This guide offers a framework for discussing sexual health issues to help complete the overall picture of your patient’s health. Sexual health can greatly
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Accessible Version: SexualHistory.htm This guide offers a framework for discussing sexual health issues to help complete the overall picture of your patient™s health. Sexual health can greatly impact overall quality of life. The health impacts of sexually transmitted infections (STIs) can range from irritating to life-threatening. Discussing a person™s sexual health offers the opportu -nity for counseling and sharing information about behaviors that may increase STI risk. A sexual history should be taken as part of routine health care, as well as when there are symptoms or physical exam findings suggestive of STIs. In short, a sexual history allows you to provide high-quality patient care by appropriately assessing and screening individuals for a broad range of sexual health concerns.

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This guide is meant to provide you with a sample of the discussion points and questions that may be asked. It is not meant to be a standard for diagnosis or a complete reference for sexual history taking. An adequate sexual history should be tailored to each person based on their preferences and the clinical situation. Providers may need to modify questions to accommodate a person™s gender identity, race/ethnicity, culture, or other important considerations.

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Clinical Environment Creating a welcoming clinical environment for all patients should begin at registration. Establishing your patient™s name and pro -nouns, as well as their sexual orientation and gender identity, are important in medi -cal care. Gender identity is independent of sexual orientation and best determined by a two-step method incorporated into a clin -ic™s initial assessment that asks sex assigned at birth (female, male, or decline to answer) and current gender identity (female, male, transgender female, transgender male, gender diverse, additional gender category, or decline to answer). In addition, some patients may not be comfortable talking about their sexual his -tory, sex partners, or sexual practices. Some patients may have experienced abuse or trauma in their lives or while in a med ical setting. Training in a trauma-informed care approach can help all clinicians apply patient-centered, sensitive care to all interactions. Some patients may be exper -iencing intimate partner violence and seeking care for medical health concerns could be their only opportunity to access safe resources. Try to put patients at ease and be prepared to link patients to nee ded resources. Let them know that taking a

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sexual history is an important part of a regular medical care. In some cases, simply offering all testing options may be the best approach. Dialogue With Patient May I ask you a few questions about your sexual health and sexual practices? I understand that these questions are personal, but they are important for your overall health. At this point in the visit I generally ask some questions regarding your sexual life. Will that be ok? I ask these questions to all my patients, regardless of age, gender, or marital status. These questions are as important as the questions about other areas of your physical and mental health. Like the rest of our visits, this information is kept in strict confidence unless you or someone else is being hurt or is in danger. Do you have any questions before we get started? Do you have any questions or concerns about your sexual health?

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The Five fiPfls To further guide your dialogue with your patient, the 5 fiPsfl may be a useful way to help you remember the major aspects of a sexual history. 1. Partners 2. Practices 3. Protection from STIs 4. Past History of STIs 5. Pregnancy Intention These are the areas that you should openly discuss with your patients. You probably will need to ask additional questions that are appropriate to each patient™s special situation or circumstances, but 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.

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PARTNERS To assess the risk of getting an STI, it is important to determine the number and gender of your patient™s sex partners. Remember: Never make assumptions about the patient™s sexual orientation or the gender identity of the patient or partners. Even if only one sex partner is noted over the last 12 months, be certain to inquire if that partner is a new sex partner. Ask about the partner™s risk factors, such as other concurrent partners, past sex partners or drug use.

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Dialogue With Patient Are you currently having sex of any kindŠso, oral, vaginal, or analŠ with anyone? ( Are you having sex? ) If no, 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? If a patient has had sex in the past, but is not currently, it is still important to take a sexual history.

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PRACTICES Asking about sex practices will guide the assessment of patient risk, risk-reduction strategies, the determination of necessary testing, and the identification of anatomical sites from which to collect specimens for 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 have genital sex ( penis in the vagina )? Anal sex ( penis in the anus )? Oral sex ( mouth on penis, vagina, or anus )? Are you a top and/or bottom?

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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. )?To learn more about the patient™s sexual practices, ask open-ended questions that are focused on the information you need to know based on what you have already learned about the patient. Based on the answers, you may discern which direction to take the dialogue.

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