Am Fam Physician. 2003;68(2):223
to the editor: We were delighted to see and enjoyed reading the article entitled, “The Proactive Sexual Health History,”1 in American Family Physician. We found it to be highly informative and important for physicians, especially for those taking care of adolescents and young adults who have the highest rates of sexually transmitted diseases (STDs). Sexual history taking is an important part of a comprehensive history. It affords the physician the opportunity to evaluate for STDs, contraceptive history, sexual abuse, and sexual dysfunction. In addition, it gives the physician the opportunity to administer appropriate diagnostic tests, treatment, and prevention counseling.
The article1reports that only a small percentage of primary care physicians in the United States actually elicit sexual histories. There are many potential barriers to sexual history taking, including embarrassment, inadequate training, time constraints, and a belief that a sexual history is not relevant.2The barrier we would like to address further is inadequate training of medical students and residents on how to elicit a sexual history.
It is imperative for medical students and residents to receive proper instruction on how to elicit a sexual history. This includes didactic as well as clinical instruction on taking a sexual history. Modeling is a valuable tool in the learning process, and it is important that medical students and residents observe their preceptors eliciting a sexual history. This modeling is necessary for instructional purposes and for validation of the importance and relevance of taking a sexual history.
In our experience, the majority of medical students and residents are not expected to obtain a sexual history as a regular part of a comprehensive examination if there is no chief complaint that warrants a history. Their only opportunity to obtain a sexual history may arise when a patient has a chief complaint that requires a sexual history, and many times they are not supervised when they elicit those histories to ensure they do so appropriately. Increased training of practicing physicians, medical students, and residents on sexual history taking has the potential to have a positive impact on the number of physicians that elicit sexual histories. Sexual history taking and increased interaction between the physician and patient are vital to potentially decreasing the rate of transmission of STDs in the United States.