In medicine, history and examination are the cornerstones on which diagnoses and treatment strategies are made. In the field of sexual medicine, history is of paramount importance.
Proper history taking requires a lot of time. Time is limited in outpatient clinics and surgeries and that is why history taking has to be shortened and concentrated on clarifying the presenting complaints and on the relevant background features. The doctor should not be embarrassed, otherwise the patient may retract or deviate from the topic. Openness, good communication skills and tact encourage and promote frank discussion.
The presenting complaint should be explored in detail regarding its nature, development and duration and the role of situational factors. Bearing in mind the nature of the sexual response in women, questions should be asked regarding the presence of sexual desire or aversion to sex, adequacy of lubrication, the partner’s ability to penetrate, reaction to penetration, pain during or after sexual intercourse and the ability to achieve orgasm. Questions should be asked about the partner’s sexual desire, quality of erection, orgasm and ejaculation. Those about sexual knowledge and expectations are very relevant: for example, the patient may not be aware that coital frequency varies considerably and tends to decrease with age and with the length of a relationship. Questions regarding the quality and duration of the current relationship, previous relationships, separation and infidelities should come next. Then comes sexual development, sexual experiences (positive/negative/traumatic) and masturbation. The important points in taking a sexual history are summarized in Table Areas that should be covered by the sexual history.
Table Areas that should be covered by the sexual history
|Nature and development of the sexual problem|
|Sexual knowledge and expectations|
|Relationship with partner|
|children and contraception|
|Sexual experience (positive/negative/traumatic)|
|Medical history (e.g., diabetes, heart disease)|
|Surgical history (e.g., pelvic or genital operations)|
|Psychiatric history (e.g., depression)|
|Alcohol, drug and tobacco use|
|Appearance and mood|
|Attitude to problem and treatment|
Inquiries about general medical, psychiatric and drug history will help in assessing the possibility of an organic, psychologic or druginduced conditions). It is essential to keep in mind the possibility of depression and to ask specific questions about mood, appetite, sleeping pattern, etc. The doctor should attempt to form some impression about the character and personality of the patient. At the end of the consultation the doctor should ask about the degree by which the problem causes personal distress or strain to the relationship. Genital examination and general physical examination should be performed only if clinically indicated and with caution if there is a history of sexual abuse. A chaperone should always be present and the option of a male or female doctor should be offered if possible. Women with vaginismus may be very reluctant to be examined and only agree to this over time, once trust has been established and they can remain in control.