The relevance of taking an extensive sexual history with LGBTQ+ patients cannot be overstated – however, initiating this conversation can feel challenging for both providers and patients when the provider may not have a lot of experience with diverse patient populations.
To navigate the intricacies effectively and respectfully, we need to foster open dialogues about sexual health, refrain from making assumptions or passing judgment, learn to normalize “sensitive” questions, and use systematic methods for taking a sexual history for all patients.
1. Explain the Importance
Discussing sexual history might seem awkward at first. However, explaining to the patients why it is important can help them feel more comfortable.
We can tell the patients that a thorough sexual history helps identify risk factors for STIs and uncover hidden health concerns that may first manifest in their sexual health. For example, erectile dysfunction could be an early sign of cardiovascular disease, or changes in libido could be related to mental health conditions or hormonal imbalances.
2. Avoid Assumptions
Avoiding assumptions is key to respectful communication. We should avoid using terms that presume a patient’s sexual behavior or orientation. For instance, ask about the patient’s sexual orientation in a respectful manner and use the term “partner” rather than “boyfriend,” “girlfriend,” “husband,” or “wife.”
To avoid misunderstanding or making assumptions, try using open-ended questions that allow patients to express their experiences without constraints. For example, when obtaining Sexual Orientation and Gender Identity (SOGI) data, instead of assuming a patient’s sexual practices, we might ask, “If you have sex, could you tell me about your sexual activities?” We expand this with examples in #5!
3. Avoid Judgement
Keeping our personal opinions and beliefs separate from our professional role is crucial. Our job is to provide medical care based on best practices, not to pass moral judgments. If a patient’s sexual behaviors do not align with our personal beliefs, it’s important to maintain our professional composure and continue to provide the best care possible.
An example might be if a patient discloses that they engage in sex work. Instead of expressing personal judgments or reactions, we could respond saying it’s important for us to understand all aspects of our patients’ lives to provide the best care, and then ask the patient if we can discuss any specific health concerns related to their work.
4. Normalize Sensitive Questions
“Normalizing” is a technique to make patients feel more at ease when asked about sensitive topics. It helps patients understand that their experiences are not uncommon, and that the physician is comfortable discussing these matters.
For example, instead of directly asking, “Have you ever had a sexually transmitted infection?” we could say, “Many people have had a sexually transmitted infection at some point. Have you ever been diagnosed with one?” Similarly, instead of asking, “Do you use protection during sex?” we might phrase it as, “A lot of people have different practices when it comes to using protection during sex. Could you tell me about your habits?”
5. Incorporating the Five P’s
The Centers for Disease Control and Prevention (CDC) developed the “Five P’s” method as an effective tool to ensure we obtain a more comprehensive understanding of our patient’s sexual health.
The Five P’s encompass:
- Partners: The number and sex of a patient’s current and past sexual partners
- Example: “Do you have sex?” (inclusive of asexual patients)
- If no, “By choice or circumstance?” or, “Do you desire to have sex?”
- “What are the genders and bodies of your sexual partners?” (Not assuming gender, gender non-conforming, or monogamy.)
- Practices: The types of sexual activity a patient engages in.
- Example: “How do you have sex with them?”, “Which body parts do you use?”, “Do you use toys?”
- Protection from STIs: Methods the patient uses to protect themselves from sexually transmitted infections.
- Example: “Do you use barriers for sexually transmitted infection prevention?”
- Past history of STIs: Any previous diagnoses of sexually transmitted infections.
- Example: “Many people have had a sexually transmitted infection at some point. Have you ever been diagnosed with one?”
- Pregnancy: Determining pregnancy intention and what information the patient needs.
- Example: “What are your family building desires, now or in the future?”
Enhance your skills in taking medical and sexual histories from LGBTQ patients with our standardized patient (SP)-based online training. Practice real-time scenarios with simulated patients, learn to handle sensitive topics with respect, and gain expertise in capturing Sexual Orientation and Gender Identity (SOGI) data. This course is ideal for all healthcare providers striving to deliver comprehensive and tailored care. Follow this link to learn more and embark on this interactive learning journey.
- Ard, K. L. “Taking an Affirming Sexual History.” https://fenwayhealth.org/wp-content/uploads/10.-Taking-an-Affirming-Sexual-History-Ard.pdf
- Centers for Disease Control and Prevention. “A Guide to Taking a Sexual History.” https://www.cdc.gov/std/treatment/SexualHistory.htm
- Gender-Affirming Care. https://bipocwomenshealth.com/gender-affirming-care
- Nusbaum, M R.H. and C. D. Hamilton. “The Proactive Sexual Health History.” American Family Physician, 2002;66(9):1705-1713