How to take a sexual history

Taking a sexual history identifies:

The presence of partners, support people or children may prevent a patient from disclosing personal information – ideally see patients alone
Asking about sex is not intimidating if it is normalised, and supported by confidentiality and professionalism
An initial framing statement will explain why you need to ask the questions
It is useful to mention that the offer of testing is routine, and that they may not need to have a full examination. This increases testing uptake

Examples:

As part of a general health check, I ask my patients about their sexual health and offer testing. Do you have any sexual health concerns you would like to discuss?
Since you’re here to talk about contraception, could we also talk about other aspects of sexual health?
I offer all my patients aged 30 and under the opportunity to have a test for chlamydia, which is a very common sexually transmitted infection. Tests can be self-collected if you’d prefer not to be examined. Would you be interested?
(If patient hesitates) Can I give you some information, so you can think about it?

I’d like to ask you some questions about sex so we can decide what tests to do. Is that ok?
When did you last have sex?
Was that with a regular or a casual sexual contact?
What gender are your partners? (Some people may prefer to be asked ‘was that someone with a penis, or someone with a vagina?’)
Was that vaginal, anal or oral sex?
Did you use a condom?
How many sexual contacts have you had in the past 3 months? 12 months?
Could you be pregnant?

…I’d like to ask you about some other activities that could increase someone’s risk of some sexually transmitted infections and bloodborne viruses. Is that ok?

Suggested list of characteristics or factors that will help identify risk:

(If the patient has sex with women) Have you ever had any sexual contact with a man?
Have you ever been paid to have sex? When?
Have you ever had any tattoos? If yes, was that here or overseas?
Have you ever injected drugs? Have you ever shared needles or any of the equipment used for injecting?
Have you ever been in prison?
How would you describe your ethnicity?

Because we know that sexual harm and partner violence affect a lot of people, and can have a big impact on health and well-being, we ask ALL of our patients/clients about it.
Before I ask you these questions, I’d like you to know that this conversation is confidential – that means I won’t share the information with others, unless I am concerned about your safety, or the safety of someone else. If what you tell me does raise concerns about safety, I will talk with you before talking to anyone else.
Have you ever been physically hurt by your partner or an ex-partner, either recently or in the past? By that I mean hit, punched, shoved, kicked, slapped or choked?
Does your partner or ex make you feel no good or worthless, or stop you seeing your family or friends?
Have you ever been made to have sex at a time or in a way that you didn’t want to?
Are you afraid of your partner or ex-partner?

If no:

I’m really glad about that because relationships like that can really affect your health and happiness / wellbeing. If it ever happens to you or someone you know, you can always talk about it here.

If yes:

I’m sorry that has happened to you. No one should be treated like that. Is it something that is happening now, or something that has happened in the past?
Would you like to tell me a bit more so I can see what things might be helpful for you?

It is important to be familiar with local resources if a positive disclosure is made

For further information: