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Careful assessment helps identify the cause of a sexual problem as psychological or physical. A sexual history provides the basis for prevention, diagnosis, and treatment.
❑ Ensure privacy, as for physical assessment. Allow sufficient time so that the patient doesn’t feel rushed.
❑ Approach a sexual history objectively. Remember, sexual health is relative; avoid making assumptions or judgments about the patient’s sexual activities.
❑ After listening to the patient, determine his level of sexual understanding and phrase your questions in language that he can understand. Avoid technical terms.
❑ Begin with the least threatening questions. Usually, a menstrual or urologic history helps lead into a sexual history.
❑ Inquire about what the patient accepts as normal sexual behavior. Ask about sexual needs and priorities and whether the patient can discuss them with a sex partner.
❑ Assess risk behavior concerning selection of sex partners and specific sexual practices.
❑ Ask about possible homosexual activity, which can influence the risk and treatment of some STDs.
❑ Ask the female patient if she has adequate lubrication during intercourse and if she has ever experienced orgasm or pain with sexual contact. Ask the male patient if he has ever had difficulties with erection or ejaculation.
❑ Ask about current or past contraceptive practices.
❑ Try to use the history therapeutically by encouraging the patient to express anxiety. Such fears may be alleviated simply by providing factual information and answering questions.
Source: Professional Guide to Diseases (Eighth Edition), 2005
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