Improving medical students

How to Take a Sexual History

Posted by medliorator on February 22, 2008

#1 Dinosaur hitting it out of the park…

Here’s my strategy:

All female patients get asked, “What do you use for birth control?”One set of answers is simply the method: the pill, the diaphragm, condoms, etc. The natural next question is, “How is that working for you?”


Another answer is, “Nothing.” Although there are several possibilities, in real life they divide themselves by whether or not the patient continues explaining on her own. Here’s how the first set of answers usually plays out:

  • “Nothing; I’ve had my tubes tied.”
    • Response: “Cool. Do you also use condoms to protect against STDs?” etc.
  • “Nothing; my husband’s been fixed.” (Vasectcomy)
    • I tell women whose husbands are considering it, “It’s great; you won’t feel a thing.”)
  • “Nothing; I’m trying to get pregnant.”
    • Response: “How long? Have you ever been pregnant?” etc. (fertility issues)
  • “Nothing; I’m not in a relationship right now.”
    • Response: “Ok. What do you use when you do have sex?” (also presents the opportunity to find out how she feels about the lack of a relationship.)

Best answer I’ve ever heard: ::glaring daggers at me:: “I have a 2-year-old. I don’t have sex.” (No response)


there’s the second group of women who say, “Nothing,” and then fall silent.


Here’s what I usually say:

“Female partners?”

If the patient is a stupid teen (or 20-something) the answer is usually a disgusted, “Eeew! No.”
Response: “So how do keep from getting pregnant when you have sex?”
The answer is usually something like, “He pulls out,” or, “I don’t know,” etc.
Note: these patients are usually pregnant.


males starting about age 14 are asked, “Do you use condoms when you have sex?” thus forcing the explicit answer, “I don’t have sex.”

Getting a Simple Answer [Musings of a Dinosaur]

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