Sexual Health History: Techniques and Tips
Am Fam Physician. 2020 Mar 1;101(5):286-293.
Patient information: Handouts on this topic are available at https://familydoctor.org/importance-of-sexual-health/ and https://familydoctor.org/health-benefits-good-sex-life/.
Related editorial: HIV Status, Preexposure Prophylaxis, Sexual Health, and the Critical Role of Family Physicians
Author disclosure: No relevant financial affiliations.
Family physicians should use a proactive, integrated, patient-centered approach to sexual health that includes, but is not limited to, disease identification and treatment. Successfully delivering positive, affirming, nonjudgmental sexual health care requires intentionally creating safe spaces for all patients. Physician and staff training could include identifying individual implicit bias around sexuality and sexual topics, adverse childhood experiences, and trauma-informed care. Models such as the five Ps (partners, practices, protection from sexually transmitted diseases, past history of sexually transmitted diseases, and pregnancy plans) and ExPLISSIT (extended permission giving, limited information, specific suggestions, and intensive therapy) can help physicians organize their approach to sexual health histories. Preventive health strategies include screening for sexually transmitted diseases and sexually transmitted infections, screening for and offering preexposure prophylaxis for HIV, behavioral counseling to reduce the risk of sexually transmitted infections, and preconception care for all patients, including gender-diverse patients. Because sexual health concerns are quite common, family physicians should be prepared to discuss topics such as erectile dysfunction, dyspareunia, and arousal disorders.
Sexual health is defined by the World Health Organization as “a state of physical, emotional, mental, and social well-being in relation to sexuality; it is not merely the absence of disease, dysfunction, or infirmity.”1 Sexual health is foundational to the physical, emotional, and social health of individuals, families, and communities. It encompasses a wide range of topics, including knowledge about anatomy and function, sexuality, sexual identity, sexual orientation and gender, reproductive health and fertility, and sexual violence.
SORT: KEY RECOMMENDATIONS FOR PRACTICE
| Clinical recommendation | Evidence rating | Comment |
|---|---|---|
Clinicians and staff should be trained in culturally sensitive terminology, transgender topics, cultural humility, and assessment of personal internal biases to facilitate improved patient interactions.4 | C | Consensus guidelines based on expert opinion and limited clinical studies |
Intensive behavioral counseling should be offered to all sexually active adolescents and to adults who are at increased risk for sexually transmitted infections.21 | B | Systematic review of variable-quality randomized controlled trials with inconsistent conclusions |
Preexposure prophylaxis with tenofovir/emtricitabine (Truvada) or tenofovir alone reduces the risk of acquiring HIV infection in high-risk individuals, including people in serodiscordant relationships, men who have sex with men, and other high-risk men and women.20,25 | A | Cochrane systematic review of high-quality randomized controlled trials |
A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to https://www.aafp.org/afpsort.
SORT: KEY RECOMMENDATIONS FOR PRACTICE
| Clinical recommendation | Evidence rating | Comment |
|---|---|---|
Clinicians and staff should be trained in culturally sensitive terminology, transgender topics, cultural humility, and assessment of personal internal biases to facilitate improved patient interactions.4 | C | Consensus guidelines based on expert opinion and limited clinical studies |
Intensive behavioral counseling should be offered to all sexually active adolescents and to adults who are at increased risk for sexually transmitted infections.21 | B | Systematic review of variable-quality randomized controlled trials with inconsistent conclusions |
Preexposure prophylaxis with tenofovir/emtricitabine (Truvada) or tenofovir alone reduces the risk of acquiring HIV infection in high-risk individuals, including people in serodiscordant relationships, men who have sex with men, and other high-risk men and women.20,25 | A | Cochrane systematic review of high-quality randomized controlled trials |
A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to https://www.aafp.org/afpsort.
Family physicians should use a proactive, integrated, patient-centered approach to sexual health that includes, but is not limited to, disease identification and treatment.2 Family physicians are in an excellent position to provide a safe environment in which patients can consensually discuss issues related to sex and sexuality across their life span.
Create a Safe Space
References
show all references1. World Health Organization. Defining sexual health. 2019. Accessed April 15, 2019. https://www.who.int/reproductivehealth/topics/sexual_health/sh_definitions/en/...
2. Ryan KL, Arbuckle-Bernstein V, Smith G, et al. Let's talk about sex. PRiMER. 2018;2:23.
3. Sitron JA, Dyson DA. Sexuality attitudes reassessment (SAR). Am J Sex Educ. 2009;4(2):158–177.
4. Klein DA, Paradise SL, Goodwin ET. Caring for transgender and gender-diverse persons. Am Fam Physician. 2018;98(11):645–653. Accessed September 6, 2019. https://www.aafp.org/afp/2018/1201/p645.html
5. Pfeffer B, Ellsworth TR, Gold MA. Interviewing adolescents about sexual matters. Pediatr Clin North Am. 2017;64(2):291–304.
6. Leasy M, O'Gurek DT, Savoy ML. Unlocking clues to current health in past history: childhood trauma and healing. Fam Pract Manag. 2019;26(2):5–10. Accessed September 6, 2019. https://www.aafp.org/fpm/2019/0300/p5.html
7. Substance Abuse and Mental Health Services Administration. SAMHSA's concept of trauma and guidance for a trauma-informed approach. July 2014. Accessed October 12, 2019. https://store.samhsa.gov/system/files/sma14-4884.pdf
8. Nusbaum MR, Hamilton CD. The proactive sexual health history. Am Fam Physician. 2002;66(9):1705–1712. Accessed September 6, 2019. https://www.aafp.org/afp/2002/1101/p1705.html
9. Centers for Disease Control and Prevention. A guide to taking a sexual history. 2011. Updated March 14, 2014. Accessed September 6, 2019. https://www.cdc.gov/std/treatment/sexualhistory.pdf
10. Kole J. Circling back to a better sexual history. Ann Fam Med. 2018;16(5):465. Accessed October 18, 2019. http://www.annfammed.org/content/16/5/465.full
11. Rafferty J; Committee on Psychosocial Aspects of Child and Family Health; Committee on Adolescence; Section on Lesbian, Gay, Bisexual, and Transgender Health and Wellness. Ensuring comprehensive care and support for transgender and gender-diverse children and adolescents. Pediatrics. 2018;142(4):e20182162.
12. Hidalgo MA, Ehrensaft D, Tishelman AC, et al. The gender affirmative care model. Hum Dev. 2013;56(5):285–290.
13. Vance SR Jr, Ehrensaft D, Rosenthal SM. Psychological and medical care of gender nonconforming youth. Pediatrics. 2014;134(6):1184–1192.
14. U.S. Preventive Services Task Force. Chlamydia and gonorrhea: screening. September 2014. Accessed September 2019. https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/chlamydia-and-gonorrhea-screening
15. U.S. Preventive Services Task Force. Human immunodeficiency virus (HIV) infection: screening. July 2019. Accessed October 12, 2019. https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/human-immunodeficiency-virus-hiv-infection-screening1
16. U.S. Preventive Services Task Force. Syphilis infection in nonpregnant adults and adolescents: screening. June 2016. Accessed September 6, 2019. https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/syphilis-infection-in-nonpregnant-adults-and-adolescents
17. U.S. Preventive Services Task Force. Hepatitis C: screening. June 2013. Accessed September 6, 2019. https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/hepatitis-c-screening
18. U.S. Preventive Ser vices Task Force. Hepatitis B virus infection: screening, 2014. May 2014. Accessed September 6, 2019. https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/hepatitis-b-virus-infection-screening-2014
19. U.S. Preventive Services Task Force. Genital herpes infection: serologic screening. November 2016. Accessed September 6, 2019. https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/genital-herpes-screening1
20. U.S. Preventive Services Task Force. Prevention of human immunodeficiency virus (HIV) infection: preexposure prophylaxis. July 2019. Accessed October 12, 2019. https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/prevention-of-human-immunodeficiency-virus-hiv-infection-pre-exposure-prophylaxis
21. U.S. Preventive Services Task Force. Sexually transmitted infections: behavioral counseling. September 2014. Accessed October 12, https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/sexually-transmitted-infections-behavioral-counseling1
22. Workowski KA, Bolan GA; Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2015 [published correction appears in MMWR Recomm Rep. 2015;64(33):924]. MMWR Recomm Rep. 2015;64(RR-03):1–137.
23. American Academy of Family Physicians. Screening for sexually transmitted infections: practice manual. 2019. Accessed October 4, 2019. https://www.aafp.org/dam/AAFP/documents/patient_care/sti/hops19-sti-manual.pdf
24. American Academy of Family Physicians. AAFP tools offer pointers on assessing patients for STIs. September 18, 2019. Accessed October 7, 2019. https://www.aafp.org/news/health-of-the-public/20190918stismanual.html
25. Okwundu CI, Uthman OA, Okoromah CA. Antiretroviral pre-exposure prophylaxis (PrEP) for preventing HIV in high-risk individuals. Cochrane Database Syst Rev. 2012;(7):CD007189.
26. Centers for Disease Control and Prevention. Pre-exposure prophylaxis (PrEP). September 25, 2019. Accessed October 12, 2019. https://www.cdc.gov/hiv/basics/prep.html
27. Office of Disease Prevention and Health Promotion. Healthy People 2020. Updated October 12, 2019. Accessed October 12, 2019. https://www.healthypeople.gov/
28. American Academy of Family Physicians. Preconception care (position paper). 2016. Accessed October 12, 2019. https://www.aafp.org/about/policies/all/preconception-care.html
29. Frayne DJ. Preconception care is primary care: a call to action. Am Fam Physician. 2017;96(8):492–494. Accessed September 6, 2019. https://www.aafp.org/afp/2017/1015/p492.html
30. Hembree WC, Cohen-Kettenis P, Delemarre-van de Waal HA, et al.; Endocrine Society. Endocrine treatment of transsexual persons: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2009;94(9):3132–3154.
31. Johnson EK, Finlayson C. Preservation of fertility potential for gender and sex diverse individuals. Transgend Health. 2016;1(1):41–44.
32. Nusbaum MR, Gamble G, Skinner B, et al. The high prevalence of sexual concerns among women seeking routine gynecological care. J Fam Pract. 2000;49(3):229–232.
33. Nusbaum MR, Braxton L, Strayhorn G. The sexual concerns of African American, Asian American, and white women seeking routine gynecological care. J Am Board Fam Pract. 2005;18(3):173–179.
34. Read S, King M, Watson J. Sexual dysfunction in primary medical care: prevalence, characteristics and detection by the general practitioner. J Public Health Med. 1997;19(4):387–391.
35. Annon JS. The PLISSIT model: a proposed conceptual scheme for the behavioral treatment of sexual problems. JSex Educ Ther. 1976;2(1):1–15.
36. Taylor B, Davis S. From PLISSIT to Ex-PLISSIT. In: Davis S, ed. Rehabilitation: The Use of Theories and Models in Practice. Churchill Livingstone; 2006:101–130.
37. Faubion SS, Rullo JE. Sexual dysfunction in women: a practical approach [published correction appears in Am Fam Physician. 2016;94(3):189]. Am Fam Physician. 2015;92(4):281–288. Accessed October 12, 2019. https://www.aafp.org/afp/2015/0815/p281.html
38. Seehusen DA, Baird DC, Bode DV. Dyspareunia in women. Am Fam Physician. 2014;90(7):465–470. Accessed September 6, 2019. https://www.aafp.org/afp/2014/1001/p465.html
39. Rew KT, Heidelbaugh JJ. Erectile dysfunction. Am Fam Physician. 2016;94(10):820–827. Accessed October 12, 2019. https://www.aafp.org/afp/2016/1115/p820.html
40. Byrne M, Doherty S, Fridlund BG, et al. Sexual counselling for sexual problems in patients with cardiovascular disease. Cochrane Database Syst Rev. 2016;(2):CD010988.
41. Levack WMM, Poot B, Weatherall M, et al. Interventions for sexual dysfunction in people with chronic obstructive pulmonary disease (COPD). Cochrane Database Syst Rev. 2015;(9):CD011442.
42. Candy B, Jones L, Vickerstaff V, et al. Interventions for sexual dysfunction following treatments for cancer in women. Cochrane Database Syst Rev. 2016;(2):CD005540.
43. Vecchio M, Navaneethan SD, Johnson DW, et al. Interventions for treating sexual dysfunction in patients with chronic kidney disease. Cochrane Database Syst Rev. 2010;(12):CD007747.
44. Taylor MJ, Rudkin L, Bullemor-Day P, et al. Strategies for managing sexual dysfunction induced by antidepressant medication. Cochrane Database Syst Rev. 2013;(5):CD003382.
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