A 29-year-old woman comes to the office for evaluation of vaginal discharge and pruritus for the past week. The discharge is thick and yellow with no associated odor. The patient is sexually active with multiple partners. When asked about the genders of her sexual partners, the patient says, "Why does it matter? I'm pretty sure this is a yeast infection, so I just need some medication." Which of the following is the most appropriate response at this time?

Question

A 29-year-old woman comes to the office for evaluation of vaginal discharge and pruritus for the past week.  The discharge is thick and yellow with no associated odor.  The patient is sexually active with multiple partners.  When asked about the genders of her sexual partners, the patient says, "Why does it matter?  I'm pretty sure this is a yeast infection, so I just need some medication."  Which of the following is the most appropriate response at this time?

Quizplus · Accepted Answer

Sexual history is an essential part of a patient's medical history but is a topic that may be uncomfortable for both patients and physicians. The best approach is to try to put the patient at ease by normalizing the sexual history as a routine component of the medical history. The physician's demeanor should convey that the sexual history is routinely obtained and necessary to provide good health care, similar to other key parts of the physician-patient interaction (eg, obtaining substance use history, physical examination) that might be experienced as intrusive in other contexts. By inquiring about sexual history in the same clinical and empathetic manner used for other aspects of a history and physical, physicians can place a patient at ease and create a trusting space in which a patient can talk about potentially uncomfortable and intimate topics. (Choice A) It is inappropriate to defer this critical aspect of the history to a later date based on an unverified assumption of patient discomfort. The patient's responses may indicate the need for additional STD testing, which should not be deferred. (Choice C) This statement has a judgmental tone and implies that the patient's lack of openness might negatively impact her treatment. It is unlikely to facilitate open communication. (Choice D) Although it may be appropriate to explore a patient's discomfort with a particular topic, this question is premature because it relies on the unverified assumption that the patient is uncomfortable with the topic, which may make her defensive. Normalizing sexual history and explaining why it is important is more likely to be productive. (Choice E) It would be inappropriate to offer a diagnosis before completing a full evaluation and workup. Educational objective: Sexual history is an essential part of gathering a complete medical history. This topic may be uncomfortable for both patient and physician, so it is important to normalize it as a routine part of a medical evaluation.

A 29-Year-Old Woman Comes to the Office for Evaluation of Vaginal