A 35-year-old man comes to the office for a routine health maintenance evaluation. After separating from his wife, the patient recently moved to "make a fresh start" and start a new job. He has no chronic medical conditions and has had no surgeries. The patient is sexually active and has had 6 lifetime partners. When completing the rest of the sexual history, which of the following questions is most appropriate for the physician to ask?

Question

A 35-year-old man comes to the office for a routine health maintenance evaluation.  After separating from his wife, the patient recently moved to "make a fresh start" and start a new job.  He has no chronic medical conditions and has had no surgeries.  The patient is sexually active and has had 6 lifetime partners.  When completing the rest of the sexual history, which of the following questions is most appropriate for the physician to ask?

Quizplus · Accepted Answer

Sexual history is a key part of comprehensive patient care and should be obtained at all initial visits, routine preventive screenings, and visits when sexually transmitted infections are suspected. Physicians should attempt to put patients of all sexual orientations and gender identities at ease when reviewing sexual history because, for some, the discussion may feel uncomfortable and intrusive. Normalizing the discussion as a routine component of the medical examination, ensuring confidentiality, remaining nonjudgmental, and expressing a willingness to address all sexual health concerns can facilitate the discussion. When asking about sexual partners, the physician should avoid using labels or making assumptions about patients or their partners' sexual orientation or gender identity. Asking an open-ended question about all sexual partners allows patients to describe their sexual partners and behavior in terms that they are familiar with and that reflect their gender identity. After inquiring about the gender of sexual partners (including trans, nonbinary), the physician can ask about pertinent types of sex (eg, vaginal, oral, anal) with each partner in order to make testing recommendations for sexually transmitted infections (eg, HIV) and discuss risk-reduction strategies. Another possible formulation is, "What is/are the sex and gender of your sexual partner(s)?" (Choice B) This question is nonspecific and does not directly address sexual behavior. An individual may be sexually active outside of a romantic relationship or may not view an interaction as romantic. Although this question may yield some information regarding the patient's relationship history, it may exclude important information about some partners and sexual behaviors. (Choice C) Questioning the patient about other sexual partners while he was married may make him feel judged and less willing to disclose his sexual history. This inquiry also fails to focus on all sexual partners. (Choice D) This question forces the patient to choose a sexual orientation label. Many individuals may identify as heterosexual but have sexual contact with individuals of the same gender. Others may not relate to any of these labels to describe their sexuality. (Choice E) Asking the patient whether he has ever had intercourse with a man is a narrow, close-ended question that does not address the possible range of his sexual behaviors or partners. Educational objective: Taking a sexual history is a key part of comprehensive care and requires an inclusive and nonjudgmental approach. Physicians should avoid making assumptions about a patient's sexual history and use an open-ended inquiry about all sexual partners. __________ References: Sexual health history: techniques and tips. (http://www.ncbi.nlm.nih.gov/pubmed/32109033) Best practices in North American pre-clinical medical education in sexual history taking: consensus from the Summits in Medical Education in Sexual Health. (http://www.ncbi.nlm.nih.gov/pubmed/30297093) Sexual orientation and patient-provider communication about sexual problems or concerns among US adults. (http://www.ncbi.nlm.nih.gov/pubmed/31452036)

A 35-Year-Old Man Comes to the Office for a Routine