Taking a good sexual history from a patient is an important step in providing contraceptive, reproductive, and sexually transmitted disease (STD) counselling. The Centres for Disease Control and Prevention’s guide to taking a patient’s sexual history uses the five Ps model: partners, practices, protection from STD/STI, past history of STD/STI, and pregnancy plans. Sexual history taking should be routine, confidential, and free of assumptions related to age, anatomy, gender, and ability. An adequate sexual history should be tailored to each person based on their preferences and the clinical situation.
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. It should be taken as part of routine health care, as well as when there are symptoms or physical exam findings suggestive of STIs. 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 opportunity for counselling and sharing information about behaviours that may increase STI risk.
Creating a welcoming clinical environment for all patients should begin at registration. Establishing your patient’s name and pronouns, as well as their sexual orientation and gender identity, are important in medical care. Some patients may not be comfortable talking about their sexual history, sex partners, or sexual practices. Some patients may have experienced abuse or trauma in their lives or while in a medical setting. Training in a trauma-informed care approach can help all clinicians apply patient-centred, sensitive care to all interactions.
The five Ps model includes:
- Partners: Are you currently having sex of any kind? What is the gender(s) of your partner(s)?
- Practices: To understand any risks for STIs, I need to ask more specific questions about the kind of sex you have had recently. What kind of sexual contact do you have, or have you had? Do you have vaginal sex, meaning “penis in vagina” sex? Do you have anal sex, meaning “penis in rectum/anus” sex? Do you have oral sex, meaning “mouth on penis/vagina”?
- Protection from STIs: Do you and your partner(s) discuss prevention of STIs and HIV? Do you and your partner(s) discuss getting tested? For condoms: What protection methods do you use? In what situations do you use condoms?
- Past history of STIs: Have you ever been tested for STIs and HIV? Have you ever been diagnosed with an STI in the past? Have any of your partners had an STI?
- Pregnancy intention: Do you think you would like to have (more) children in the future? How important is it to you to prevent pregnancy (until then)? Are you or your partner using contraception or practicing any form of birth control? Would you like to talk about ways to prevent pregnancy?
These are some examples of questions that can be asked under each category of the five Ps model.
In summary, taking a good sexual history from a patient is an important part of providing high-quality patient care. It allows for appropriate assessment and screening for a broad range of sexual health concerns and offers the opportunity for counselling and sharing information about behaviours that may increase STI risk.
If you are a health care provider and you want to learn more about women’s health check out our Understanding our Gillick Competency and Fraser Guidelines article
and our recommended training courses, such as our online Gynae Core Skills course for practitioners working with women in primary care.