How to take a patient’s sexual history

Taking an accurate and appropriate sexual history is crucial to patient health, especially for STI prevention and management. Not only can it assist you in screening for and assessing a wide range of sexual health issues, but you can use it to guide treatment and patient education.
Around 92% of GPs and nurse practitioners feel “comfortable and confident” taking a sexual history¹, but only 29% say they'd ask about sexual orientation or practices if a patient talked about them or mentioned STI symptoms².  

We know that sometimes it can be challenging to talk about sexual health with patients³, especially if you're:

• Pressed for time
• Worried about discussing sensitive topics
• Not sure about culturally appropriate responses in certain situations⁴. 

To help make it easier for you and your patients, here’s a helpful overview of how to take a sexual history. 

Tips for respectful and inclusive sexual history taking

It's important to reassure patients about privacy and that any information they share is confidential. Ensure there's a clear understanding of how they'd like to be contacted if a follow-up is required⁵.

Seek your patient’s permission before starting to take their sexual history⁶.

It can help to normalise the conversation when initiating the discussion. For example, during a consultation with a new patient⁷, you could say, “I ask all of my new patients these questions so that I can gain a full understanding of their health. Is it ok if I ask some specific questions about your sexual history?”
To help patients feel comfortable starting conversations about their health, use inclusive and respectful language and adopt a non-judgemental attitude⁸. Ask about their preferred terms for body parts.

How to get the conversation started

In addition to normalising the conversation, the Australian STI Guidelines recommend the following strategies to initiate sexual history discussions: 

• Incorporating it into an existing discussion. e.g., “Since you’re here for your travel vaccines, let’s talk about other ways you can keep yourself safe while travelling.”⁹ 
• Using a conversational hook. e.g., “Have you heard about the hepatitis B and human papillomavirus (HPV) vaccines? They protect against infections that can be sexually transmitted. Would you like to find out more?”¹⁰ 

Example sexual health history questions

The following are some examples of questions you could ask as part of a sexual health check-up. The questions are designed to help identify potential health risks and if any testing is required^11,12.

• When was the last time you had sex? 
• Was that with a regular or casual partner?
• When you had sex, was it vaginal, oral or anal sex?
• When was the last time you had sex without a condom? 
• Have you had sex with people with a penis, a vagina or both? 
• Have you ever been diagnosed with (or thought you had) an STI?

Sexual health history considerations for specific populations 

You may need to do a more detailed sexual health risk assessment for some groups who may be at higher risk of infection or more likely to experience adverse health outcomes. Some of these key affected populations include:

• People who use drugs
• Men who have sex with men
• Aboriginal and Torres Strait Islander people
• Pregnant people
• People in custodial settings
• Sex workers
• Trans and gender-diverse people
• Travellers and mobile workers

You can find more information about key affected populations and STI management considerations here.