Healthcare Challenges:

• Some ways that providers can better patient outcomes [5]:

• Trustworthy and compassionate interactions with patients can improve patient outcomes. 

• Learn the terms, understand the healthcare risks of the community. 

• Apply gender-neutral language during conversations.

• Consider screening for anxiety and depression.

Social History:

• A thorough conversation about the patient’s sexuality and gender identity can reveal potential challenges and concerns, especially in adolescents.7

  • How do you feel about the changes in your body?

  • How do you feel about potential changes during puberty?

  • It is also appropriate to ask if the patient is attracted to men, women, or both.

• The incorporation of appropriate behavioral health referrals may allow for a better health outcome [8].

  • Do you feel that you are getting enough support and acceptance of your sexual/gender identity from friends and/or family? 

  • Would you like to speak with anyone about any concerns you may have about your sexual / gender identity? 

Inclusive Sexual History:  

• Questions adapted CDC “A Guide to Taking a Sexual History” and Fenway Health’s “Taking a sexual history with sexual and gender minority individuals.” 

• Developed by Samantha Levine, MS4 of Saint Louis University School of Medicine 

• 8 P’s of Sexual History 

  • Preferences - Establish language to use, kinds of sex the patient is having

  • Partners - Assess for number, gender, and timeframe of partner(s) while avoiding assumptions 

  • Practices - Assess for body part(s) that patients use in sex

  • Past History of STDs and Protections from STDs - Assess for future risk based on condom use practices, and completion of treatment for past diagnosesPregnancy Plans - Understand patient’s reproductive plans and talk about family planning options

  • Pleasure  - Assess for pain, sexual satisfaction, and changes in arousal 

  • Partner Violence   - Assess patient safety 

    • Survival sex is a form of prostitution engaged in by various communities secondary to extreme need.

• Examples:

  • Set the stage 

    • “May I ask you a few questions about your sexual health practices? These are questions that I ask all my patients, with their permission, to guide my screenings and recommendations.” It is important to explain why you are asking these questions – be sure to ask from a place of care and not curiosity.

  • Preferences:

    • “Do you have a preferred language that you use to refer to your body (i.e genitals)? I typically stick with medical terms, but am happy to use other words if you prefer” 

      • It is generally best practice to mirror the language that your patients use

    • “Do you have sex?”or “Have you had sex before?”

      • Avoid “ Are you sexually active?” which can be misinterpreted by the patients. Individuals might have their own definitions of sex which can be different from the norm established in health care and heteronormative culture. 

    • “ What kinds of sex do you engage in” 

      • Could further elaborate with oral, anal, manual or penetrative vaginal sex. 

    • “When was the last time that you had sex?"

  • Partner: 

    • “What is /are the gender(s) of your sexual partners(s)?”

    • “What body parts does your partner use for sex?”

    • Make sure to ask for time frame of each partner

  • Practices:

    • “What parts of your body are involved when you have sex?” 

    • “What kind of sexual contact do you have, or have you had?”

    • “Are you having sex for pleasure or are there other reasons ( survival sex or transactional sex)?”

  • Past history of STDs:

    • “Have you ever been tested for STIs (sexually transmitted infections)?Have you been diagnosed in the past?” Those are things like HIV, syphilis, gonorrhea, chlamydia, trichomoniasis, or HSV? If so, have you been told that you have one of them? Do you remember being treated at that time?”

    • “Do you remember what site?”

  • Protection from STDs:

    • “Do you and your partner discuss STI prevention?”

    •  “Do you use a condom when having sex?”

    • If your patient is not using a condom all the time, consider digging deeper: “What factors help you decide when to use a condom?”

    • “If you use prevention tools, what methods do you use?”

  • Pregnancy plans:

    • “Do you think you would like to have (more) children at some point?”

    • “How important is it to you to prevent pregnancy (until then)?”

  • Pleasure

    • “Do you feel you are able to become physically aroused during sex?”

    • “How satisfied are you with your ability to achieve orgasm?”

    • “Do you have any pain or discomfort during or after orgasm?”

  • Partner violence

    • “Has anyone ever forced or compelled you to do anything sexually that you did not want to do?”

    • “Is there any violence in any of your relationships? This could be physical, emotional, etc.” 

    • “Do you feel safe at home?”

  • Other considerations 

    • “What other concerns or questions regarding your sexual health or sexual practices would you like to discuss”