Inclusive questions are needed when taking a sexual history

EDITOR—I welcome the ABC of Sexual Health but found the article on taking a sexual history to be limited.1

Creating the best environment for patients to feel comfortable when discussing issues of sex and sexuality starts before the patient enters the doctor's office. Intake forms that ask if the patient is married or single and health information pamphlets that do not include information for gay and lesbian couples reinforce the real and perceived homophobia of the medical system, making the hurdle of disclosure to the provider formidable. The article clearly assumed that patients are heterosexual, as most doctors do: a psychiatrist colleague recently told me that she thought she had no gay or lesbian patients. If the doctor's first concern is to determine the patient's marital status or to rule out marital dysfunction, as suggested in the article, then a gay, lesbian, or bisexual patient is immediately alienated.

The use of more inclusive questions such as “Who are the most important people in your life?” and, more specifically, “Are you sexually active with men, women, or both?” will allow the patient to answer honestly and validate his or her relationships. The use of such questions will send a clear, normalising message and tell the patient that this is a safe place in a largely hostile health system.