Taking a Sexual History

Our patient care course this year started off with taking the sexual history, an important yet sensitive topic. I'm not sure what the best way to teach or learn this is. I feel that lecture was somewhat mundane in reviewing points like "be sensitive and nonjudgmental," "respect cultural differences," and things like that. It's not as if we keep suspended in our minds the list of do's and don'ts as we interview a patient with pelvic inflammatory disease. But in small group, we watched some video clips of complicated patient interviews, and I realized there was a lot more to this topic than I first thought. What do you do if as a physician, you discover your patient is having an affair which puts his health and his wife's health at risk? You have to respect confidentiality and this private information comes only because the patient trusts you. Yet you have an obligation to protect the health of others. What do you do if a patient starts making overt gestures of attraction to you? How do you deal with a patient who has no problems describing wild and unimaginable sexual activity that embarrasses you? What about the kid who may be attracted to the same gender but living in a social situation that prohibits it? There are a lot of tough situations that physicians find themselves in, and I'm not sure I'll be the right person to handle these things.