www rastinclinic com 2202021 Taking a Sex History

www. rastin-clinic. com 2/20/2021 Taking a Sex History BY GH. GHAEDI MD. ASSOCIATE PROFESSOR OF PSYCHIATRY SHAHED UNIVERSITY TEHRAN IRAN WWW. RASTIN-CLINIC. COM

A sex history provides important information about patients, regardless of the presence of a sexual disorder or whether that is the patient’s chief complaint. The information can be obtained gradually as therapy progresses and through open-ended questions. It is important for the interviewer to be nonjudgmental and sensitive to many patients’ embarrassment in discussing sexual issues. www. rastin-clinic. com 2/20/2021 The importance of taking a sexual history

Information regarding : I. Safe sex practices II. Sexually transmitted diseases III. Sexual orientation IV. Gender identity V. History of any sexual abuse The percentage of sexual abuse survivors seen in sex therapy programs is higher than that in the general population www. rastin-clinic. com 2/20/2021 What information do we need to obtain in sexual history?

www. rastin-clinic. com 2/20/2021 The following slides provide a guide to areas to be covered and a structure that can be used when time is limited.

1. Identifying data Age 2. Sex 3. Occupation 4. Relationship status 5. More details Sexual orientation: Heterosexual Homosexual Bisexual www. rastin-clinic. com 2/20/2021 1.

1. 4 - Relationship status Single Married Number of times previously married Separated Divorced Cohabiting Serious involvement Casual dating Difficulty forming or keeping relationships should be assessed throughout the interview www. rastin-clinic. com 2/20/2021

2. Current functioning Unsatisfactory or highly satisfactory? If unsatisfactory, why? 2. Feelings about partner satisfaction 3. Dysfunctions 4. Frequency – partnered sex (coital and noncoital sex play) 5. Desire/libido – frequency of sexual feelings, thoughts, etc. 6. Description of typical sexual interaction 7. Sexual compulsivity? (intrusion of sexual thoughts or participation in sexual activities to a degree that interferes with relationships or work, requires deception, and may endanger the patient) www. rastin-clinic. com 2/20/2021 1.

2. 3 - Dysfunctions Lack of desire Erectile disorder Inhibited female arousal Anorgasmia Premature ejaculation Retarded ejaculation Pain associated with intercourse www. rastin-clinic. com 2/20/2021

2. 3 - Dysfunctions Onset (lifelong or acquired) If acquired, when? Onset coincidence with drugs, life stresses, interpersonal difficulties? Generalized Occurs in most situations or with most partners Situational Only with current partner In any committed relationship Only with masturbation In socially proscribed circumstance (such as an affair) In definable circumstance (such as parental home, very late at night, etc. ) www. rastin-clinic. com 2/20/2021

Manner of initiation or invitation (Verbal? Physical? Does the same person always initiate? ) Presence, type, and extent of foreplay (such as kissing, caressing, manual or oral genital stimulation) Coitus? Positions used? Verbalization during sex? If so, what kind of verbalization? Afterplay? (after completion or disruption because of dysfunction); typical activities (such as holding, talking, return to daily activities, sleeping) Feeling after sex: relaxed, tense, angry, loving, etc. www. rastin-clinic. com 2/20/2021 2. 6 - Description of typical sexual interaction

3. Past sexual history Childhood sexuality 2. Childhood sex activities 3. Adolescence 4. Adult sexual activities (may be experienced by some adolescents) 5. Sex after widowhood, separation, divorce 6. Special issues www. rastin-clinic. com 2/20/2021 1.

3. 1 - Childhood sexuality From parents (Initiated by child’s questions or parent volunteering information? Which parent? What was child’s age? ) Ø Subjects covered (pregnancy, birth, intercourse, menstruation, nocturnal emission, masturbation) From books, magazines, or friends at school or through religious group? Significant misinformation Feeling about information Viewing or hearing primal scene - Reaction? Viewing sex play or intercourse of person other than parent 5. Viewing sex between pets or other animals 4. www. rastin-clinic. com 2/20/2021 Parental attitudes about sex - degree of openness or reserve 2. Parents’ attitudes about nudity and modesty 3. Learning about sex 1.

3. 2 - Childhood sex activities Genital self-stimulation before adolescence - Age? Reaction if apprehended? 2. Awareness of self as boy or girl - Bathroom sensual activities (regarding urine, feces, odor, enemas)? 3. Sexual play or exploration with another child (playing doctor) - Type of activity (such as looking, manual touching, genital touching)? Reactions or consequences if apprehended? by whom? www. rastin-clinic. com 2/20/2021 1.

3. 3 - Adolescence Age of onset of puberty B. Sense of self as feminine or masculine C. development of secondary sex characteristics, age of menarche for girl, wet dreams or first ejaculation for boy (preparation for and reaction to) body image, acceptance by peers (opposite sex and same sex), sense of sexual desirability, onset of coital fantasies Sex activities www. rastin-clinic. com 2/20/2021 A.

3. 3. C- Adolescence sex activities Masturbation - Age begun? Ever punished or prohibited? Method used, accompanying fantasies, frequency? 2. Homosexual activities - Ongoing or rare and experimental episodes? Approached by others? If homosexual, has there been any heterosexual experimentation? 3. Dating - casual or steady; description of first crush, infatuation, or first love 4. Experiences of kissing, necking, petting (“making out” or “fooling around”), age begun, frequency, number of partners, circumstances, type(s) of activity 5. Orgasm - When first experienced (experienced or not)? With masturbation, during sleep, or with partner? With intercourse or other sex play? Frequency? 6. First coitus (experienced or not) - age, circumstances, partner, reactions, contraception and/or safe sex precautions used www. rastin-clinic. com 2/20/2021 1.

3. 4 - Adult sexual activities Premarital sex A. B. C. D. E. Types of sex play experiences - frequency of sexual interactions, types and number of partners Contraception and/or safe sex precautions used First coitus (if not experienced in adolescence) - age, circumstances, partner Cohabitation - age begun, duration, description of partner, sexual fidelity, types of sexual activity, frequency, satisfaction, number of cohabiting relationships, reasons for breakup(s) Engagement - age; activity during engagement period with fiancé(e), with others; length of engagement www. rastin-clinic. com 2/20/2021 1.

3. 4 - Adult sexual activities Marriage (if multiple marriages have occurred, explore sexual activity, reasons for marriage, and reasons for divorce in each marriage) Types and frequency of sexual interaction describe typical sexual interaction (see above). Satisfaction with sex life? View of partner’s feeling B. First sexual experience with spouse - When? What were the circumstances? Was it satisfying? Disappointing? C. Honeymoon - Setting, duration, pleasant or unpleasant, sexually active? Frequency? Problems? Compatibility? A. www. rastin-clinic. com 2/20/2021 2.

3. 4 - Adult sexual activities Effect of pregnancies and children E. Extramarital sex - Number of incidents, partner, emotional attachment to extramarital partners? Feelings about extramarital sex F. Postmarital masturbation - Frequency? Effect on marital sex? G. Extramarital sex by partner - effect on interviewee H. Ménage à trois or multiple sex (swinging) (polyamony) I. Areas of conflict in marriage (such as parenting, finances, division of responsibilities, priorities) on marital sex www. rastin-clinic. com 2/20/2021 D.

Celibacy Orgasms in sleep Masturbation Noncoital sex play Intercourse Number of Relationship to partners Other www. rastin-clinic. com 2/20/2021 3. 5 - Sex after widowhood, separation, divorce

3. 6 - Special issues History of rape, incest, sexual, or physical abuse Spousal abuse (current) Chronic illness (physical or psychiatric) History or presence of sexually transmitted diseases Fertility problems Abortions, miscarriages, or unwanted or illegitimate pregnancies Gender identity conflict - (such as transsexualism, wearing clothes of opposite sex) Paraphilias - (such as fetishes, voyeurism, sadomasochism) www. rastin-clinic. com 2/20/2021

www. rastin-clinic. com 2/20/2021 Thank you for your attention