Sexuality and Health Care

Sexuality, being a core component of people, needs to be considered during health care encounters. A considerate sexual history is a very important skill.

 

Sexual History

Sexual history questions can be incorporated into a general medical history and can be an important source of patient education. A sexual history should be taken with new patients, a new diagnosis, management of a chronic disease, side effects of medications, major life cycle changes, well women exam, unplanned pregnancy, or at-risk behaviours identified.

Remember with sexual questioning to include permission-giving statements to normalize sexual questioning and the patient’s sexual feelings. If YOU are comfortable about sex, this will greatly enhance the conversation. Ensure privacy and confidentiality, but discuss reportability. If people are quite uncomfortable at the getgo, ask "what can I do to make you more comfortable?"

Don't assume monogamy, even in partners.

Some helpful phrases:

"I don't know about you, but some people..."

"I have had patients with (this med/problem/etc) have sexual health issue. Is this an issue for you?

 

It can be very good to approach an emerging topic by saying "this sounds important, and I think we need to sit down and talk about this. can you come back next week?" people like to hear this and know you are interested in them.

 

 

Introductory Questions

• Are you sexually active? When was the last time that you had sex?

• Are you in a relationship? How long have you been with your current partner?

• Are your sexual partners male, female or both?

• Are you sexually active with one partner or more than one partner?

 

 

STIs and Protection

• How do you protect yourself and your partner(s) from sexually transmitted infections?

• Do you use condoms sometimes, usually, always or never?
• Do you require birth control? What method do you use?

• Have you ever been treated for a sexually transmitted infection? What infection? How long ago?
• Has your partner ever had a sexually transmitted infection? What infection? How long ago?

 


Satisfaction

• Are you satisfied with your sexual life?
• Do you and your partner enjoy a mutually satisfying sexual relationship?

• Do you have any concerns about your level of desire for sex?
• Have you ever been forced to have sex? Have there ever been times when you participated in sexual activity that you didn’t consent to?
• Do you have any sexual concerns that you would like to discuss?


Sexual Functioning and Potential Difficulties

Have you ever experienced pain with sexual activity?
• Have you experienced any changes in your sexual functioning? (this question could be prefaced with a permission giving statement such as, “As women enter menopause, they sometimes notices changes in their sexuality…” or “Menopausal women sometimes experience vaginal dryness than can make intercourse uncomfortable. Are you experiencing any problems?” or “As a man ages, he may experience changes in his sexuality…”)
• Have you ever experienced loss of/decrease in sexual desire/arousal/orgasm before? For how long? Only at certain times or in certain situations?
• Does anything improve desire/arousal/orgasm? Does anything make it worse?
• How are these changes affecting you and your relationship?
• Does your partner have any sexual difficulties? How has this affected you/your relationship?


Sexual Activity

Inquire about specific sexual activities when assessing the risk for sexually transmitted infections or when discussing a patient’s concerns about sexual functioning or satisfaction. Remember that the sexual orientation of a patient does not determine the types of sexual activity that s/he engages in.
• How often do you engage in sexual activity?
• What kind of sexual activities do you engage in?

Is your mouth/penis in contact with your partner's mouth, vagina, anus?

 

 

An approach to approaching sexuality in health care is PLISSIT:

  • Permission
  • Limited Information
  • Specific Suggestions
  • Intensive Therapy

health care and LGBTO patients

 

Therapeutic relationship is not be used to further the physicians own needs. Consent is not an appriate

 

Examples of sexual misconduct include:

voyeurism:

CPSNS has a reference list...

www.sexualityandu.ca

 

Be aware of beginning to think or act differently about patients who are particularly charming, attractive, etc.