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Your sexual history directly influences your physical, mental and emotional health in a multitude of ways
We make doctor appointments for a variety of reasons. Sometimes, we come in for routine general check-ups. Other times, we have a common cold or the flu and just need a little bit of relief for our symptoms. Maybe we’re getting treatment for a very specific medical issue like blurry vision. Or maybe we have questions about safer sex practices or testing for sexually transmitted infections (STIs).
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In all of these scenarios, a healthcare provider will often ask you a series of questions related to your personal medical history and family medical history. Having this information about what you’re allergic to, your other underlying medical conditions, the medications you’re currently taking, and any past patterns related to your health and wellness informs a healthcare provider’s ability to give you proper care and treatment for your specific needs.
Your sexual history functions in much the same way. It’s an area of healthcare that your family medicine doctor or primary care provider may bring up in passing conversation or in response to very specific situations that involve your sexual health. That’s because your sexual history directly influences your physical, mental and emotional health in a multitude of ways.
“A sexual history helps me include or exclude diseases or conditions that someone might have when they’re coming in for a diagnosis, and it helps me think about risk factors so that I know how to counsel and educate a person on prevention,” says primary care physician and transgender medicine specialist Antonia “Nia” Nwankwo, MD.
Dr. Nwankwo explains what’s involved in a person’s sexual history, what kinds of questions are asked when a sexual history is discussed in a medical setting and how this information informs your medical care.
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In a medical setting, your sexual history gives a healthcare provider a full picture of your risk factors for STIs. But it also opens up the door for counseling, education and conversation around any questions, concerns or curiosities you have related to your sexual health. This is an important element of routine healthcare and may be brought up during regular visits with your general healthcare provider (like a family physician or primary care provider) for a few reasons.
But some might feel overwhelmed, scared or unsafe to disclose information related to their sexual behaviors either because they feel it’s a taboo subject or because it’s a difficult and complex conversation for them to have. Trusting your healthcare provider with this information, though, allows for the creation of a safe space in which you can confidently broach this topic without fear of judgment or criticism. A healthcare provider’s role when discussing your sexual history is to:
“Sometimes, people have high-risk behaviors and they don’t realize they’re high-risk,” says Dr. Nwankwo. “But beyond that, some disease presentations only occur in the setting of certain sexually transmitted infections. So, you might see an eye doctor and they might notice something in your eye that leads them to believe that maybe you have a herpes infection. In that situation, an optometrist might ask for some sexual history so that they can better provide you with care and counsel on how to treat and prevent infections from happening.”
You can raise questions and concerns about your sexual health at any point in your health and wellness journey. But it’s common for primary care providers to ask questions related to your sexual history, sometimes at every visit.
“I ask every person at every visit if they want to talk about their sexual health because things can change and I know people often don’t feel comfortable bringing these things up on their own,” shares Dr. Nwankwo. “So, I try to make sure I provide a safe space by bringing it up in case they have something they want to talk about.”
When asking questions about your sexual health, healthcare providers will typically follow what the U.S. Centers for Disease Control and Prevention (CDC) refer to as “the 5P’s.” This series of questions explore five areas of sexual health:
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And each of these areas directly impacts other facets of your life and influences your overall health and wellness.
“Sexual health is tied to everything that we are,” says Dr. Nwankwo. “A large part of what people do is have sex, and when you have a safe space to bring up these conversations, it really contributes to providing care and looking at someone as a whole person and every facet of who they are as a human being.”
Here’s a breakdown of the different parts of your sexual history that may come up in conversation when discussing your sexual history with a healthcare provider.
A healthcare provider may ask you whether or not you’re actively sexually engaged with another individual or how many sexual partners you’ve had in the last three months or six months.
“I also like to ask how their partners identify in terms of their gender identity and their anatomy and the kinds of sexual intercourse they participate in because I don’t want to make assumptions,” explains Dr. Nwankwo.
“I also ask about how many partners they are in relationships with because there may be some people who are in polyamorous relationships, and the relationship dynamics can be very different depending on who’s involved and how many people are involved.”
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For example, someone who’s in a polyamorous relationship may have a nesting partner at home who functions like a core partner that they live with, while engaging with other sexual partners outside of the home. Other polyamorous relationships may have a tighter-knit circle of partners who all engage in sexual activities with each other.
“Information about who you’re engaging with sexually and how you’re engaging with them is important so that we can make sure everyone involved is being safe and protecting each other,” she adds.
A healthcare provider might ask what kinds of sex you participate in and what body parts or parts of your anatomy you use to engage in those sexual activities.
Most often, Dr. Nwankwo says that people will come into appointments with questions prepared to ask their healthcare providers about how to do certain activities safely or to talk about problems or pain points they’ve experienced while participating in these activities.
“How we screen for certain STIs may change depending on a person’s anatomy and the parts they engage with during those sexual activities, so I always ask which parts of their body they’re using during sex because it helps us know what tests we should run when we’re looking for STIs,” she adds.
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Beyond STIs, being open about your sexual behaviors and any symptoms or side effects you’re experiencing can be helpful, even if you’re not actively having sex with other partners. This includes masturbation and self-stimulation or experimentation.
“Self-stimulation is still a practice of sex, and if you’re comfortable telling us what’s going on, we can be helpful by pointing out things you might not be thinking about like, ‘Yes, you’ve got this yeast infection from this thing you’re doing with this sock,’” explains Dr. Nwankwo.
“By people asking sexual health questions or taking a sexual history, it allows us to check in with how safe you’re being and your practices. And maybe there are things we can support you on.”
“Would you like any STI screening today?” is a question that’s almost always asked, even if you tell your healthcare provider that you haven’t had any other sexual partners and that you haven’t been sexually active in the last six months.
“People can always tell us no, but we always ask because it allows us to give you the opportunity to know your status,” says Dr. Nwankwo. “We can do blood draws, urine analysis, oropharynx (mouth and throat) swabs and rectal swabs. Occasionally, if someone has an ulcer, sore or open wound, we’re able to swab those as well and check for possible STIs, even if they’re dried up.”
Regardless of the results, it also provides yet another opportunity for you and your healthcare provider to talk about how to protect yourself and your partner(s) from STIs and what safer sex practices and options are out there to improve or maintain your safety.
Even if you don’t currently have an STI, or if you’ve had an STI in the past that has since been treated, your past history of STIs is important information to discuss with your healthcare provider. This is especially true if you have a lifelong STI that goes dormant and occasionally or even rarely flares up like herpes.
“Having an STI is a risk factor for getting another one,” explains Dr. Nwankwo. “Having those infections changes the tissue a little bit and makes it more susceptible to getting other infections, so knowing that history informs your provider of what’s happening in your body now and what’s happened to you in the past.”
STI prevention is only one piece of the overall safer sex puzzle. Pregnancy prevention and family planning is a big part of sexual health, and not just for women and people assigned female at birth (AFAB).
“I always say anybody who has a uterus or knows someone with a uterus can have the discussion about family planning regardless of their gender identity because there are so many ways to get pregnant if having a child is something you’re interested in,” says Dr. Nwankwo.
“Family structure is important to a lot of people and people don’t always know how things work. So, we can help decrease unplanned pregnancies, or we can talk about things like adoption and other options like in vitro fertilization (IVF) — if you decide you want to use your uterus to carry a child or someone else’s uterus to carry a child.”
“Sexual satisfaction with your partner is also a part of your well-being because it’s a part of your quality of life,” notes Dr. Nwankwo. “As we look at the whole picture of someone’s health, it’s important to ask what things we can tap into to improve their quality of life and what we can do to help make it pleasurable for them if they want to participate and engage in those activities.”
She points to erectile dysfunction (ED) as an example of a common medical condition. A healthcare provider may diagnose someone for ED based on a series of tests, but the inability to get an erection may occur because of factors like stress, anxiety, depression or low testosterone.
“In some cases, we can restore sexual function without the use of any medication,” she continues. “So, sexual function is an important part to ask about because it’s a part of everyday life for some people.”
Sex isn’t an enjoyable experience for everyone. Sometimes, sex can be triggering or traumatic, particularly for anyone who’s experienced sexual trauma or domestic violence in the past or anyone who’s living through those experiences right now.
If talking about sex and your sexual history is uncomfortable in any way, you can opt out of answering these questions or take a break whenever you need it. Your healthcare provider is there to support you. If you’re concerned for your safety or feel you’re in danger, that’s information you can share with your healthcare provider in confidence. They can connect you to resources, shelters and support, and offer you guidance, counseling and onsite testing should you need it.
“When I start asking someone about their sexual history, I always tell them that we’re going to talk about some more personal questions and some of the questions I ask may be triggering, so if they need a break or need to talk about anything that concerns them, they can let me know,” reassures Dr. Nwankwo.
“We have resources available onsite, we have information about safe houses and, sometimes, we can do a warm, hand-off where we make sure another provider is connected to them before they leave the office.”
Other helpful resources include:
Your sexual history is just one small part of the overall picture of who you are as a person. It impacts other areas of your life that directly relate to your mental, physical and emotional health. By having open communication with your healthcare providers and being open and honest about your questions, concerns and anything else related to your sexual health, you’re setting yourself and your safety up for success.
Dr. Nwankwo also advises putting these conversations into practice and advocating for your health and safety by having these discussions with your partners and protecting yourself at every turn.
“In this hookup-heavy culture, not everyone is having these discussions. So, if you’re worried and cautious about yourself, make sure that you’re doing the things to protect yourself like having condoms, making sure you know your status, asking people if they’ve been tested and if they believe in getting tested,” advises Dr. Nwankwo. “Try to be honest and pick people that you feel will be honest with you.”
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