PRESENTING COMPLAINT: HISTORY OF PRESENTING COMPLAINT: = Reasons for attendance + Are you sexually active? - Symptom review — Should cover all partners in the last 3 Last sexual intercourse (LSI) months - Date, gender, sites of exposure, + Check relationship of symptoms to LSI with a condom use particular partner - Previous sexual partners + Condom used? Always, sometimes, never - Date, gender, sites of exposure, + Type of sex? Oral, vaginal, anal condom use + Symptoms or diagnosis in partners? - Previous STDs + Sex with same sex or opposite sex partners? = For women: LMP, contraceptives, ~ Be direct: “Have you ever had sex with cytology another man?" - HIV, Hep B&C risk + Sex work - Establish mode of giving results — “Have you ever been paid / paid = Establish competency / child protection someone for sex?" concerns + Partners from overseas in the last year TAKING A SEXUAL SYMPTOMS REVIEW paseo) MENSTRUAL HISTORY & ‘CONTRACEPTIONS: WOMEN ~ Change in vaginal ~ Put patients at ease and let + Check if contraception discharge them know that taking a sexual — What method - Vulval skin problems history is routine practice + Check correct usage - Lower abdominal pain + LMPILS! in relation to = Dysuria = Consultations should be in cycle = Changes in menstrual private rooms. ~ Possibility of cycle or abnormal pregnancy bleeding = Ideally see patients alone. + Menstrual abnormalities — Intermenstrual or MEN - Patients should be assured of pote ~ Urethral discharge bleeding pane confidentiality. eee = Avoid intrusive and PREVIOUS STDs: problems unnecessary questions + Previous diagnosis and - Ask questions in a matter-of- dates fact, yet sensitive manner. e:drestnent + Compliance - Explain why you need to ask Sa ecunen Olnetne the questions PSYCHOSOCIAL: Ifa sexual problem is identified, ask + How the patient sees the problem and what they consider the cause The duration of the problem and whether itis related to time, place or partner Loss of sex drive or dislike of sexual contact Sources of stress, anxiety, guilt or anger Any physical problems, e.g. pain + Exclude illnesses that may affect sexual function = CVD, testosterone or thyroid deficiency, etc,