The list below is a sample of the terms of which you must be aware

  • Drug abuser vs. drug/substance user
  • Prostitute vs. sex worker, working girl/boy
  • Affairs vs. sexual contacts
  • Promiscuous vs. more than one sexual partner.

Law & McCoriston (1996)

There are several styles of taking a sexual history and you will develop your own style with experience and practice. It is very important that you use language that you are comfortable with and understand. Familiarise yourself with the terminology used in sexual health settings and where possible either sit in with an experienced colleague or at least watch one of the health education videos available (Clutterbuck, 2004; Green, 1999). There have been a number of helpful videos produced, which will help you understand how to obtain a history in a variety of settings (Law & McCoriston, 1996).

One of the most damaging things that you can do as a healthcare worker is to make assumptions about the person with whom you are working. This can lead to the person's not being provided with the most appropriate screening, nor indeed the correct treatment. There is nothing wrong with trusting your instincts; however, always be mindful of the biases that may impact on your practice (Law & McCoriston, 1996). Examples of these are the ideas that all homosexually active men engage in anal sex or all people who inject drugs are chaotic people who steal to fund their habit.

The order in which you conduct your history-taking is a personal one. What is important is that you have a structure to follow. A good example of a framework is 'The Enhanced Calgary-Cambridge Guide to the Medical Interview' (Kurtz et al., 2003).

The two major styles commonly seen in sexual health can be described as follows. The non-confrontational 'gentle' approach is to ask the generic components of any health history first. The consultation progresses from the introduction to the general medical history and the social history, and leaves the sexual history until the end. This technique allows you to build up rapport with the person and get a general view of their life story prior to asking the 'intimate' questions, which may be embarrassing.

Conversely, some clinicians believe that if you are working in a sexual health context the person has come to ask/tell you about a sexual issue, and therefore not to ask about it first may appear to the person as lack of interest. In this format, after the introduction the clinician moves directly into the collection of the sexual history, followed by the other components (Clutterbuck, 2004; Green, 1999).

Remember that you must use the style which suits you and the setting in which you work, as there is no absolute way. You may alter your approach according to the age, cultural background and other social information available; this is particularly important if the person is coming to see you after a sexual assault (Law & McCoriston, 1996). You must ensure the dignity and privacy of the person at all times and, if a question appears to have upset them, clarify it and explain why you need to know the answer.

Clinicians are often worried about how to find out the gender of a person's sexual partner without causing offence to the person. Some clinicians will use non-gender-specific terms when requesting information about a client's sexual contacts or relationships. You must be careful and ensure that you do establish the gender of the sexual partners, bearing in mind that some people will have both male and female partners. Some clinicians will use 'What is your partner's first name?' This is immediately problematic, especially if the response is gender-neutral, for example, 'Chris', as this could be a Christine or a Christopher. Cultural variance can also lead to ambiguity: therefore you must politely validate the gender. If you have set the scene with your initial introduction, asking these questions should cause little offence (see the sample history proforma below) (Clutterbuck, 2004; Green, 1999; Temple-Smith et al., 1998).

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