Sexual History-taking Research Articles

Insufficient Assessment of Sexual Dysfunction: A Problem in Gynecological Practice

Sexual health is an important part of a woman's life and well-being. Female sexual dysfunction is a complicated problem, it is often underestimated in the healthcare process, and its management is complex. Giving women the opportunity to talk about sexual problems is a fundamental part of healthcare and may improve their quality of life. The aim of this study was to find out patients' experience and attitudes toward the involvement of gynecologists addressing sexual issues, to disclose the main barriers to initiate a conversation, and to assess the prevalence of sexual disorders among patients in a gynecological clinic. A questionnaire-based approach was used to survey 18- to 50-year-old voluntary patients in the gynecological clinic. The study population comprised 300 different gynecological (except oncologic) patients independently of reasons for being in the clinic. The duration of the study was 6 months. Only one-third of the patients had ever been asked about their sexual life by a gynecologist, whilst the majority (80%) of the respondents reported they would like to be asked abaut and discuss sexual issues. The patients mostly did not complain because of psychoemotional barriers, and shame was the main barrier for patients to talk about their problems. Sexual dysfunction was a frequent disorder among gynecological patients, reaching especially high levels in the arousal (46.41%) and lubrication (40.67%) domains. The assessment of sexual health is insufficient in gynecological care, and sexual history-taking and evaluation of sexual functions should be included in routine gynecological health assessments.

Gonorrhoea resistance among men who have sex with men: what's oral sex got to do with it?

The term “men who have sex with men” (MSM) refers to men who engage in sexual activity with other men, but who may also have sex with women. Relevant to healthcare delivery and sexual historytaking, many MSM do not consider themselves to be “homosexual” or “gay”, so it is important that appropriate language is used during clinical consultations. MSM are an important group of individuals from the public health perspective as they may act as a bridging population for sexually transmitted infections (STIs), including human immunodeficiency virus, to pass from high-risk MSM sexual networks into the general population, and vice versa. Research conducted on 1783 men in the Eastern Cape and KwaZulu-Natal provinces showed that more than one in 20 South African men engage in consensual sexual activity with other men. 1

An LGBTI-Inclusive Sexual History Taking Standardized Patient Case

Abstract Introduction The lesbian, gay, bisexual, transgender, and intersex (LGBTI) population is disproportionately affected by providers' lack of training, particularly related to the inability t...

UK national re-audit of sexual history-taking

A focused repeat national audit of sexual history-taking was conducted in genitourinary (GU) medicine clinics in the UK in 2010, addressing several areas of practice under-performance identified in the baseline 2008 national audit. The case-notes of 4285 patients were audited. An increase in documentation was observed for all measures, except legibility which was unchanged. Despite the overall improvement, several measures (chaperone offer, condom usage and four of five aspects of HIV risk assessment) remained below target.

Teaching Sexual History-Taking: A Systematic Review of Educational Programs

Because of the importance of sexual history-taking, the authors attempted to identify all randomized controlled trials on teaching this topic and reviewed the methods used for teaching and the efficacy of the educational interventions. From June to November 2010, the authors searched the published English-language literature indexed in PubMed, PsycINFO, and SCOPUS, using the key terms sexual history-taking, teaching, medical students, residents, sexual health, sexually transmitted infections, HIV, and AIDS. The authors selected and critically appraised randomized controlled trials and controlled nonrandomized trials of educational programs designed to enhance sexual history-taking skills. Of 11 trials identified, 7 included medical students, 2 included residents, 1 involved community-based physicians, and 1 involved attendings, fellows, and residents. The educational interventions and outcome measures were heterogeneous, and the quality of study methodologies varied widely. The authors judged only 1 study to be of very high quality, although 8 studies explicitly mentioned at least one of the following: group differences at baseline, blinding, follow-up, and validated measurement tools. In the highest-quality study, primary care physicians who were mailed educational materials and received an unannounced instructor visit performed better in risk assessment and counseling than two comparison groups. Evidence also supported interactive workshops over didactic presentations. The dearth of high-quality controlled studies hampers the development of sexual history-taking curricula for medical students and residents. The available literature supports formal opportunities to directly practice and receive feedback on interviewing skills. More rigorous research on sexual history-taking education is needed.

Patient, Resident Physician, and Visit Factors Associated with Documentation of Sexual History in the Outpatient Setting

Providers need an accurate sexual history for appropriate screening and counseling, but data on the patient, visit, and physician factors associated with sexual history-taking are limited. To assess patient, resident physician, and visit factors associated with documentation of a sexual history at health care maintenance (HCM) visits. Retrospective cross-sectional chart review. Review of all HCM clinic notes (n = 360) by 26 internal medicine residents from February to August of 2007 at two university-based outpatient clinics. Documentation of sexual history and patient, resident, and visit factors were abstracted using structured tools. We employed a generalized estimating equations method to control for correlation between patients within residents. We performed multivariate analysis of the factors significantly associated with the outcome of documentation of at least one component of a sexual history. Among 360 charts reviewed, 25% documented at least one component of a sexual history with a mean percent by resident of 23% (SD = 18%). Factors positively associated with documentation were: concern about sexually transmitted infection (referent: no concern; OR = 4.2 [95% CI = 1.3-13.2]); genitourinary or abdominal complaint (referent: no complaint; OR = 4.3 [2.2-8.5]); performance of other HCM (referent: no HCM performed; OR = 3.2 [1.5-7.0]), and birth control use (referent: no birth control; OR = 3.0 [1.1, 7.8]). Factors negatively associated with documentation were: age groups 46-55, 56-65, and >65 (referent: 18-25; ORs = 0.1, 0.1, and 0.2 [0.0-0.6, 0.0-0.4, and 0.1-0.6]), and no specified marital status (referent: married; OR = 0.5 [0.3-0.8]). Our findings highlight the need for an emphasis on documentation of a sexual history by internal medicine residents during routine HCM visits, especially in older and asymptomatic patients, to ensure adequate screening and counseling.

Nurse Practitioners' Sexual History-Taking Practices with Adults 50 and Older

Purpose To identify the sexual history-taking practices of nurse practitioners (NPs) for patients 50 and older. Data Sources The study involved a random sample of 500 American Academy of Nurse Practitioners (AANP) members. A mailed questionnaire was adapted from the Knowledge of HIV and HIV-Risk Screening tools and reflected the assumptions of Pender's Health Belief Model. Conclusion Only 2% of respondents indicated they always conduct a sexual history with their patients age 50 and older, while 23.4% never or seldom do such an assessment. The main barriers to taking sexual histories were identified as lack of time, interruptions, and limited communication skills. Implications for Practice The findings support the need for NPs to be more conscientious about completing a sexual history with their older patients.

Sexual history-taking: using educational interventions to overcome barriers to learning

Sexual history-taking is a basic medical skill that is traditionally taught poorly in medical school. Practising medical professionals have frequently reported feeling inadequately trained at taking these histories or discussing sexual risk. In order to promote and enhance the learning of this basic skill, those who teach sexual history-taking need to understand how it is that learners learn to take sexual histories and, crucially, the barriers that stand in the way of this being effectively done. This paper is therefore firstly concerned with identifying the barriers that health professionals in training might face when learning how to take a sexual history and, secondly, with proposing the use of well-recognised educational interventions, such as constructivist and experiential learning theories, to overcome these barriers and facilitate appropriate learning.

What is Queer About Sex?: Expanding Sexual Frames in Theory and Practice

Psychotherapists often believe if couples improve their communication and emotional dynamics, good sex follows. In practice we often find otherwise and have many questions about how to proceed to work with sexuality issues more directly. This paper presents the many challenges working with sex including the following: the fluidity and multidimensionality of sex and gender, the incongruities and paradoxes in sexual behavior, thoughts, attractions, feelings, and sensations, and the powerful feelings, impasses, surprises, and confusion therapists often experience doing the work. In essence, what is queer about sex? Using the couple as client, expansive ways of thinking and working with sexuality are presented including the development of inclusive models of sex, gender, and sexual response, as well as new approaches to standard sex therapy techniques such as sexual history-taking, redefining sex, and sensate focus. Techniques are presented with an emphasis on the therapist's use of self as sexual change agent including integrating multiple theoretical perspectives (psychodynamic, systemic, and cognitive-behavioral), co-creating a safe treatment frame, and how to intervene within the cognitive, affective, behavioral, somatic, and discursive realms.

Teaching Sexual History-Taking Skills Using the Sexual Events Classification System

The authors review the literature about educational programs for teaching sexual history-taking skills and describe novel techniques for teaching these skills. Psychiatric residents enrolled in a brief sexual history-taking course that included instruction on the Sexual Events Classification System, feedback on residents' video-recorded interviews with simulated patients, discussion of videos that simulated bad interviews, simulated patients, and a competency scoring form to score a video of a simulated interview. After the course, residents completed an anonymous survey to assess the usefulness of the experience. After the course, most residents felt more comfortable taking sexual histories. They described the Sexual Events Classification System and simulated interviews as practical methods for teaching sexual history-taking skills. The Sexual Events Classification System and simulated patient experiences may serve as a practical model for teaching sexual history-taking skills to general psychiatric residents.

Assessing changes in medical student attitudes toward non-traditional human sexual behaviors using a confidential audience response system

Medical students encountering patients with unfamiliar, unconventional sexual practices may have attitudes that can affect open communication during sexual history-taking. We measured changes in first-year US medical student attitudes toward 22 non-traditional sexual behaviors before and after exposure to human sexuality instruction. An electronic, hand-held audience response system was used in a lecture hall to sample anonymous student attitudes toward this sensitive topic. Several attitudes were influenced by instruction, as shown by statistical comparisons before and after instruction. Students' attitudes shifted toward patterns favoring treatment for five out of 10 paraphilias that are not harmful of others. Most students favored imprisonment for pederasty before instruction, consistent with lessons about mandatory reporting of child sexual abuse, and this attitude increased non-significantly after instruction. Student attitudes were generally accepting of homosexuality, but were more accepting of female than male homosexuality, both before and after instruction. Implications of these diverse effects of our lecture-based curriculum on attitudes toward non-traditional human sexual behavior are discussed, as well as benefits of audience response systems in anonymously assessing students' attitudes toward sensitive topics.

A survey of Cambodian health-care providers' HIV knowledge, attitudes and intentions to take a sexual history

Cambodia has one of the highest prevalence rates of HIV in Asia and is scaling up HIV testing. We conducted a cross-sectional survey with 358 health care providers in Phnom Penh, Cambodia to assess readiness for voluntary testing and counselling for HIV. We measured HIV knowledge and attitudes, and predictors of intentions to take a sexual history using the Theory of Planned Behaviour. Over 90% of health care providers correctly answered knowledge questions about HIV transmission, but their attitudes were often not positive towards people living with HIV. The Theory of Planned Behaviour constructs explained 56% of the variance in intention to take a sexual history: the control providers perceive they have over taking a sexual history was the strongest contributor (51%), while social pressure explained a further 3%. Attitudes about taking a sexual history did not contribute to intention. Interventions with Cambodian health care providers should focus on improving skills in sexual history-taking.

UK National Audit of Sexual History-taking: Clinic policies audit

Provision of a confidential, private environment for sexual history-taking was provided in almost all clinics. However, less than half of the clinics had a policy displayed about their confidentiality policy in waiting areas, although more had this available by other means. About two-thirds of clinic information/advertising literature included information about the need to take a sexual history. Sixty percent of clinics assessed clinician communication skills as part of service quality. Most clinics had policies relating to patients whose first language is not English, but only around half of clinics had policies for hearing difficulties and learning difficulties. Policies are also lacking in some clinics for documentation of the offer of chaperones and assessment of the competency of under-16-year-olds to consent to history-taking and examination.

UK National Audit of Sexual History-taking: Case-notes audit

A national audit of sexual history-taking was conducted in genitourinary medicine clinics in the UK in 2008. Data were aggregated by region and clinic, allowing practice to be compared between regions, as well as to national averages and against national Guidelines. In this paper the case-notes of 4121 patients were audited. A high proportion of the case-notes were deemed to be completely legible. In other respects there is considerable inter-regional variation in the adherence to national Guidelines. Interventions are especially required to improve documentation of practice in discussing condom use, HIV risk assessment, offer of a chaperone and assessment for hepatitis B vaccination and hepatitis C testing, and issues concerning sexual contacts.

Psychosocial Factors and Therapeutic Approaches in the Context of Sexual History Taking in Men: A Study Conducted among Swiss General Practitioners and Urologists

Male sexual dysfunction is a common medical condition, which is addressed mainly from a biomedical perspective by Swiss general practitioners (GPs) and urologists as the results of part I of our study showed. A psychosocial orientation in sexual history taking (SHT) leads to a truly patient-centered approach and is crucial for improving therapy decisions related to sexual dysfunction. To analyze to what extent Swiss GPs and urologists have a psychosocial orientation in SHT, and what therapeutic options they focus on when confronted with male sexual dysfunction. A semistructured interview was developed and used in face-to-face encounters with 25 GPs and 25 urologists. Content and frequency of interview responses. The GPs and urologists differed significantly from each other in 5 out of 22 psychosocial factors. Summarizing these psychosocial factors in four domains showed a difference between the GPs and urologists in only one domain. Both groups focus on an open conversation as their approach in SHT. No GP and only a minority of urologists based their diagnosis on criteria of the International Classification of Diseases (10th edition) (ICD-10) or Diagnostic and Statistical Manual of Mental Disorders (4th edition) (DSM-IV). The GPs and urologists differed significantly from each other in 4 out of 16 combinations resulting from the given therapeutic options and form of sexual dysfunction. The urologists focus more strongly on medication as a therapeutic option. The results of part II additionally justify establishing guidelines and training resources related to SHT in Switzerland. Swiss physicians should be encouraged to apply a more psychosocial orientation in SHT. This will contribute to a better patient-centered approach with positive consequences on physicians' therapeutic decisions. Optimizing the approach in SHT and the choice of therapeutic options may better facilitate real sexual satisfaction for the patient and ultimately result in fewer health insurance costs.

Tackling STI epidemics through the HIV clinic: is sex high enough on the agenda?

Sexually transmitted infection (STI) rates among men having sex with men continue to increase. HIV services may operate independently to genitourinary medicine clinics and the sexual health of HIV-positive patients may be of low priority in the context of medical problems related to HIV. A prospective study of HIV-positive gay men was conducted in a London outpatient clinic over a three-month period. Data were available for 90 men. Forty-five percent had STI screens in the preceding six months. These revealed a high rate of infections; 26 infections diagnosed in 14 men in the study period. Fifty-seven percent of the 90 men in the study had more than one partner in the past three months and approximately one-third had unprotected sexual activity. A significant proportion of men were unaware of recent outbreaks of hepatitis C and lymphogranuloma venereum and of HIV postexposure prophylaxis. We therefore recommend that sexual history-taking, STI screens and health promotion should become a routine feature of HIV outpatient consultations in this group.

ORIGINAL RESEARCH–EDUCATION: Frequency and Focus of Sexual History Taking in Male Patients—A Pilot Study Conducted among Swiss General Practitioners and Urologists

General practitioners (GPs) and urologists are the first medical contacts for men with sexual dysfunction. Previous studies have shown that many GPs hesitate to address sexual issues and little is known about the sexological skills of urologists. To analyze sexual history taking (SHT) by Swiss GPs and urologists, in terms of active exploration, focus, and competence in discussing and treating sexual dysfunction. A semi-structured interview was developed and used in face-to-face encounters with 25 GPs and 25 urologists. Content and frequency of interview responses. Urologists reported a significantly higher frequency of actively asking male patients about sexual dysfunction (22.80% vs. 10.42%, P = 0.01). GPs and urologists avoided actively asking certain patient groups about sexual dysfunction (e.g., "immigrants,""macho men"). GPs reported a significantly lower percentage of male patients who spontaneously address sexual problems (6.35% vs. 18.40%, P < 0.001). Both physician groups emphasized erectile dysfunction in SHT. Eight percent of GPs and 28% of urologists considered their competence in discussing sexual dysfunction as very good. No GP and 20% of urologists considered their competence in treating sexual dysfunction as very good. Urologists reported having significantly greater competence in discussing (P = 0.02) and treating (P < 0.001) sexual dysfunction than the GPs. Competence in discussing correlated positively with competence in treating sexual dysfunction for GPs (P = 0.01) and urologists (P < 0.001). The majority of GPs (92%) and urologists (76%) reported a need for continuing education in sexual issues. Our results justify establishing guidelines for SHT in Switzerland to better meet the sexual health needs of male patients. Physicians should be encouraged to routinely inquire about sexual issues, overcome their discomfort with the subject, and regard male sexuality as more than erectile function. A clear need exists for relevant continuing education for Swiss GPs and urologists.

Same‐Sex Activity Among Women May Be a Marker for Adverse Sexual and Reproductive Health Outcomes

Same‐Sex Activity Among Women May Be a Marker for Adverse Sexual and Reproductive Health Outcomes

Does physician bias affect the quality of care they deliver? Evidence in the care of sexually transmitted infections

Background:Primary care providers are well placed to control the spread of sexually transmitted infections (STI); however, care is likely to be influenced by their attitudes and beliefs. The present study...

STIs in women: symptoms and examination

STIs are common, particularly in young women. Sexual history-taking is eased by private and comfortable surroundings, establishing a good professional relationship, having a non-judgemental attitude, and choosing words that are both appropriate to the consultation and readily understood by the woman. Genital examination is facilitated by privacy, careful and sensitive technique and the availability of the right equipment, including a gynaecological examination couch and a range of speculums. The screening investigations selected depend on the setting, local availability of investigations and prevalence of infections, and the presentation and wishes of the client. Sampling requirements are changing with the advent of new diagnostic techniques such as nucleic acid amplification tests for Chlamydia; these can be undertaken on samples taken by the woman herself (e.g. perineal swabs, urine), thereby avoiding the need for speculum examination in some circumstances.