new sexual partners in the last year?
Practices:
To better understand your risk for STIs, I need to ask you a few questions about the kind of sex you have had recently.
- Have you had vaginal sex (penis in vagina)?
- Have you had anal sex (penis in anus)?
- Have you had oral sex (mouth on vagina, penis, or anus)?
Protection from STIs:
- Do you and your partner(s) ever use protection against STIs (e.g., condoms, dental dams, etc.)?
- If not, could you tell me why?
- If so, what kind of protection do you use?
- How often do you use protection against STIs?
- If “sometimes,” in which situations do you use protection?
- With whom do you use protection?
- Do you have any questions about types of protection against STIs or how to use protection properly that you would like to discuss today?
Past history of STIs:
- Have you ever been tested for HIV or any other STIs?
- Would you like to be tested for STIs?
- Have you ever been diagnosed with an STI?
- If so, which STI?
- When were you diagnosed?
- Did you receive treatment? How were you treated?
- Have you had any recurring symptoms?
- Have any of your current or former partners been diagnosed with an STI?
- If so, have you been tested for this STI?
- When were you tested?
- What was the diagnosis?
- Did you receive treatment? How were you treated?
Prevention of pregnancy:
- Are you currently trying to get pregnant or father a child?
- Are you currently trying to avoid getting pregnant or getting your partner pregnant?
- Do you have concerns about getting pregnant or getting your partner pregnant?
- Are you using any type of birth control (e.g., condoms, birth control pills, an IUD, etc.)
- Would you like more information on birth control options?
Wrap up the sexual health history.
Once you finish discussing the essential questions from each of the five key areas, you can conclude the sexual health history by asking if the patient has any other sexual health questions or concerns that they would like to talk about. You can offer information and resources on protection against STIs to patients at risk and family planning resources to those trying to conceive or prevent pregnancy.
Resources:
American Academy of Family Physicians. Taking an Accurate Sexual History Sample Script. https://www.aafp.org/dam/AAFP/documents/patient_care/sti/hops19-sti-script.pdf.
Centers for Disease Control and Prevention. National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. A Guide to Taking a Sexual History. https://www.cdc.gov/std/treatment/sexualhistory.pdf
