The Gender-neutral Sexual History

Background:
Sexual health counseling and testing is most effective when it is comfortable, relevant and specific. Sexual history techniques which force the clinician to make assumptions about the kinds of sex a patient is having may be uncomfortable for the patient and lead to inaccurate risk assessments. What we really need to know is what kinds of sex a patient has engaged in (oral, vaginal, anal, etc.) as performer and recipient, and which of these were unprotected encounters.

Objective:
To optimize our sexual history taking to allow for any personal or partner sexual orientation or identity.

Method:
Asked to develop a “Transgender Health” clinic, we involved students, faculty, staff, transgender-identified community members and allies in the development of a pre-visit questionnaire and clinical exam form. We ultimately produced a sexual history instrument which first elicits total number of partners, then categorizes unique partners for oral sex, vaginal sex and/or anal sex, then establishes whether in each case the student was the performer or recipient and if the sex was always protected or ever unprotected. Finally we ask about any other sexual practices which the patient may be concerned represent risks.

Result:
Our history is easy to use and elicits information that would not routinely be acquired (e.g. occasional anal sex among heterosexual partners) but may be important for counseling, testing or treatment (e.g. recommendation for Hepatitis A vaccination). Students evince appreciation for being able to comprehensively share their sexual histories without having to “out” themselves.

Conclusion:
The gender-blind sexual history is a novel way to accurately elicit risk behaviors of patients undergoing sexual health counseling and screening.

Implications:
The use of the gender-blind sexual history may facilitate acquisition of more accurate sexual histories. It may protect against missed opportunities for counseling and testing. It is a part of efforts to reduce barriers to care.