A comprehensive patient history can help a health care provider understand a patient’s state of health, assess any health risks that they may be facing, and determine the appropriate preventative health care measures to be taken. Sexual health is an important part of a person’s overall health, but one that is often overlooked during patient health history taking and routine medical visits.

Ideally, a thorough sexual health history would cover sexual practices, sexual partners, sexual orientation, gender identity, history of sexually transmitted infections (STIs), protection from STIs, and pregnancy prevention.

Undiagnosed HIV is a worldwide health problem that affects people from all countries. In South Africa, like other countries, screening for HIV is of particular importance due to the prevalence of HIV infection, which is estimated to be about 13.5%.

The authors of a recent qualitative study analyzed the video-recordings of 151 medical consultations (primarily of patients with diabetes and hypertension) to glean insights on if/how sexual health is addressed by doctors during routine health visits in rural South Africa. A sexual health history was taken in just five of the 151 recorded consultations.

Each of the patients in these five consultations was offered HIV screening and the opportunity to talk about potential sexual dysfunction. Nevertheless, the authors expressed concern about the low percentage of appointments in which sexual histories were taken (3%) and some of the patient-doctor interactions during sexual history taking process.

To facilitate better care and health outcomes, the authors emphasized the following:

• Health care providers should screen for sexual risks and sexual dysfunction in primary care settings, even when it is not the presenting complaint or specified reason for the visit.
• Training and resources related to sexual health are necessary to support health care professionals in addressing patients’ sexual health needs.
• When taking a sexual health history, it is important for providers to be warm, empathetic, and nonjudgmental.
• Clear, professional communication is key for discussing sexual history. The provider can show respect for the patient by greeting them, using their name, being polite, maintaining eye contact, and listening when the patient speaks.
• Time is necessary for patients to disclose sensitive information. One study on the subject indicated that if the time of a consultation was extended from nine minutes to 13 minutes, the rate of personal patient disclosures would go up by 32% (Stirling, 2021). (The authors suggested implementing an electronic recordkeeping process to save health care professionals time from tasks like looking through files for health records and lab results).
• Patients should be granted as much privacy as possible for discussing sexual history. When another individual such as a translator is present, questions should still be directed toward the patient.
• A sexual health history should be culturally sensitive and take into account the patient’s lifestyle, background, relationship status, and health literacy level.

Addressing a person’s sexual health can have a significant effect on their overall health. It may reduce the risk of contracting or spreading an STI, help prevent unplanned pregnancies, and alleviate the mental or emotional burdens that can accompany sexual problems. Patients should be empowered to bring up their sexual health needs during medical appointments, even if a provider does not ask about them first.

Resources:

• Pretorius, D., Couper, I., & Mlambo, M. (2021). Sexual History Taking: Perspectives on Doctor-Patient Interactions During Routine Consultations in Rural Primary Care in South Africa. Sexual Medicine Open Access, 9(4), 100389. DOI: https://doi.org/10.1016/j.esxm.2021.100389.