TAKING A SEXUAL HISTORY
A GUIDE TO
TAKING A SEXUAL HISTORY
For a more complete picture of your patient’s
health, the following guide offers parameters
for discussion of sexual health issues. A sexual
history needs to be taken during a patient’s
initial visit, during routine preventive exams,
and when you see signs of sexually transmitted
diseases (STDs). The dialogue lends itself to the
opportunity for risk-reduction counseling and
sharing information about behaviors that may
place your patient at risk of contracting STDs.
A sexual history allows you to identify those
individuals at risk for STDs, including HIV, and
to identify appropriate anatomical sites for
certain STD tests.
This guide was created to help you
determine the STD's risk among your
patients. The impact of STDs on a
patient’s health can range from irritating
to life threatening. Sexual health can greatly
impact overall quality of life.
Please note:
This guide is meant to provide you with a
sample of the discussion points and ques-
tions that may be asked. It is not meant to
be a standard for diagnosis or a complete
reference for sexual history taking. This guide
may need to be modified to be culturally
appropriate for some patients based on
culture or gender dynamics.
Some patients may not be comfortable
TAKING A SEXUAL HISTORY
talking about their sexual history, sex
partners, or sexual practices. Try to put
patients at ease and let them know that
taking a sexual history is an important
part of a regular medical exam
or physical history.
Sexual History
Taking a
DIALOGUE WITH PATIENT
> I am going to ask you a few questions
about your sexual health and sexual
practices. I understand that these
questions are very personal, but they
are important for your overall health.
> Just so you know, I ask these questions
to all of my adult patients, regardless
of age, gender, or marital status.
These questions are as important as the
questions about other areas of your
physical and mental health. Like the
rest of our visits, this information
is kept in strict confidence. Do you have
any questions before we get started?
The five “P”s stand for:
THE 5 “P”S OF SEXUAL HEALTH
• Partners
• Practices
• Protection from STDs
• Past history of STDs
• Prevention of pregnancy
These are the areas that you should
openly discuss with your patients.
You probably will need to ask
additional questions that are
appropriate to each patient’s
special situation or circumstances.
The 5 “P”s
1
To assess the risk of contracting
Partners
an STD, it is important to determine
the number and gender of your patient’s
sex partners. Remember: Never make
assumptions about the patient’s
sexual orientation.
If only one sex partner is noted over
the last 12 months, be certain to inquire
about the length of the relationship.
Ask about the partner’s risk factors,
such as current or past sex partners
or drug use.
If more than one partner is noted
in the last 12 months, be certain to explore
for more specific risk factors, such
as condom use (or non-use) and partner
risk factors.
DIALOGUE WITH PATIENT
> Are you currently sexually active?
(Are you having sex?)
1. Partners
If no, have you ever been sexually active?
> In recent months, how many sex partners
have you had?
> In the past 12 months, how many sex
partners have you had?
> Are your sex partners men, women,
or both?
If a patient answers “both” repeat first
two questions for each specific gender.
If a patient has been sexually active in the
past, but is not currently active, it is still
important to take a sexual history.
2
If a patient has had more than one
Practices
sex partner in the past 12 months or has
had sex with a partner who has other
sex partners, you may want to explore
further his or her sexual practices and
condom use.
Asking about other sex practices will
guide the assessment of patient risk, risk-
reduction strategies, the determination
of necessary testing, and the identifica-
tion of anatomical sites from which
to collect specimens for STD testing.
DIALOGUE WITH PATIENT
> I am going to be more explicit here
about the kind of sex you’ve had over the
last 12 months to better understand
if you are at risk for STDs.
> What kind of sexual contact do you have
2. Practices
or have you had? Genital (penis in the
vagina)? Anal (penis in the anus)?
Oral (mouth on penis, vagina, or anus)?
3
To learn more about the patient’s sexual
Protection from STDs
practices, use open-ended questions.
Based on the answers, you may discern
which direction to take the dialogue.
You will need to determine the appro-
priate level of risk-reduction counseling
for each patient.
If a patient is in a monogamous relationship
that has lasted for more than 12 months,
risk-reduction counseling may not
be needed.
However, in other situations, you may
need to explore the subjects of absti-
nence, monogamy, condom use,
the patient’s perception of his or her
own risk and his or her partner’s risk,
and the issue of testing for STDs.
DIALOGUE WITH PATIENT
> Do you and your partner(s) use any
protection against STDs?
If not, could you tell me the reason?
> If so, what kind of protection do you use?
> How often do you use this protection?
If “sometimes,” in what situations
or with whom do you use protection? 3. Protection
from STDs
> Do you have any other questions, or are
there other forms of protection from STDs
that you would like to discuss today?
4
A history of prior STDs may place your
Past History of STDs
patient at greater risk now.
DIALOGUE WITH PATIENT
> Have you ever been diagnosed with
an STD? When? How were you treated?
> Have you had any recurring symptoms
or diagnoses?
> Have you ever been tested for HIV, or other
STDs? Would you like to be tested?
> Has your current partner or any former
partners ever been diagnosed or treated
for an STD? Were you tested for the same
STD(s)?
4. Past History
of STDs
If yes, when were you tested? What was
the diagnosis? How was it treated?
5
Based on partner information from the
Prevention of Pregnancy
prior section, you may determine that
the patient is at risk of becoming
pregnant or of fathering a child. If so, first
determine if a pregnancy is desired.
Questions should be gender appropriate.
DIALOGUE WITH PATIENT
> Are you currently trying to conceive
or father a child?
> Are you concerned about getting pregnant
or getting your partner pregnant?
> Are you using contraception or practicing
any form of birth control? Do you need
any information on birth control?
of Pregnancy
5. Prevention
By the end of the interview session,
COMPLETING THE HISTORY
the patient may have come up with
information or questions that he or
she was not ready to discuss earlier.
DIALOGUE WITH PATIENT
> What other things about your sexual
health and sexual practices should
we discuss to help ensure your good
health?
> What other concerns or questions
regarding your sexual health
or sexual practices would you like
to discuss?
At this point, thank the patient for being
open and honest and praise any protective
practices.
For patients at risk for STDs, be certain
to encourage testing and offer praise for
protective practices. Explain that STD
prevention methods (or strategies) can
include abstinence, monogamy, i.e., being
faithful to a single sex partner, or using
condoms consistently and correctly.
These approaches can avoid risk (abstinence)
or effectively reduce risk for getting STD
(monogamy, consistent and correct
condom use).
After reinforcing positive behavior, it is
appropriate to specifically address concerns
regarding high-risk practices. Your expression
of concern may help the patient accept
a counseling referral, if one is recommended.
Completing
the History
Notes
Notes
Notes
Notes
Information
For more information, please visit:
www.cdc.gov/std
CS280343-A
CDC Publication: 30-0166
