ABC of sexual health:Taking a sexual history

Many doctors are concerned about their ability to take an appropriate history from a patient with a sexual problem. The main difference from an ordinary medical history is that the patient (and often the doctor) is commonly embarrassed and uncomfortable. Patients may feel ashamed or even humiliated at having to ask for help with a sexual problem that they think is private and that they should be able to cope with themselves. This is particularly so with men, especially young men, who have to admit to erectile dysfunction and therefore, as they see it, the loss of their masculinity. Some hospital doctors get over this initial difficulty by giving patients a preconsultation questionnaire. Many patients like this, but a substantial number dislike its anonymity and apparent coldness.

Placing seats at the side of the desk is a more friendly arrangement for an interview and makes it easier to observe a couple's body language to each other, which gives clues to their relationship. (Reproduced with subjects' permission)

As with other history taking, the doctor must consider how to put the patient at ease,find out what the real problem is, discover the patient's background and clinical history, and then work out a plan of management with the patient. The doctor should try to avoidshowing embarrassment, especially if the patient wants to talk about things that are outside the doctor's experience, as this can cause the patient to clam up.

Above all, there must be sufficient time allowed, and 45-60 minutes is an ideal that is unfortunately not often possible to achieve, although in general practice the patient can be asked to come back for a longer appointment at another time.

Patients' body language, such as defensively crossing arms, can reveal their state of mind