Sexual History Taking
Dr Katie Boog, ST6 in Community Sexual and Reproductive Health joined the pod to talk us through how to take a Sexual History with some top tips along the way.
Here are her notes for the episode which she kindly shared:
What is different about a sexual history compared to a normal medical history?
Asking about sexual partners and sexual practices is not routine/Embarrassing for patient/Out of our comfort zone
It can be difficult to bring up, outside of the sexual health clinic setting
What do we need to know?
All the usual things: PC, history of PC, medical/surgical history, medications/allergies, gynae history for women, social history PLUS the sexual history – who have they been having sex with, what type of sex, when etc
Why do you need to know about medical history?
Sexually transmitted infections can present outwith the genitals e.g. syphilis, scabies
Medical conditions can present on the genitals – e.g. psoriasis, lichen planus, diabetes
Side effects from meds can affect genitals e.g. rash or dryness
And aside from their partners, what social history do you need to know?
General health promotion advice
Drugs/alcohol and risk taking/interactions
Smoking and BV/warts
So what exactly do you ask for the sexual history?
When they last had sex –window periods, PEP, EC
Who they had sex with: gender, relationship/casual, how long they’ve been having sex with them – assessing risk, partner notification
What type of sex – which orifices to swab, assessing risk
Giving/receiving top/bottom anal/oral/ano-oral
Was there a condom used, did it break etc
Does this person have any symptoms/known infection
Then repeat for other partners, 3-6 months
Then we do a blood-borne virus screen
How do you ask those questions?
Avoid assumptions!
"You're married, so no other partners, right?"
"Your partners are all male, yes?"
"And you just have normal sex?"
"Have you had any other sexual partners in the last 3 months?"
"Are your partners male, female, or both?/Do you have sex with men, women, or both?”
"Do you have vaginal sex? Oral sex? Anal sex? All three?"
"Was this partner regular, casual, or a one-off?"
“Do you use condoms sometimes, always, never?”
What do you ask about in the blood borne virus screen?
MSM
Injected drugs/Chemsex
Paid for sex/Been paid for sex
Had sex with someone who is not from the UK
Medical procedures/blood transfusions abroad
Tattoos/piercings in non-professional place
Coercive sex
Identify risk factors for HIV and hepatitis
Any top tips?
Use a warning shot/explain why you are asking
Language – make sure you both understand
Confidentiality – room/ward, relatives, interpreters
Practice your poker face
And here is the #TakeVisually for this episode: