Sexual histories and lesbian women

Nurse Practitioner, Mar 2002 by Castle, Jennifer Chalupa

Although sexual histories are vital to comprehensive patient care, only 11% to 37% of primary care providers take them, and only 9% of lesbian women report being asked about their sexual preferences.1,2 You should take thorough sexual histories in all patients but not assume heterosexuality.

Prior to the history or as a prelude to discussing sensitive information, reinforce patient-clinician confidentiality and ask the patient how she would like the sexual information documented. Patient charts are accessible to most health care personnel; therefore, use code phrases or avoid chart documentation about sexuality at the patient's request. Such precautions are necessary because of potential health care and life insurance issues.

When examining and taking the sexual history, maintain a nonhomophobic, nonjudgmental level of communication and use gender-neutral terms. For some clinicians, this mandates a paradigm shift away from heterosexuality.

Explain to the patient that an accurate sexual history is necessary to determine the tests, screening, diagnoses, and health promotion activities appropriate to her care. Patients must understand that different sexual behaviors pose different risks for acquiring infections and that women can transmit infections to each other. When clinicians exhibit open, non-- judgmental attitudes, they are rewarded with patients who provide candid information about their sexual history and health practices.

REFERENCES

1. American Medical Association: Health care needs of gay men and lesbians in the United States. JAMA 1996;275(17):1354-59.

2. Brogan M: Healthcare for lesbians: Attitudes and experiences. Nurs Stan 1997;11(45):39-42.

Jennifer Chalupa Castle, RN, MSN Walden, Vt.