This is a topic that makes many physicians uncomfortable and is one of the most culturally laden aspects of any society. Sexual customs and taboos are ingrained in us and some people respond to “different” sexual practices and orientations with strong emotion. Physicians raised in more conservative cultures may have difficulty dealing with topics like abortion, homosexuality or sexual violence.
While we might adapt our actions to the local context, attitudes often remain because they form an important part of an individual’s moral approach to life. Does this mean that, as physicians, we have to give up our beliefs and adapt to the beliefs of others? How can we find common ground if our beliefs are at odds with those of our patients? To address these issues, read the “Attitudes” section of the Observation Guide. You can also review the self-assessment exercises in Module 2. Honesty, self-awareness and genuine respect for people help the physician to be non-judgmental and to be patient-centred when discussing topics relating to sexuality.
There are two basic types of sexual history. One is part of a general interview and consists primarily of screening questions. This is usually done during the first visit with a new patient and can consist of a form or checklist to fill out. Even if a form is completed, it is wise to explore the topic briefly to make sure there are no issues the patient might want to bring up. The second type of sexual history is when a patient comes with a sexual problem or the physician has reason to explore this topic because of a related health issue. In these cases, the context is quite different and the amount of information obtained is usually greater and specific to the problem.
Regardless of the situation, the major barriers involved for the physician are likely to be:
- Discomfort with the topic
- Difficulty in finding appropriate words and phrases to use in the conversation
- Making assumptions about sexual orientation, level of activity, practices or attitudes
- Focusing on the sexual orientation of the patient rather than risk behaviour
- Difficulty in remaining non-judgmental
Such barriers make it more difficult for the physician to explore the topic and for patients to respond completely and honestly. There are three interviews that illustrate a general approach to obtaining the sexual history of a new male or female patient. The physician uses some of the words and phrases that might be useful in these situations. The interview with the woman has two versions — one is a basic screening and the other is more detailed. The basic interview with the male patient is also more detailed and is related to Module 1. There are two other examples of patients presenting with a sexual problem as the main complaint. Each has two versions, reflecting both physician-centred and patient-centred behaviours.