Mature Sexuality: Sexual HistoryTaking

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Mature Sexuality Sexual History-Taking

• Association of Reproductive Health Professionals
• www.arhp.org

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Expert Medical Advisory Committee

• Jean Fourcroy, MD, PhD, MPH
• Kirtly Parker Jones, MD (chair)
• Louis Kuritzky, MD
• Sharon Schnare, FNP, CNM, MSN
• Michael A. Thomas, MD

Required Slide
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Learning Objectives

• Understand why assessment of sexual function
  should be included in the health care of
  middle-aged and older adults
• Incorporate assessment of sexual function and
  risk for STIs into routine health care of mature
  adults

more
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Learning Objectives (Continued)

• Identify factors that may affect sexual function
  in older men and women
• Provide appropriate treatment, counseling, or
  referral to patients experiencing problems with
  sexuality

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What Is a Sexual History?
That portion of the medical, surgical, and/or
psychiatric conditions or circumstances that
might compromise the sexual and reproductive
functioning of an individual.
Sickle MA, Rosenstock H. The Female Patient. 1999.
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Why Take a Sexual History?

• Sends a message about interest in quality of life
  
• Opens the door for patients to discuss issues of
  concern

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What Are You Looking For?

• Risk for genital infections
• Sexual or reproductive concerns
• Genital or reproductive disorders
• Psychosocial concerns
• Level of sexual education/knowledge
• Sexual traumas, abuse, or injuries
• Contraceptive use or needs

Sickle MA,Rosenstock H. The Female Patient. 1999.
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Barriers to Taking a Sexual History
Providers lack adequate training
Providers embarrassed to ask about sex
Patients dont discuss sex unless prompted
Younger age of clinician
Sickle MA,Rosenstock H. The Female Patient.
1999. McCaffee, K. SIECUS Report. 1998.
Merrill, JM. South Med J. 1990.
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Creating a Positive Atmosphere
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Who Should Participate?

• Ideally, only the patient and clinician
• Chaperone if necessary
• Family members and friends NOT allowed

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When is a Chaperone Appropriate?

• Clinician has no previous knowledge of the
  patient or rapport established
• Patient is litigious
• Patient is in some way impaired
• Patient acts or speaks in a sexual manner

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Using an Interpreter

• Use an interpreter who works for your facility
  and who has appropriate experience
• Assess the cultural appropriateness of having
  interpreters work with clients of the opposite
  sex
• Avoid having family members interpret

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Respect the Patients Privacy
Tell me only as much as you need me to know.
If you do not want specific information noted
in your chart, let me know.
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Reassuring the Patient

• Other patients have shared concerns about
  sexual activity, such as sexual satisfaction,
  difficulty achieving erection or orgasm,
  masturbation, pain or other specific kinds of
  sexual activity. I would be happy to discuss
  these or other issues with you. If I cant answer
  your question, Ill find someone who can.

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Initiating a Sexual History
Tell me about your sexual activity.
On a scale of 1-10, how would you rate your sex
life? What would you have to change to make it
better (a 10)?
Do you have any concerns about your sexual life
that you would like to discuss?
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Discussing Sexual Activity


I need to ask you some very personal questions
so that I can provide complete care for you.
These questions are important to help me examine
you better and to determine where I may need to
check for infections. If you do not wish to
answer a question, tell me. I respect your right
not to share information with me.
more
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Discussing Sexual Activity (continued)
Are you currently sexually active?


Do you have a sexual partner?
Do you have sex with men, women, or both?
Tell me about your sexual activity.
Do you masturbate or self pleasure?
Are you sexually satisfied?
more
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Discussing Sexual Activity (continued)
Do you have orgasms?


Do you have pain with sexual activity?
Does your partner(s) have pain with sexual
activity?
Is there anything you would change about your
sexual activity?
Do you have any sexual concerns?
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Menstrual Obstetrical History

• Age of onset of menses
• Last menstrual period
• History of unprotected intercourse
• Length, regularity, and periodicity of menses

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Pregnancy and the Perimenopause

• Do you plan to become pregnant?

If so, how soon would you like to become
pregnant?
If not, how are you and your partner protecting
yourselves from pregnancy?
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Assessing STI Risks
?

• Evaluate all patients for risks of sexually
  transmitted infections (STIs), including AIDS.
• Dont make assumptions

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Effects of STIs on Sexual Expression
Chronicpelvic pain
Psychological and emotional disturbances
Effects ofSTIs
Dyspareunia
Prostatitis
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Assessing STI Risk
Have you ever had a sexually transmitted
infection?
What steps or precautions do you take during
sexual activity to prevent transmission of
diseases?
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Assessing STI Risk
How many sexual partners have you had in the
past 12 months?
Have you ever used IV drugs?
Have you ever had a blood transfusion?
Have you ever experienced burning when you
urinate?
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Assessing Prostate Health
Have you had any pain when you defecate or when
you ejaculate?
Have you felt the urge to urinate frequently or
had dribbling when you urinate?
Have you ever had any lower abdominal pain?
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Assessing for Hepatitis
Have you had yellowing skin or eyes?
Have you had upper abdominal pain, light-colored
stool, or dark urine?
Has any friend or family had hepatitis?
Have you ever been told you had a liver
problem/hepatitis?
Have you been vaccinated for hepatitis?
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Assessing Alcohol Drug Use
How many drinks do you have each day? Beer,
wine, or hard liquor?
Is alcohol or drugs interfering with your life?
Does your use concern you or your friends and
family?
Have you gotten into trouble because of drug or
alcohol use?
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Assessing Medication Use
What prescription medications are you currently
taking?
What over-the-counter (non-prescription)
medications are you taking?
Are you taking herbs, vitamins, or supplements?
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Assessing Abuse
Have you ever been forced to have sex against
your will?
Did anyone ever touch you, or make you touch
them, in a way that made you feel uncomfortable?
Has anyone ever battered you or hit you?
Do you live with anyone who verbally abuses you?
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Assessing Medical/Surgical Trauma
Have you had any injuries to your genitals or
surgeries on your genitals?
Have you had testicular or prostate cancer?
Have you ever had surgery on your reproductive
organs, such as a hysterectomy?
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Making Referrals
Some of my other patients with this experience
have found it helpful to discuss this issue with
a psychologist/sex therapist. Have you ever
thought about doing that?
Would you be interested in seeing a
psychologist/sex therapist?
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Making Referrals

• Reassure the patient
• Emphasize your ongoing involvement in the
  patients care
• Follow up with the patient on his/her next visit

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• Appendix

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Expert Medical Advisory Committee
Jean Fourcroy, MD, PhD, MPHFourcroy Consulting
Bethesda, MD
Kirtly Parker Jones, MD (chair)Professor,
Department of Ob/Gyn University of Utah Health
Sciences CenterSalt Lake City, UT
Louis Kuritzky, MD Clinical Assistant
ProfessorUniversity of Florida Gainesville, FL
more
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Expert Medical Advisory Committee (Continued)
Sharon Myoji Schnare RN, FNP, CNM, MSN,
FAANPClinical Instructor Department of Family
and Child Nursing University of Washington
Seattle School of Nursing Olalla, WA
Michael A. Thomas, MD Director, Center for
Reproductive Health University of
Cincinnati Cincinnati, OH