11/13/24, 8\:12 PM Guide | Sexual history

Sexual history

Table of contents

Introduction

The ability to take a thorough sexual health history is an important skill that is often assessed in OSCEs. This guide provides a
structured approach to taking a sexual history in an OSCE setting.
Patients often feel embarrassed when discussing their sexual health. They may minimise symptoms or delay seeking medical
care. To deliver the best possible inclusive care for our patients, we need to feel comfortable asking questions regarding sexual
health.
Terminology in sexual health can sometimes be challenging for students. Patients may use colloquial terms or vague language,
and it is important always to clarify what the patient means to avoid misunderstandings. For example,
"sex
" is not synonymous
with penetration and could take several forms for the patient. You should be able to obtain a thorough and accurate history
without using innuendos!
Taking a sexual history involves more than identifying symptoms. You must also consider\:
Con
Safeguarding\: identifying any safeguarding concerns (e.g. suicide risk or sexual violence)
Risk-taking behaviours\: sexually transmitted infections (e.g. HIV), recreational drug use
Prevention of onward transmission\: potential exposed partners, partner noti
Above all else, taking a good sexual health history requires excellent communication skills to build trust and rapport with the
patient.

Opening the consultation

Wash your hands and don PPE if appropriate.
Introduce yourself to the patient, including your name and role.
Con
Explain the con
" E v e r y t h i n g w e d i s c u s s d u r i n g t h i s c o n s u l t a t i o n i s k e p t c o n
b e t w e e n o u r h e a l t h c a r e t e a m t a k i n g c a r e o f y o u u n l e s s y o u s a y s o m e t h i n g t h a t m a k e s m e c o n c e r n e d a b o u t t h e s a f e t y o f
y o u r s e l f o r o t h e r s . I f , i n t h i s e v e n t , I w o u l d n e e d t o b r e a k y o u r c o n
"
Explain that you'd like to take a history from the patient\:
“ T o d a y , I n e e d t o a s k y o u s o m e p e r s o n a l q u e s t i o n s a b o u t y o u r s e x u a l
h e a l t h . W e a s k t h e s e q u e s t i o n s t o a s s e s s y o u r r i s k o f s e x u a l l y t r a n s m i t t e d i n f e c t i o n s . P l e a s e l e t m e k n o w i f y o u w o u l d p r e f e r n o t
t o a n s w e r a p a r t i c u l a r q u e s t i o n o r s t o p t h e c o n s u l t a t i o n a t a n y p o i n t . S o m e t i m e s t h e r e a r e s o m e p r e f e r r e d w o r d s o r t e r m s
p e o p l e w o u l d l i k e t o r e f e r t o t h e i r g e n i t a l s o r w o r d s t h e y w o u l d r a t h e r u s n o t u s e . D o y o u h a v e a n y p r e f e r e n c e ?”
Gain consent to proceed with history taking.
General communication skills
It is important you do not forget the general communication skills which are relevant to all patient encounters.
Demonstrating these skills will ensure your consultation remains patient-centred and not checklist-like (just because
you're running through a checklist in your head doesn't mean this has to be obvious to the patient).
Some general communication skills which apply to all patient consultations include\:
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Demonstrating empathy in response to patient cues\: both verbal and non-verbal.
Active listening\: through body language and your verbal responses to what the patient has said.
An appropriate level of eye contact throughout the consultation.
Open, relaxed, yet professional body language (e.g. uncrossed legs and arms, leaning slightly forward in the chair).
Making sure not to interrupt the patient throughout the consultation.
Establishing rapport (e.g. asking the patient how they are and o
Signposting\: this involves explaining to the patient what you have discussed so far and what you plan to discuss next.
Summarising at regular intervals.

Presenting complaint

Use open questioning to explore the patient’s presenting complaint\:
" W h a t’ s b r o u g h t y o u i n t o s e e m e t o d a y ?"
" T e l l m e a b o u t t h e i s s u e s y o u’ v e b e e n e x p e r i e n c i n g .
"
Provide the patient with enough time to answer and avoid interrupting them.
Facilitate the patient to expand on their presenting complaint if required\:
" O k , c a n y o u t e l l m e m o r e a b o u t t h a t ?"
" C a n y o u e x p l a i n w h a t t h a t p a i n w a s l i k e ?"
Open vs closed questions
History taking typically involves a combination of open and closed questions. Open questions are e
consultations, allowing the patient to tell you what has happened in their own words. Closed questions can allow you to
explore the symptoms mentioned by the patient in more detail to gain a better understanding of their presentation.
Closed questions can also be used to identify relevant risk factors and narrow the di

History of presenting complaint

Vaginal symptoms

We have included a focused list of vaginal symptoms with relevant background information.
Vaginal symptoms and causes
Abnormal vaginal discharge\: sexually transmitted infections, bacterial vaginosis, candidiasis, retained foreign body
(e.g. tampon or condom)
Post-coital vaginal bleeding (vaginal bleeding after sexual intercourse)\: cervical ectropion, cervicitis caused
by sexually transmitted infections, vulvovaginal atrophy, cervical cancer.
Intermenstrual vaginal bleeding (vaginal bleeding between menstrual periods)\: physiological (ovulation),
contraception (progesterone depot), sexually transmitted infections, polyps and
cancer, cervical cancer, vaginal cancer).
Post-menopausal bleeding (vaginal bleeding after menopause)\: vaginal atrophy, sexually transmitted infections,
hormone replacement therapy and malignancy (e.g. uterine cancer, cervical cancer and vaginal cancer).
Dyspareunia (pain during sex)\: sexually transmitted infections, vaginal atrophy, endometriosis.
Abdominal and pelvic pain\: pelvic in, urinary tract infection, ectopic pregnancy, ruptured ovarian
cyst, endometriosis, and ovarian torsion.
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Vulval skin changes/itching/lesions\: vulval candidiasis, genital warts, genital herpes, syphilis (chancre), vaginal
atrophy, lichen sclerosis and vulval malignancy.
Vaginal discharge
It is important to distinguish between normal and abnormal vaginal discharge.
Vaginal discharge is normal and often varies across a menstrual cycle. This pattern can indicate a ''fertile window
" for those
using a natural family planning contraceptive method.
However, any change in vaginal discharge is relevant and important to clarify as this can indicate pathology.
You should ask if the patient has noticed any changes to the following characteristics of their vaginal discharge\:
Volume\:
" H a v e y o u n o t i c e d a n y c h a n g e i n t h e a m o u n t o f v a g i n a l d i s c h a r g e ?"
Colour (e.g. green, yellow or blood-stained)\:
" H a v e y o u n o t i c e d a n y c h a n g e i n t h e c o l o u r o f y o u r d i s c h a r g e ?"
Consistency (e.g. thickened or watery)\:
" H a v e y o u n o t i c e d t h a t y o u r d i s c h a r ge h a s b e c o m e m o r e w a t e r y o r t h i c k e n e d
r e c e n t l y ?"
Smell\:
" H a v e y o u n o t i c e d a n y c h a n g e i n t h e s m e l l o f t h e v a g i n a l d i s c h a r g e ?"
Several STIs can cause abnormal vaginal discharge. For more information, see the Geeky Medics guide to sexually
transmitted infections.
Vaginal bleeding
Abnormal vaginal bleeding is an important symptom relevant to a wide range of gynaecological conditions. With all vaginal
bleeding, it is important to clarify the following\:
Nature and pattern of the bleeding (e.g. post-coital, intermenstrual)
Volume (spotting, soaking through pads)
Colour (bright red vs dark)
Impact on quality of life
Post-coital bleeding refers to vaginal bleeding occurring after sexual intercourse\:
" H a v e y o u n o t i c e d a n y v a g i n a l b l e e d i n g a f t e r s e x ?"
Intermenstrual bleeding refers to vaginal bleeding occurring between menstrual periods\:
" H a v e y o u n o t i c e d a n y v a g i n a l b l e e d i n g b e t w e e n y o u r p e r i o d s ?"
Dyspareunia
Dyspareunia refers to pain that occurs during sexual intercourse.
The location of the pain can vary\:
Super
Deep dyspareunia\: pain deep in the pelvis (more common with sexually transmitted infections and pelvic in
disease)
You should clarify\:
Duration of the symptom
Location of the pain (e.g. super
Nature of the pain (e.g. sharp, aching, burning)
Abdominal and pelvic pain
Abdominal and pelvic pain is a broad symptom associated with various conditions. Use SOCRATES to establish an accurate
pain history and narrow the list of potential causes.
The nature of the pain can indicate the underlying cause\:
Dysuria (pain when urinating)\: most often caused by a urinary tract infection, which could be a sexually transmitted infection
Abdominal pain with shoulder tip pain\: typical of a ruptured ectopic pregnancy
Constant cramping pelvic pain\: pelvic in
Vulval skin changes/itching/lesions
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Vulval skin changes will require a clinical examination to assess the lesion (s) accurately. Vulval itching, soreness or lesions can
indicate a genital skin infection (e.g. folliculitis), a sexually transmitted infection (e.g. genital herpes) or a dermatological
condition (e.g. contact dermatitis, lichen sclerosis). During the history, clarify the location and if any lesions are painful or non-
painful, as this can indicate the underlying pathology\:
“ H a v e y o u n o t i c e d a n y s k i n c h a n g e s ?”
“ H a v e y o u n o t i c e d a n y l u m p s , b u m p s o r r a s h e s ? A r e t h e s e p a i n f u l ?”
You should clarify\:
Timing of the symptom\:
Episodic vs constant\:
Skin irritants\:
" W h e n d o e s t h e i t c h i n g o c c u r ? I s i t w o r s e a t n i g h t ?"
" I s i t a l w a y s t h e r e , o r d o e s i t c o m e a n d go ?"
" D o y o u u s e a n y s h o w e r g e l s o r c l e a n i n g p r o d u c t s ? H a v e y o u c h a n ge d y o u r w a s h i n g p o w d e r r e c e n t l y ?
Menstrual history
A menstrual history involves exploring the characteristics of the patient's menstrual cycle. This section can be omitted in
patients who do not have a uterus or who have gone through menopause.
In a sexual health history, the key points to establish are\:
Date of last menstrual period (LMP)
Cycle length (i.e., how long from day 1 of bleeding until the next episode of bleeding)
Cycle regularity (i.e., is the cycle duration consistent or variable)
Ask the patient when the
“ W h a t d a t e w a s t h e
Ask the patient about the length and regularity of their menstrual cycle\:
" H o w o f t e n d o y o u r p e r i o d s o c c u r ?"
" A r e y o u r p e r i o d s r e g u l a r a n d p r e d i c t a b l e ?"
Periods typically occur every 28 days. However, there is signi
Pregnancy testing
If the patient’s period is late, o
important in patients with abdominal pain (to exclude ectopic pregnancy).
Gynaecological history
Previous gynaecological history may in
Ask if the patient has previously had any gynaecological problems\:
Ectopic pregnancy
Sexually transmitted infections
Abnormal cervical smear
Endometriosis
Bartholin's cyst
Cervical ectropion
Malignancy (e.g. cervical, endometrial, ovarian)
Ask the patient if they've previously undergone any surgery or procedures in the past such as\:
Abdominal or pelvic surgery
Caesarean section
Loop excision of the transitional zone (LETZ)
Vaginal prolapse repair
Hysterectomy
Clarify the patient's cervical screening history\:
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Con
Ask if the patient received any treatment (if the cervical screening test was abnormal) and if follow-up is in place
Ask if the patient has been vaccinated against HPV
Obstetric history
It is important to take a brief obstetric history as part of sexual history taking, as it may be relevant to the patient's presentation
and may inobstetric history.
If the patient is pregnant, clarify the gestation, planned mode of delivery and any obstetric concerns.

Penile symptoms

We have included a focused list of penile symptoms with relevant background information.
Penile symptoms and causes
Urethral discharge\: sexually transmitted infection
Dysuria\: sexually transmitted infection, urinary tract infection (less common due to the longer urethra), balanitis
(in
Testicular pain or swelling\: orchitis/epididymo-orchitis (from a sexually transmitted infection or non-sexually
transmitted infection such as E.coli), testicular torsion
Penile skin changes/itching/lesions\: balanitis secondary to a sexually transmitted infection, candidiasis, genital
warts, genital herpes, syphilis (chancre), penile cancer and lichen sclerosus.
Penile swelling\: balanitis (could be due to a sexually or non-sexually transmitted infection), paraphimosis
Abdominal and pelvic pain\: urinary tract infection, prostatitis
Urethral discharge
can be normal.
It is important to distinguish between normal and abnormal penile discharge. A small amount of clear discharge at the meatus
Clarify the characteristics of the discharge\:
Colour (e.g. green, yellow or blood-stained)\:
" W h a t c o l o u r i s t h e d i s c h a r g e y o u' v e n o t i c e d ?"
Consistency (e.g. thickened or watery)\:
" I s t h e d i s c h a r g e t h i c k o r t h i n a n d w a t e r y ?"
Volume/frequency\:
" A r e y o u c o n s t a n t l y h a v i n g t o w i p e a w a y t h e d i s c h a r ge , o r d o e s i t c o m e a n d go ?"
Several STIs can cause urethral discharge. For more information, see the Geeky Medics guide to sexually transmitted
infections.
Dysuria
Dysuria can be a symptom of a sexually transmitted or non-sexually transmitted urethral infection (UTI)\:
“ D o y o u h a v e a n y b u r n i n g o r s t i n g i n g i n y o u r p e n i s w h e n y o u p a s s w a t e r”
In young patients, penile dysuria is more likely to be caused by a sexually transmitted infection than in older patients.
Dysuria may be associated with urinary frequency and haematuria\:
“ D o y o u f e e l y o u a r e p a s s i n g u r i n e m o r e o f t e n ?”
“ I s t h e r e a n y b l o o d i n y o u r u r i n e ?”
Testicular pain and/or swelling
Testicular pain and swelling may suggest epididymo-orchitis (in
“ H a v e y o u n o t i c e d a n y p a i n o r s w e l l i n g i n y o u r t e s t i c l e s ?”
" H a v e y o u n o t i c e d a n y l u m p s o r s w e l l i n gs i n t h e s c r o t u m ?"
If pain or swelling is present, explore this further using SOCRATES.
Testicular torsion
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Acute onset unilateral testicular pain is a red testicular torsion, a surgical emergency requiring urgent surgical
review.
Penile skin changes/itching/lesions
Penile skin changes will require a clinical examination to accurately assess the lesion(s). Penile itching, soreness or lesions can
indicate a genital skin infection (e.g. candidiasis), a sexually transmitted infection (e.g. genital herpes) or a dermatological
condition (e.g. contact dermatitis, lichen sclerosis).
During the history, clarify the location and if any lesions are painful or non-painful, as this can indicate the underlying
pathology\:
“ H a v e y o u n o t i c e d a n y s k i n c h a n g e s ?”
“ H a v e y o u n o t i c e d a n y l u m p s , b u m p s o r r a s h e s ? A r e t h e s e p a i n f u l ?”
You should clarify\:
Timing of the symptom\:
Episodic vs constant\:
" W h e n d o e s t h e i t c h i n g o c c u r ? I s i t w o r s e a t n i g h t ?"
" I s i t a l w a y s t h e r e , o r d o e s i t c o m e a n d go ?"
Skin irritants\:
" D o y o u u s e a n y s h o w e r g e l s o r c l e a n i n g p r o d u c t s ? H a v e y o u c h a n ge d y o u r w a s h i n g p o w d e r r e c e n t l y ?
Penile swelling
In
conditions (e.g. lichen sclerosus, Zoon's balanitis). This in
present).
“ D o y o u h a v e a n y s w e l l i n g o f t h e p e n i s ?”
Balanitis can lead to paraphimosis, where the foreskin cannot be replaced over the glans. This could compromise the blood
supply to the penis and requires urgent review.
“ A r e y o u a b l e t o r e t r a c t a n d r e p l a c e y o u r f o r e s k i n ?”
Abdominal and pelvic pain
Abdominal and pelvic pain may suggest prostatitis or a urinary tract infection.

Rectal symptoms

Asking about rectal symptoms is an important component of the sexual history, as patients may not routinely disclose these
symptoms. Most sexually transmitted infections can a
penetration has occurred.
We have included a focused list of rectal symptoms with relevant background information.
Rectal symptoms and causes
Rectal discharge\: sexually transmitted infection, foreign body, in
Rectal pain\: anal
Rectal lump\: haemorrhoids, genital warts, malignancy
Anal skin changes/itching/lesions\: genital warts, genital herpes, lichen sclerosus, syphilis (chancre),
threadworm, anal cancer
Rectal discharge
Rectal discharge is abnormal and should prompt further questioning if disclosed.
Clarify the characteristics of the discharge\:
Colour (e.g. green, yellow or blood-stained)\:
" W h a t c o l o u r i s t h e d i s c h a r g e y o u' v e n o t i c e d ?"
Consistency (e.g. thickened or watery)\:
" I s t h e d i s c h a r g e t h i c k o r t h i n a n d w a t e r y ?"
Volume/frequency\:
" A r e y o u c o n s t a n t l y h a v i n g t o w i p e a w a y t h e d i s c h a r ge , o r d o e s i t c o m e a n d go ?" " I s i t m i x e d i n w i t h
s t o o l ?"
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Several STIs can cause rectal discharge. For more information, see the Geeky Medics guide to sexually transmitted infections.
Rectal pain
Rectal pain may arise as a result of an anal
the rectum. Proctitis can be due to a sexually transmitted infection.
" D o y o u h a v e a n y p a i n a r i s i n g f r o m t h e b a c k p a s s a g e ?"
" I s i t p a i n f u l t o o p e n y o u r b o w e l s ?"
Rectal lump
Most causes of rectal lumps are benign (e.g. genital warts and haemorrhoids). However, it is important not to miss a malignancy
and an examination should be o
Anal skin changes/itching/lesions
Anal skin changes will require a clinical examination to assess the lesion(s) accurately. Itching or soreness can indicate an
anogenital skin infection (e.g. folliculitis, scabies), a sexually transmitted infection (e.g. genital herpes) or a dermatological
condition (e.g. contact dermatitis, lichen sclerosis). Other causes are haemorrhoids,
During the history, clarify the location and if any lesions are painful or non-painful, as this can indicate the underlying
pathology\:
“ H a v e y o u n o t i c e d a n y s k i n c h a n g e s ?”
“ H a v e y o u n o t i c e d a n y l u m p s , b u m p s o r r a s h e s ? A r e t h e s e p a i n f u l o r i t c h y ?”
" H a v e y o u n o t i c e d a n y t i n g l i n g o r b u r n i n g i n t h e a r e a o f t h e l e s i o n s ?"
You should clarify\:
Timing of the symptom\:
Episodic vs constant\:
Skin irritants\:
" W h e n d o e s t h e i t c h i n g o c c u r ? I s i t w o r s e a t n i g h t ?"
" I s i t a l w a y s t h e r e , o r d o e s i t c o m e a n d go ?"
" D o y o u u s e a n y s h o w e r g e l s o r c l e a n i n g p r o d u c t s ? H a v e y o u c h a n ge d y o u r w a s h i n g p o w d e r r e c e n t l y ?"

Oral symptoms

Sexually transmitted infections can also be transmitted to the oral cavity and infect the pharynx. Symptoms can include a sore
throat (e.g. gonorrhoea) or ulcer(s) (e.g. HSV, chancre).
It is important to ask about oral sex during the sexual history, as pharyngeal swabs may be appropriate. However, most sore
throats are not due to a sexually transmitted infection!

Ideas, concerns and expectations

A key component of history taking involves exploring a patient’s ideas, concerns and expectations (often referred to as ICE) to
gain insight into how a patient currently perceives their situation, what they are worried about and what they expect from the
consultation.
The exploration of ideas, concerns and expectations should be
This will help ensure your consultation is more natural, patient-centred and not overly formulaic.
It can be challenging to use the ICE structure in a way that sounds natural in your consultation, but we have provided several
examples for each of the three areas below.
Ideas
Explore the patient’s ideas about the current issue\:
“ W h a t d o y o u t h i n k t h e p r o b l e m i s ?”
“ W h a t a r e y o u r t h o u g h t s a b o u t w h a t i s h a p p e n i n g ?”
“ I t’ s c l e a r t h a t y o u’ v e g i v e n t h i s a l o t o f t h o u gh t , a n d i t w o u l d b e h e l p f u l t o h e a r w h a t y o u t h i n k m i gh t b e go i n g o n .
”
Concerns
Explore the patient’s current concerns\:
“ I s t h e r e a n y t h i n g , i n p a r t i c u l a r , t h a t’ s w o r r y i n g y o u ?”
“ W h a t’ s y o u r n u m b e r o n e c o n c e r n r e g a r d i n g t h i s p r o b l e m a t t h e m o m e n t ?”
“ W h a t’ s t h e w o r s t t h i n g y o u w e r e t h i n k i n g i t m i g h t b e ?”
Expectations
Ask what the patient hopes to gain from the consultation\:
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“ W h a t w e r e y o u h o p i n g I’ d b e a b l e t o d o f o r y o u t o d a y ?”
“ W h a t w o u l d i d e a l l y n e e d t o h a p p e n f o r y o u t o f e e l t o d a y’ s c o n s u l t a t i o n w a s a s u c c e s s ?”
“ W h a t d o y o u t h i n k m i g h t b e t h e b e s t p l a n o f a c t i o n ?”

Summarising

Summarise what the patient has told you about their presenting complaint. This allows you to check your understanding of
the patient’s history and provides an opportunity for the patient to correct any inaccurate information.
Once you have summarised, ask the patient if there’s anything else that you’ve overlooked. Continue to periodically
summarise as you move through the rest of the history.

Signposting

Signposting, in a history taking context, involves explicitly stating what you have discussed so far and what you plan to
discuss next. Signposting can be a useful tool when transitioning between di
provides the patient with time to prepare for what is coming next.
Signposting examples
Explain what you have covered so far\:
a c h i e v e t o d a y .
”
“ O k , s o w e’ v e t a l k e d a b o u t y o u r s y m p t o m s , y o u r c o n c e r n s a n d w h a t y o u’ r e h o p i n g w e
What you plan to cover next\:
“ N e x t I’ d l i k e t o q u i c k l y s c r e e n f o r a n y o t h e r s y m p t o m s a n d t h e n a s k s o m e q u e s t i o n s a b o u t y o u r
s e x u a l p a r t n e r s . W o u l d t h i s b e o k a y ?”

Systemic enquiry

A systemic enquiry involves performing a brief screen for symptoms in other body systems which may or may not be relevant
to the primary presenting complaint. A systemic enquiry may also identify symptoms that the patient has forgotten to mention
in the presenting complaint.
Sexually transmitted infections can cause systemic symptoms such as\:
Fever (secondary to pelvic in
Malaise
Weight loss (e.g. HIV)
Rash
Swelling and tenderness of large joints, conjunctivitis (reactive arthritis secondary to chlamydia)

Last sexual contact

Signposting here is bene
“ N e x t , I’ m g o i n g t o m o v e o n t o d i s c u s s y o u r s e x u a l h i s t o r y . S o m e o f t h e s e q u e s t i o n s a r e q u i t e i n-d e p t h a n d p e r s o n a l . T h e r e a s o n
w e a s k t h e s e q u e s t i o n s i s s o t h a t w e c a n a c c u r a t e l y a s s e s s t h e r i s k o f s e x u a l l y t r a n s m i t t e d i n f e c t i o n s . W e a s k t h e s a m e
q u e s t i o n s t o e v e r y o n e , s o p l e a s e d o n' t t a k e a n y t h i n g p e r s o n a l l y . J u s t l e t m e k n o w i f y o u f e e l u n c o m f o r t a b l e a n d w o u l d p r e f e r
n o t t o a n s w e r .
”

Timing

Ask about the timing of the last sexual contact\:
“ W h e n w a s t h e l a s t t i m e y o u h a d a n y s e x u a l c o n t a c t ?”

Sexual contact

You should clarify the nature of the sexual contact to establish which anatomical sites will require testing. Establishing if a
barrier method was used is important to assess the risk of STI transmission and to ascertain if emergency contraception is
required (if penile-vaginal penetration occurred).
" W h a t t y p e o f s e x d i d y o u h a v e w i t h t h e m ?"
" D i d y o u g i v e o r r e c e i v e v a g i n a l / f r o n t a l s e x ?"
https\://app.geekymedics.com/osce-guides/history/sexual-history/ 8/1211/13/24, 8\:12 PM Guide | Sexual history
" D i d y o u g i v e o r r e c e i v e a n a l s e x ?"
" D i d y o u g i v e o r r e c e i v e o r a l s e x ?"
" D i d y o u u s e a n y s e x t o y s ?"
" W a s a c o n d o m o r d e n t a l d a m u s e d ?"
" W e r e y o u h a v i n g s e x a s p a r t o f a gr o u p ?"

Relationship

Ask if this was a regular sexual partner or a one-o
them. This will help establish if they are outside the window periods (appropriate time to test) for testing\:
" W a s t h i s a r e g u l a r s e x u a l p a r t n e r o r a c a s u a l s e x u a l e n c o u n t e r ?"
" H o w l o n g h a v e y o u b e e n h a v i n g s e x w i t h t h i s p a r t n e r ?"

Contraception

Clarify the method of contraception used (if any) and the consistency of usage if penile-vaginal penetration has occurred\:
“ W e r e y o u o r y o u r p a r t n e r u s i n g a n y c o n t r a c e p t i o n d u r i n g t h i s c o n t a c t ?"
" D i d y o u h a v e a n y p r o b l e m s u s i n g c o n t r a c e p t i o n d u r i n g s e x ( e .g. c o n d o m s p l i t o r p i l l f o r g o t t e n ) ?"
“ W a s t h e r e a n y p o i n t a t w h i c h c o n t r a c e p t i o n w a s n o t u s e d d u r i n g s e x ?"

Other sexual partners

Ask about other sexual partners in the last three months\:
“ H a v e y o u h a d a n y o t h e r p a r t n e r s w i t h i n t h e l a s t t h r e e m o n t h s ?”
- if so, repeat the above questions for each

STI testing history

Ask the patient when their last sexual health screen was and if they or any of their partners have previously been diagnosed
with a sexually transmitted infection.
" W h e n w a s y o u r l a s t s e x u a l h e a l t h s c r e e n ?"
" H a v e y o u b e e n d i a g n o s e d w i t h a s e x u a l l y t r a n s m i t t e d i n f e c t i o n b e f o r e ? I f s o , w h i c h o n e a n d h o w w a s i t t r e a t e d ?"
" H a v e a n y o f y o u r s e x u a l p a r t n e r s b e e n d i a g n o s e d w i t h a s e x u a l l y t r a n s m i t t e d i n f e c t i o n ?"

Sexual violence

It is important in a sexual history to screen for sexual violence so appropriate screening, post-exposure prophylaxis (if
applicable), signposting, and support can be provided\:
" D o y o u f e e l s a f e w i t h y o u r c u r r e n t p a r t n e r ?"
" A n y v i o l e n c e t o w a r d s y o u i n t h i s r e l a t i o n s h i p ?"
" H a v e y o u e v e r h a d s e x t h a t y o u' v e n o t c o n s e n t e d t o ?"
" H a v e y o u e v e r h a d a n y p r o c e d u r e s t o y o u r ge n i t a l s f o r n o n-m e d i c a l p u r p o s e s s u c h a s c u t t i n g, p i e r c i n g o r b u r n i n g?"
Female genital mutilation
The World Health Organisation de as " a l l p r o c e d u r e s i n v o l v i n g p a r t i a l o r t o t a l r e m o v a l o f t h e
e x t e r n a l f e m a l e g e n i t a l i a o r o t h e r i n j u r y t o t h e f e m a l e g e n i t a l o r g a n s f o r n o n-m e d i c a l r e a s o n s"
. Performing or assisting
someone to perform FGM is illegal in the United Kingdom.
For more information, see the NHS page on female genital mutilation.

Other safeguarding issues

In a sexual health history, it is important to identify any other safeguarding issues, including\:
Age of the sexual partner (if the patient is under 18)
Recreational drug use
https\://app.geekymedics.com/osce-guides/history/sexual-history/ 9/1211/13/24, 8\:12 PM Guide | Sexual history
Power imbalance
Contact with social services

Blood borne virus risk assessment

Blood borne sexually transmitted infections include syphilis, HIV and some types of hepatitis. It is important to ask about risk
factors for blood borne viruses to determine the patient's risk. Risk factors for blood borne viruses include\:
Partners from countries where HIV and hepatitis viruses have a high prevalence
Sex between cisgender men or transgender woman
Current or past use of injecting drugs
Recreational drug use during sex
Sex with someone living with HIV (if they don't have an undetectable viral load) or hepatitis?
Sex work
Sex with more than >10 partners in 12 months
Post-sexual assault
Example questions to ask to assess risk\:
" W h e n w a s y o u r l a s t b l o o d t e s t f o r H I V a n d s y p h i l i s ?"
" H a v e a n y o f y o u r p a r t n e r s b e e n f r o m a b r o a d o r w e r e b o r n a b r o a d ?"
“ H a v e y o u e v e r h a d a p a r t n e r k n o w n t o b e H I V p o s i t i v e ?”
“ H a v e y o u e v e r i n j e c t e d a n y r e c r e a t i o n a l d r u g s ?”
" H a v e y o u e v e r u s e d a n y r e c r e a t i o n a l d r u g s d u r i n g s e x ?"
“ A r e y o u a w a r e o f a n y o f y o u r p r e v i o u s p a r t n e r s h a v i n g e v e r i n j e c t e d d r u gs ?”
“ H a v e y o u e v e r p a i d s o m e o n e f o r s e x o r b e e n p a i d f o r s e x ?”
" H a v e y o u e v e r h a d a n y s e x y o u' v e n o t c o n s e n t e d t o ?"
Explore which immunisations the patient has previously received\:
Hepatitis A/B
Human papillomavirus (HPV)
Ask if the patient has been taking pre-exposure prophylaxis (PrEP) or post-exposure prophylaxis (PEP) to prevent HIV
acquisition.

Past medical history

It is important to ask about the patient’s medical history, as this may in
of a sexually transmitted infection.
Ask if the patient has any medical conditions\:
“ D o y o u h a v e a n y m e d i c a l c o n d i t i o n s ?”
“ A r e y o u c u r r e n t l y s e e i n g a d o c t o r o r s p e c i a l i s t r e gu l a r l y ?”
If the patient does have a medical condition, you should gather more details to assess how well controlled the disease is and
what treatment(s) the patient is receiving. It is also important to ask about any complications associated with the condition,
including hospital admissions.
Allergies
anaphylaxis).
Ask if the patient has any allergies and if so, clarify what kind of reaction they had to the substance (e.g. mild rash vs

Drug history

Ask if the patient is currently taking any prescribed medications or over-the-counter remedies\:
“ A r e y o u c u r r e n t l y t a k i n g a n y p r e s c r i b e d m e d i c a t i o n s o r o v e r-t h e-c o u n t e r t r e a t m e n t s ?”
https\://app.geekymedics.com/osce-guides/history/sexual-history/ 10/1211/13/24, 8\:12 PM Guide | Sexual history
If the patient is taking prescribed or over the counter medications,
document the medication name, dose, frequency, form and route.
Examples of relevant medications
Some examples of medications relevant to a sexual health history include\:
PrEP and PEP\: used to prevent HIV acquisition
Antiretrovirals\: used to treat HIV and some forms of hepatitis
Antivirals (e.g. aciclovir)\: used for the suppression of herpes simplex virus
Antibiotics\: can cause candidiasis (thrush)
SGLT2 inhibitors (e.g. dapagli

Social history

Most of the social history will have already been explored in the sections above (e.g. recreational drug use), and you may not
need to ask all the questions in this section.
Smoking
Record the patient’s smoking history, including the type and amount of tobacco used.
Smoking can make it more digenital warts.
See our smoking cessation guide for more details.
Alcohol
information).
Record the frequency, type and volume of alcohol consumed on a weekly basis (see our alcohol history taking guide for more
Some medications used to treat sexually transmitted infections (e.g. metronidazole) should not be taken with alcohol.
O
Sexual problems
Patients presenting to a sexual health clinic may have an underlying problem or di
disclose for fear of embarrassment (e.g. premature ejaculation, erectile dysfunction, dyspareunia, low libido or anorgasmia).
Some of these problems may have associated underlying organic pathology (e.g. erectile dysfunction is associated with
atherosclerosis), and are important to identify and treat.
Depending on the patient's presentation, it may be appropriate to ask about sexual problems\:
" S o m e t i m e s p e o p l e e x p e r i e n c e p r o b l e m s d u r i n g s e x . D o y o u h a v e a n y p r o b l e m s o r c o n c e r n s w e h a v e n' t d i s c u s s e d s o f a r ?"

Closing the consultation

Summarise the key points back to the patient.
Ask the patient if they have any questions or concerns that have not been addressed.
Thank the patient for their time.
Dispose of PPE appropriately and wash your hands.

References

1. British Association for Sexual Health and HIV. U K N a t i o n a l G u i d e l i n e f o r c o n s u l t a t i o n s r e q u i r i n g s e x u a l h i s t o r y t a k i n g \: C l i n i c a l
E LINK]
2. World Health Organization. F e m a l e g e n i t a l m u t i l a t i o n . Published in 2023. Available from\: [LINK]
https\://app.geekymedics.com/osce-guides/history/sexual-history/ 11/1211/13/24, 8\:12 PM Guide | Sexual history
3. NHS. F e m a l e g e n i t a l m u t i l a t i o n ( F G M ) . Published in 2022. Available from\: [LINK]
Source\: geekymedics.com
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