Principles of taking a sexual history
Taking a sexual history presents different challenges to the physician, not least because most physicians have had little or no training or experience in doing so. Many people, both lay and professional, find talking about sex uncomfortable to a greater or lesser degree. Many people, again both lay and professional, have their own beliefs, rooted in the culture and religion of their upbringing, about what is acceptable sexual behavior and what is not. The ability to talk freely about sexual behavior and lifestyles is a skill that must be acquired if the physician is to help people with sexual problems. If, for whatever reason, they find themselves unable to do this, it is better that they acknovsledge the fact and promptly refer people with sexual problems to a colleague. There is no shame in doing this, but it is shameful to withhold treatment or discriminate against people who adopt sexual lifestyles and behaviors that are legally acceptable, but at variance with our own belief system.
In general, the foUowing principles of taking a sexual history should be considered.
• Use appropriate language — for the understanding and comfort of the couple. Keep checking that you all agree what particular words and expressions mean. For example, ‘arousal’ may mean ‘sexual excitement’ to one person, ‘erec’ tion’ to another and ‘orgasm’ to a third.
• Allow adequate time for the consultation. Even relatively straightforward problems will take 20—30 minutes to assess. This may seem like a long time, but is really not much different from the time that is spent in assessing a patient with newly diagnosed asthma or diabetes. It may not be possible to accommodate a consultation of that length in a normal clinic appointment. In this case, a special appoint’ ment or, less desirably, spreading the assessment over more than one consultation might be more appropriate.
Privacy and confidentiality — ensure that complete privacy is possible and that the confidentiality of both partners is maintained.
Consider the cultural and religious beliefs of the couple and how these might affect their sexual behavior, their response to questions of an intimate nature, and the acceptability of physical examination to them.
Beware of recording third-party information in the patient’s notes. You should not record identifiable details of the partner’s sexual behavior or problems other than in their own notes.
Tags: 30 Minutes, Adequate Time, Asthma, Belief System, Clinic Appointment, Colleague, Consultation, Diabetes, Expressions, Orgasm, Privacy And Confidentiality, Sexual Behavior, Sexual Excitement, Sexual History, Sexual Lifestyles, Sexual Problems, Shame, Talking About Sex, Upbringing, Variance