Taking A Culturally Safe Sexual History

Permission & Pronouns

Ensure you gain consent prior to starting.

Ask what your patient’s preferred pronouns are and what their gender identity is.

“One part of your health history I want to discuss further is your sexual health. It’s an important part of your overall health as we want to make sure we are safe and protecting against any infections. Can I ask you questions about your sexual health?”

“The questions I ask are questions I ask to all of my patients. Our discussion will be confidential and kept between us. Do you have any questions or concerns before we start?”

Practices

It may be appropriate to discuss harm reduction strategies (e.g. safe needle exchange) and support services (e.g. counselling). Ask the patient if they have used these services or are interested in learning more about these services.

“Are you currently sexually active?”

• If no: “Have you ever been sexually active?”

“What kind of sex do you have/have you had in the past year?”

• E.g. Vaginal, anal, oral, manual stimulation of penis/vagina/anus 

“Do you have any concerns with your sexual function like pain, dryness, or lack of desire or pleasure?”

“Have you ever shared sex toys? Any barrier protection used?” 

“Do you exchange sex for food, shelter, substances, or money?”

“Have you ever been hurt or felt unsafe when having sex?”

“Do you use any alcohol, marijuana, tobacco, or other substances?”

• “How do you use them? How often? How much?”

• “Have you ever shared equipment?”

• “Have you ever had sex while under the influence?”

Partners

Do not assume a person’s sexual orientation based on their practices or vice versa – see our information on ensuring cultural safety in relationships

“What do they identify as? Are you in a relationship with them? Do you feel safe in this relationship?”

“How many partners have you had sex with in the past 12 months?”

“What do they identify as?”

Protection

Remember that protection is relevant during intercourse and with substance use – talking about harm reduction strategies is key.

“What do you know about protecting yourself against STBBIs?”

“Is there anything you and your partner(s) use for protection?”

• E.g. condoms, dental dams, split condoms/gloves
• “How often is it used and for what kind of intercourse?”
• If no: Discuss what challenges make it difficult for your patient to access barrier contraception. 

“Have you been vaccinated for HPV, Hepatitis A, and/or Hepatitis B?”

Past History

Discuss that positive results are required to be reported to Public Health and that anonymous testing is possible as well. Partners should also be tested and treated for STBBIs.

“Have you been tested for HIV or other infections before? Would you like to be tested?”

“Do you have any concerns of having an STBBI now?”

• Possible symptoms: genital/mouth sores, abdominal pain, pain during sex/bowel movements, new discharge

“Have you had any STIs in the past?”

• “When? Were you treated? Did you have a test after treatment?”
• “Has your partner had an STBBI before? When? Were they treated?”

“Have you been diagnosed with HIV, Hepatitis B/C, or Syphilis?”

• “Are you on any treatment? Do you have any problems with taking medication? Have you been treated for it in the past?”

“Have you ever had a Pap smear?”

• “When was your last? Any abnormal results previously?”

Pregnancy

This could be an opportunity for education on preventing pregnancy and emergency contraception – see our information for an overview of types of contraception and prevention rates

“Are you currently pregnant?”

“Do you currently use any contraception?”

• “What kind? Any side effects? Any problems with taking it?”
• If no: “Have you used contraception in the past? Are you currently trying for a pregnancy?”