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
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