Questioning Styles

There are two major types of questions used in sexual history taking, the 'open' and the 'closed' variety. It is usual to use a mixture of both in the context of a sexual history. Try to avoid the overuse of one style, as using nothing but closed questions can feel like an interrogation. Conversely, using nothing but open questions can lead to a very long consultation if the interviewee is prone to being talkative (Kurtz et al., 1998;Tomlinson, 1998). Examples of open questions might include:

'Could you tell me why you have come to see us today?' 'What do you think has caused the problem?'

These will usually lead to an explanation of the issue in the person's own words, which can lead to clues for further investigation. Examples of closed questions include:

'Do you have pain when you pass urine?' 'Did you use a condom?'

The responses are often a simple 'yes' or 'no', which allows you to gather significant amounts of information in a short time.

There is debate about the use of colloquial language, mirroring the language of the client. The interview is an opportunity for education as well as problemsolving, and the author believes that as a professional you need to assist the interviewee to tell you their story. 'When you say screwing her, do you mean your penis in her vagina?' The use of this style may assist the person in future visits with your service, as they may pick up the terms you have used to describe how they have sex with their partner (Clutterbuck, 2004; Green, 1999; Law & McCoriston, 1996).

Try to avoid the use of the medically correct terms for sexual practice, as they are so rarely used outside textbooks or theoretical lectures. An example of this would be 'his penis in your mouth rather than 'fellatio' or 'your tongue in her vagina' rather than lcunnilingus\

If you have not had the opportunity to learn about sexual practices before, familiarise yourself now with all the things people can do in enjoying a full sex life, as well as the language that is used to describe each of them. Here are a few examples:

  • Skin to skin - body rubbing, frottage
  • Oral contact - fellatio, cunnilingus
  • Oro-anal contact - rimming
  • Vaginal intercourse - penis in vagina
  • Digital sex - fingers in vagina/anus
  • Anal intercourse - penis in anus
  • Use of pleasure devices/'sex toys' - dildos, vibrators
  • Others, for example 'fisting' - fingers leading to hands in the rectum or vagina.

When you are working with people you need to be aware that it is what they have done that puts them at risk of acquiring an infection, not the particular social group to which they belong. Check for behaviours that may have put them at risk. Do not assume that your client is automatically at risk if they belong to what the public may identify as a 'risk group'. When seeing men and women who present themselves as gay, remember to check for possible further sexual contact with the opposite sex (Clutterbuck, 2004; Law & McCoriston, 1996; Verhoeven et al., 2003).

26 ADVANCED CLINICAL SKILLS FOR GU NURSES

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