mediscope
Manchester Medical School
Don’t worry, Chloe thought. I’m never going to sleep with anyone again! “And I know it may be hard, but it’s important that you tell your partner so that they can get tested and treated too if necessary.” Chloe stayed quiet. Josh didn’t deserve to be told. “Your partner might not have known.” The doctor held her troubled gaze before turning away to fill out a prescription. As Chloe got up to leave clutching her bit of green paper the doctor said, “Remember, the pill doesn’t protect against sexually transmitted diseases like Chlamydia and you should get tested regularly. Here are some leaflets with more information, and we’re always here if you need help.” Chloe felt like she had suddenly aged; become wiser and more troubled. She took the leaflets and left quickly.
Taking a Sexual History Taking a sexual history is not something many students feel comfortable doing; however, to take a comprehensive history it is important we are able to ask personal questions in a way that makes you and the patient feel at ease. To make this a little less daunting we have come up with a few helpful hints: Before you start, ensure there is complete privacy, most patients wouldn’t feel happy discussing their number of sexual partners or genital warts with the whole ward listening! Emphasize confidentiality before asking any questions. The way you approach the patient will influence what they tell you, do not assume anything – the seemingly straight woman you are talking to may be gay or bisexual, or the happily married husband may have been having an affair, these issues should be discussed sensitively in order to gain the patient’s trust. Using words such as partner instead of boyfriend/girlfriend will show the patient that you are non-judgemental. As always begin with open questions and let the patient divulge the information they feel comfortable with before asking specific questions. The choice of language you use should be guided by the patient, try and use the same words the patient does, often these are colloquialisms. The patient may present with the guise of another symptom; “I’ve got this terrible cough….oh, and by the way I think I might have caught something off my boyfriend…” It is important not to ignore this
education
Health
but ask appropriate questions to clarify what is actually wrong in a tactful way as the patient obviously feels embarrassed. Signpost before asking certain questions, for example; “I’m going to ask you a few personal questions about your sexual risk factors, is that ok?” Through out the consultation observe the patient’s body language; this will also help to guide you as to what the patient feels comfortable discussing. Think about how you would feel if you were in the place of the patient, sex is an embarrassing subject to talk about to strangers, respect the patient and give them the time and patience they need.
Questions to be asked in sexual history Find out the reason the patient has presented, is there a particular symptom such as an unusual discharge or dysuria? The patient may present because they are concerned after having unprotected sex, or they may have a problem such as loss of sex drive. Ask open questions to find out this problem then use closed questions to find out details such as how long the symptoms have been there. Ask about sexual partners; you will need to inquire about the number of sexual partners in the past year, the gender of the partners and their sexual risk factors. Ask direct questions about sexual practice (remember to signpost) such as the type of sex the patient is having – vaginal, anal or oral. Did the patient use any form of contraception? If they did what type of contraception did they use and was it used effectively? Remember to ask if the patient may be pregnant. Has the patient had a sexually transmitted disease before? Ask about their immunization history, specifically Hepatitis B and C. Find out if the patient has been tested for HIV in the past. Remember that other parts of the full medical history may be relevant, for example certain chronic illnesses and some drugs can cause sexual dysfunction. Advise the patient on safe sexual practice and explain to them any further tests or management that may be needed. Finally, thank the patient and ask them if there are any other issues they would like to discuss.
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