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Sexual History Guide

Maribel Perry

MFT 6109 V2: Sex Therapy in MFT

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In our society, sexuality is manifested through a combination of desire, attraction,

pleasure, eroticism, and the need to be liked or desired. For some, sexuality is linked to erotic

pleasure and for others as means of reproduction. And all these feeling and demonstrations have

been conditioned by what each society defines it as private or public, allowed or prohibited. As

sexuality becomes parts of our personality, it may also be a source of pleasure or anguish.

As I was doing the readings, and specially when choosing the questions, I would

incorporate to gather information about my clients’ sexual history, it brought a myriad of

emotions and feelings about my own sexual history. I couldn’t help answering the questions or

imagining my husband and I sitting with a sex therapist and sharing this information. Personally,

many of the answers for these questions made me feel shame, disappointment, and even anger.

This only made me realize the role emptions play not only on myself but on my future clients

when conducting a sexual history. Emotions are an important source of information of who we

are and the type of bonds we form with important people in our lives. The emotions experienced

by the therapist become a significant tool of knowledge that can be used to better understand the

client and intervene

I also believe that while assessing the client or the couple, the therapist should observe

the couple in terms of motivation and expectations that both clients have while in therapy.

Different societies interpret different sexual behaviors differently. Behaviors, attitudes, and

culture are some of the aspects that contribute to defining sexual identify. Individuals are

constantly interacting between biological and cultural norms that eventually define us as a man

or a woman. As one would expect, sexual identity describes the patterns of emotions and sexual

attract that a person may have toward men, women, both, and neither sex.
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As I continue to learn and evolve as a Marriage and Family Therapist (MFT), I would

certainly incorporate a review or examination of sexuality to assess the overall well-being of any

client or couple. I would talk the couple about the satisfaction in their sexual lives and looking at

nonverbal behaviors that may suggest anxiety or discomfort on the topic. It will be important to

always take into consideration cultural, ethnic, religious, and socioeconomic factors. All these

factors may bring fear of being judged, breach of confidentiality regarding personal and intimate

sexual tendencies, problems or difficulties, religious beliefs, gender identities, and moral or

ethnic convictions influencing both on sexual behavior and communication between the couple.

Nevertheless, it is essential for the MFT to gather enough information after all other areas

such as physical and physiological, psychological such as depression, anxiety, phobias, etc., have

been rules out. From there, the MFT can begin inquiring about areas of sexuality such as

education, myths, knowledge about their sexual partner’s functioning, communication, ways of

expressing affection, desires, distastes, and any predisposing, precipitating, and/or maintained

factors of the dysfunction or problem.

When working with the LGTBQ+ communities, initial societal and cultural

considerations must also be discussed and how the clients or couple have coped with these.

Factors to take into consideration include discrimination, fear of rejection by family and loved

ones, shame, stigma, prejudice, internalized homophobia which could be affecting the

psychological well-being of the client of couple (Lasenza, 2010).

It is also important to note that the best approach for the therapist is to an attitude of

affective listening making sure there is nonverbal language that may imply judgement or

surprise. In addition, it is best to use open-ended questions, avoid inducing answer, or any
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confusing qualifiers or prejudices such as promiscuity or a question such as are you not

homosexual?

I first learned about the genogram as a toll to gather information about my clients in a

non-threatening way and generating my own personal genogram as one of my assignments, I

have become a fan and advocate to using this tool. What I like the most about this tool is the

visual impact it has since it allows the clients and the therapist to identify interactions, patterns,

and roles in their family system among several generations (Belous et al. 2012). I also like the

idea of a homework timeline to be done at home to allow time to think about the answers. They

can bring it to the next session and discuss each period.

Questions that I would include in my assessment to allow a better understanding any

relational, affective, social, or erotic influences to determine the focus of the treatment. I would

first like to determine how they have lived or maintain different aspects of their intimacy.

A. Antecedent and early childhood: birth, age of parents, occupation, marital status,

siblings, quality of relationships, etc.

1. Basic questions to gather information

2. Does anyone in your family have a history of sexual abuse, sex addicition,

3. Does mental illness run in your family?

B. Religious influences: parental beliefs, involvement, and participation

1. What role did religion play in shaping your sexual values? What role did culture

play?

C. Attitudes toward sex at home: sexual education received, display of affection between

parents, communication attitudes toward sex and nudity.

1. What are your first memories regarding sex?

2. Did your parents give you the “talk” about sex or they left books around?

3. Was one parent more open about sex than the other?

4. Did they explain what an orgasm is?

5. If you had a question about sex, who did you go to ask the question?

6. What was your parents’ relationship like?

7. What did intimacy look like?

8. Did they show affection to one another? If they show affection, did they do it

openly around you?

9. Did you ever walk into your parents having sex? If so, how did they handle the

situation?

10. How were sex values communicated at home?

D. Sexual manifestations in childhood: first sexual sensations, first experiences, puberty,

and adolescence.

1. Did you tell your parents about your first sexual experience? If yes, how did they

react?

2. Were there any secrets kept in the family?

3. Did you reach orgasm when you masturbated?

E. Sex education: sources of information, parental messages, ejaculation, masturbation,

menstruation.

1. Did you know what a period was when you first one?

2. Did you know what a wet dream was before you got one?

3. If you had a sexual question now, and you had to go to a family member, who

would it be?
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F. Was school or classmates were you first learned about sex?

G. When was the first time you masturbated? How old were you?

H. How did it make you feel?

I. Dating: age of first dates, first sexual experience, first exposure to pornography

1. At what age were you allowed to date?

2. At what age were you first exposed to pornography? How did it make you feel?

Once the genogram is completed and discussed, we can engage in a conversation on

current attitudes and general beliefs about sexuality and different aspects of sexuality. Topics

will include non-coital sexual behaviors, communication, quality of relationship, perceived

sexual issues, more specifics about current difficulties

Some sample questions would include:

1. As an adult, I feel most vulnerable in the bedroom when…

2. My sexual expectations of myself are….. Of my partner……..

3. The way I wish I was in the bedroom is……

4. What prevents me form being my ideal self in the bedroom?

5. What are your sex rituals?

6. When did your sexual experiences begin to feel problematic?

7. What have you done to try to fix them?

After all information is gathered, the MFT can provide adequate information and sexual

education to the client and/or couple, provide training on sexual and social skills to improve

relationship with significant other.

References

Althof, S. E., Rosen, R. C., Perelman, M. A., & Rubio-Aurioles, E. (2013). Standard operating
procedures for taking a sexual history. The journal of sexual medicine, 10(1), 26-35.

Belous, C. K., Timm, T. M., Chee, G., & Whitehead, M. R. (2012). Revisiting the sexual
genogram. The American Journal of Family Therapy, 40(4), 281-296.

Iasenza, S. (2010). What is queer about sex? Expanding sexual frames in theory and
practice. Family Process, 49(3), 291-308.

Levine, S. B. (2006). How to take a sexual history (without blushing). Current Psychiatry, 5(8),

Robboy, Carloline, (2014). The Center for Growth. Sexual Genogram: Making Sense of your
History. https://www.sextherapyinphiladelphia.com/sexual-genogram/