Empowering Conversations

About Sexual Health and Wellness

Why is it important to discuss sexual health and sexual wellness?

Discussing sexual health is necessary to understanding an individual’s overall wellness.
Sexual health is connected to happiness, well-being, and longevity.
Taking a sexual history can help open up a conversation about:
- Self-identified sexual wellness concerns
- Need for primary prevention
  (e.g., contraception, PEP, PrEP, etc.)
- STIs (sexually transmitted infections), including testing, diagnosis, and increased risk for HIV acquisition through lesions, ulcers or inflammation

Assess your own comfort discussing sex with various patient groups and identify any biases that you may have. If you are uncomfortable talking about sex and sexuality, your patient will be too.
Make your patient feel comfortable and establish rapport before asking sensitive questions.
Use neutral and inclusive terms (e.g., “partner”) and pose your questions in a non-judgmental manner.
Avoid making assumptions about your patient based on age, appearance, marital status, or any other factor. Unless you ask, you cannot know a person’s sexual orientation, behaviors, or gender identity.
Try not to react overtly, even if you feel uncomfortable or embarrassed. Pay attention to your body language and posture.¹
Ask patients for their pronouns. Use the pronouns they prefer, even if their anatomy does not match that identity. Introduce yourself first with your name and pronoun to set the tone for a safe environment.
Rephrase your question or briefly explain why you are asking a question if a patient seems offended or reluctant to answer.
Use ubiquity statements to strive to neutralize the conversation. For example, “It is important to know that sexual concerns are common among individuals. Many people experience similar concerns and it is completely normal.”
Ensure that you and your patient share an understanding of the terms being used to avoid confusion. If you are not familiar with a term your patient used, ask for an explanation.¹

USE THIS...	...INSTEAD OF THIS
Genitals	Vulva, vagina, penis, testicles
External area, external pelvic area, outside	Vulva
Genital opening, front pelvic opening	Vaginal opening
Frontal canal, Internal canal, inside	Vagina
Internal organs, organs you retain	Uterus, ovaries, cervix
Chest	Breasts
Bleeding	Period, menstruation

Have you had sex in the last three months? If so, what kind(s) of sex have you engaged in?
How would your partners identify themselves in terms of gender?

Do you have any other types of sex that hasn’t been asked about?
Do you use toys inside your [insert preferred language for genitals] or anus, or on your partner(s)?

Do you have any pain or discomfort during or after an orgasm?
Are you having sex for pleasure or are there other reasons (survival sex/transactional sex)?

Has anyone ever forced or compelled you to do anything sexually that you did not want to do?
Is there any violence in any of your relationships?

Have you thought about having your own biological children, or carrying a pregnancy?
When you are having sex, is there any exposure to sperm or chance of pregnancy?

AVOID ASKING:	HOW COME?	INSTEAD ASK:
Are you sexually active?	No timeframe, vague	Have you had sex in the last three months? If so, what kind(s) of sex have you engaged in?
Do you have a girlfriend, husband, etc.?	Assumes heterosexuality	What is the gender identity of your partner(s)?
Do you have sex with men, women, or both?	What about trans and/or non-binary people?	Do you share the same gender identity as your sexual partners(s)?
Do you use condoms?	Protection is more than condoms – PrEP, OCPs, etc	What methods of protection do you prefer when having sex?
Have you had insertive or receptive anal intercourse?	Patients may not understand these terms	The last time you had sex, were you the Top, Bottom, or both?

1. Altarum Institute. Sexual Health and Your Patients: A Provider’s Guide. Washington, DC: Altarum Institute; 2016. Updated 2020. nationalcoalitionforsexualhealth.org/tools/for-healthcare-providers/document/Provider-Guide_2021.pdf