Sexual History Taking for Midwives

By Daphne Singingtree , CPM
Excerpted from the Birth Song Midwifery Workbook

 ©2000 may be reproduced freely as written with credits and references intact for any non-commercial or educational use.

A complete sexual history is an important tool for midwives to give thorough and holistic care.  A healthy sexual life is associated with a greater sense of well-being which can affect general health. Birth begins with sex.  Women's feelings or issues about their bodies or sex can affect how they give birth.  Medical issues arise such as STDs or certain sexual practices may be contraindicated in pregnancy. Estimates suggest that the lifetime incidence of sexual difficulties is about 50% in the general population, but the majority of sexual dysfunction is not identified. Many times a midwife may be the only person that the woman trusts enough to discuss sexual matters or difficulties. While it is outside the scope of midwifery care to give extensive counseling for sexual dysfunction, an assessment of sexual health is an important part of holistic midwifery care.

Because sexuality is so difficult for most people to talk about, privacy, sensitivity and a non-judgmental attitude are necessary to encourage clients to discuss their problems openly.

Guidelines for Midwives on Sexual History Taking

Introduction - always use a transition statement explaining the routine nature of the questions and why they are relevant to avoid surprising the person, e.g., "I would like to take your sexual history now - I ask these questions routinely because sexual issues can have a significant impact on overall health and well-being."

Timing - best done when a degree of trust has been established. If it doesn't arise naturally, it may be discussed in reference to menarche or past STDs. It is worthwhile to begin discussion by covering the less sensitive areas first, and then moving into the more sensitive topics. It is usually appropriate to reassure the client with a statement that most people initially feel awkward or uncomfortable discussing their sexuality. The initial interview may be too soon for clients to really open up about sexual matters. It can be brought up later when appropriate.

 

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Confidentiality - clients will be more willing to discuss difficult issues if the interview takes place behind closed doors, there are no interruptions and where they are reassured that confidentiality is guaranteed. Some people may not want you to record the information they disclose to you.

Practitioner discomfort - any discomfort or anxiety you bring into the interview will be communicated to the client and may prevent honest disclosure of concerns. The best way to overcome this anxiety is to take sexual histories so often that it really does become routine.

Judgmental attitudes - as in other parts of the interview, the midwife should avoid imposing her own values on the client. This is particularly critical in taking a sexual history. The problem may be greater when there is an ethnic, racial, or social class difference between a midwife and the client. No assumptions are safe to make in taking a sexual history. A particularly difficult issue for some heterosexual or Christian midwives is interviewing lesbian clients.  Also sexual practices that are unfamiliar to the midwife or couples who are non-monogamous are other examples of areas where a midwife's personal biases may interfere with communication.

Competence anxiety - midwifery training often does not include the physiology and psychology of sex, the midwife may feel inadequate in her knowledge of this area. Errors made will not destroy the interview if the midwife is sensitive to the client's response. Clients are usually willing to provide sexual information when your approach is relaxed but professional, concerned, self-confident and non-judgmental.  Some issues may come up that is outside the scope of midwifery training or care. A client may require ongoing counseling, medical evaluation or other referrals.

Terminology - terms that are overly technical or overly colloquial often get in the way of clarity in taking a sexual history. Many people, especially teenagers, may not understand the meaning of certain words i.e., "monogamous"   Non -medical people may think "sexually active" means vigorous sex or having multiple partners. Some consider overly medical terms to be intimidating, or less friendly.  Ann Frye promotes midwives using the word "yoni" as a more feminist and less medical model term for vagina.  Ina May Gaskin use to encourage midwives to use the words "puss" or "pussy". However, certain words bring up different reactions for each individual and I believe it is best to stay with specific clinical terms; I do not think there is anything wrong with the terms vagina or penis.  Slang words  like "pussy" can interfere with the client-midwife professional relationship if they are trigger words for clients.   Sometimes a general term like "bottom" can be useful, however they are best avoided if you need to give specific information. For example, making love can mean something very different than intercourse. Words such as "adultery" and  "kinky" have negative moral connotations and should also be avoided.

Sexual abuse -  it is estimated that a third of all women have had some sort of unwanted sexual contact, and many of these women have experienced significant childhood sexual abuse. This may have a profound effect on their pregnancy and birth or current sexual relationship. If a woman tells you she is a survivor of sexual abuse, that may open the door to asking her if she is interested in further counseling about it. Assure her that you will be respectful of her feelings, and if something is making her uncomfortable to let you know right away.
 

Topics Covered in a Sexual History for Pregnant Women


Sample Questions to ask in Taking a Sexual History

Most people have sexual concerns at some point in their life - Have you had any concerns you would like to discuss?

Are you satisfied with your sexual life?  Is your partner? Is frequency an issue? Any problems or questions?

Do you have more than one sexual partner? Is your partner male or female? Change in partners recently?

Any problems with desire? with arousal? any change recently?  problems with lubrication? problems with orgasm?

Any discomfort and if so, duration, frequency, etc. using any lubricant?

How is communication with your partner about this (if problem exists)? What is the effect of your sexual problems on the relationship?

Prior history of sexual abuse? Have you ever been force to have sex when you didn't want to?
 

 

References

Bates, B. (1974) A Guide to Physical Exams. Philadelphia : Lippincott
Fogel, K. Taking a Sexual History retrieved 11/2/2000 from http://www.unc.edu/~cfogel/taking_history.htm
Rathe, R. (1997) Sexual History retrieved 11/2/2000 from http://www.medinfo.ufl.edu/year1/bcs/clist/sexhx.html
Potter, J., Flory, J (ND) Taking a Sexual History retrieved 11/2/2000 from http://www.hmcnet.harvard.edu/coe/cultural/html/repro-history.html