1. Taking a Sexual History Katherine Marx, MS, MPH, FNP-BC

2. Objectives Explain health benefits of taking a sexual history Name elements of a sexual history Practice elements of the sexual history DHHS, CDC. A Guide to Taking a Sexual History, http://www.cdc.gov/std/treatment/sexualhistory.pdf

3. Why take a sexual history?

4. Morbidity and mortality: STDs and HIV Reproductive health and family planning Sexual dysfunction Happiness and overall health High-quality, comprehensive care Primary prevention Nusbaum RH, Hamilton CD. American Family Physician. 2002; 66(9):1705-1713.

5. Who needs a sexual history? Adolescents and adults – Initial visit – Routine preventive visits – When there are symptoms or signs of STDs DHHS, CDC. A Guide to Taking a Sexual History, http://www.cdc.gov/std/treatment/sexualhistory.pdf

6. Try to put patients at ease Let them know why you are asking about sex Clarify confidentiality Make sure they know you ask all patients about sexual health and sexual practices DHHS, CDC. A Guide to Taking a Sexual History, http://www.cdc.gov/std/treatment/sexualhistory.pdf

7. Sexual risk assessment http://www.cdc.gov/std/treatment/SexualHistory.pdf, http://www.nachc.com/

8. Partners Number (past 6-12 months) Gender DHHS, CDC. A Guide to Taking a Sexual History, http://www.cdc.gov/std/treatment/sexualhistory.pdf

9. Practices DHHS, CDC. A Guide to Taking a Sexual History, http://www.cdc.gov/std/treatment/se xualhistory.pdf

10. Protection from STDs Assess risk-reduction appropriate for the patient – Condoms – Monogamy – Perception of risk – STD and HIV screening DHHS, CDC. A Guide to Taking a Sexual History, http://www.cdc.gov/std/treatment/sexualhistory.pdf

11. Past History of STDs STD or HIV testing History of STDs History of treatment DHHS, CDC. A Guide to Taking a Sexual History, http://www.cdc.gov/std/treatment/sexualhistory.pdf

12. Prevention of Pregnancy Assess risk of pregnancy (or fathering a child) Ask if pregnancy is desired DHHS, CDC. A Guide to Taking a Sexual History, http://www.cdc.gov/std/treatment/sexualhistory.pdf

13. Completing the History Give the patient a chance to ask questions Thank the patient Reinforce protective practices Express concerns for high-risk practices Risk reduction DHHS, CDC. A Guide to Taking a Sexual History, http://www.cdc.gov/std/treatment/sexualhistory.pdf

14. Practice: Sexual history 32 year old black female seeks pregnancy. She is not infected with HIV. Her partner is HIV-infected and not currently on antiretroviral treatment. What can you ask to learn more about her sexual history?

15. Practice: Risk Reduction 32 year old black female seeks pregnancy. She is not infected with HIV. Her partner is HIV-infected and not currently on antiretroviral treatment. What can you offer to help her reduce her risk?

16. Summary Routine, comprehensive sexual history – Reduce morbidity and mortality – Identify sexual dysfunction – Avoid unplanned pregnancy – Improve care and quality of life – Offer preventive care and risk reduction support 5 P’s: partners, practices, protection, past history of STDs, prevention of pregnancy