Clinical Issues

Sexual Health

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Learning about the sexual health and behavior of all adolescent and adult patients reflects a commitment to both patient-centered care and community health.  By routinely asking sexual health questions as a standard of care, we reduce stigma and concerns about sensitivity for providers, patients, and the broader community. By routinely asking sexual health questions as part of a patient’s comprehensive history, the care team is prepared to engage the patient in a discussion about sexual health and behaviors, gender identity, and sexual orientation; collect data and information to guide clinical care decisions and patient goals; and coordinate the patient’s needs for prevention and treatment services.  A routine sexual health history provides the opportunity to talk with patients about HIV, sexually transmitted diseases (STDs), and viral hepatitis, diseases that can go unnoticed for long periods of time until they lead to more serious illness.  Without treatment, they can also spread to sexual partners and increase disease in the community.  As a key primary care provider in the United States, health centers play a critical role in the national response to the HIV, hepatitis C, and STD epidemics and in improving the lives of impacted individuals. 

Taking Routine Histories of Sexual Health:  A System-Wide Approach for Health Centers was created to help health centers develop and implement systems for collecting routine sexual health histories as part of the primary care visit. A collaboration between NACHC and the Fenway Institute’s National LGBT Health Education Center, this toolkit was designed specifically for use by health centers.  It offers a variety of resources, including recommended screening questions and subsequent risk assessments; an algorithm; sample EMR templates; information on coding and billing; and working with special populations, including patients who are transgender and men who have sex with men.  Each section includes an extensive list of external resources. Very importantly, the toolkit provides contextual information to support integrating sexual health as a vital sign for improved patient health and patient engagement, including a companion PowerPoint presentation that can be used for orienting staff to the key recommendations and concepts in the toolkit.

The toolkit can be downloaded here:

Taking Routine Histories of Sexual Health:  A System-Wide Approach for Health Centers (PDF)

The companion all-staff PowerPoint presentation can be downloaded here:

Asking Patients About Sexual Health and Behavior for Improved Quality in
Prevention and Care

Key components of the toolkit are available as Word documents so that they can easily be customized and branded for your organization:

Asking Sexual History Questions: How to Begin (Word)

Sexual History Algorithm (Word)

Effective Communication Strategies (Word)

In addition, NACHC offers resources on Hepatitis C, HIV Screening, and LGBT Health as part of its sexual health framework.

E-mail Caryn Bernstein with questions, suggestions or corrections.

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