Check your approach in taking sexual history
Learn to be more specific in your sexual health history taking. Results of a new study from the Kinsey Institute for Research in Sex, Gender and Reproduction at Indiana University in Bloomington indicate that no uniform consensus exists when the term "had sex" is used.1
The study examines the responses from 486 Indiana residents, ages 18-96, who took part in a telephone survey conducted by the university's Center for Survey Research. Participants, most of whom were heterosexual, were asked, "Would you say you 'had sex' with someone if the most intimate behavior you engaged in was ...," followed by 14 behaviorally specific items.
In evaluating the responses from the 204 men and 292 women, researchers found that replies did not differ significantly overall between the two genders. An overview of the complete findings shows:
- 95% of respondents considered penile-vaginal intercourse as having had sex, yet only 89% did so if there was no ejaculation.
- 81% saw penile-anal intercourse as having had sex, with the rate dropping to 77% for men in the youngest age group (18-29), 50% for men in the oldest age group (65 and up), and 67% for women in the oldest age group.
- 71% and 73% considered oral contact with a partner's genitals, performing or receiving, as having had sex.
- Men in the youngest and oldest age groups were less likely to answer "yes" compared with the middle two age groups for when they performed oral-genital sex.
- Significantly fewer men (77%) in the oldest age group answered "yes" for penile-vaginal intercourse.1
"These findings highlight the need to use behavior-specific terminology in sexual history taking, sex research, sexual health promotion, and sex education," state the researchers. "Researchers, educators, and medical practitioners should exercise caution and not assume that their own definitions of having 'had sex' are shared by their research participants or patients."
Specificity is important when clinicians are taking a sexual health history, says William Yarber, HSD, professor in the departments of applied health science and gender studies at Indiana University and senior research fellow at the Kinsey Institute. Clinicians might ask how many sexual partners a patient has had; however, the number will differ according to the patient's definition of sex, he observes.
"I think that if you just ask an individual if they 'had sex,' whether or not they answer yes or no is based on how they define sex," says Yarber, a co-author of the current study. "For example, if they don't consider oral sex as sex, then they may underreport their past behavior, and without that kind of specific information the health care provider may not know what type of risk reduction or preventive information to provide."
Don't be hesitant
Some health care providers might be hesitant to bring up specific sexual behaviors such as anal sex because they sense that it might be embarrassing to a patient and might influence the level of trust the provider has worked to develop, says Yarber. However, for the health of the individual, specificity is important, he notes.
Take a tip from material presented at a Contraceptive Technology conference. When initiating a sexual history, use such wording as "Tell me about your sexual activity" and "Do you have any concerns about your sexual life that you would like to discuss?" The elements of a sexual history can include such questions as "Are you currently sexually active?" "Do you have a sexual partner?" and "Do you have sex with men, women, or both?"2
Researchers with the current study now plan to look at how cultural differences might impact the definitions of "had sex," says Brandon Hill, research associate at the Kinsey Institute and a researcher in the university's Department of Gender Studies. The scientists have conducted similar surveys in the United Kingdom and are comparing responses to those in the United States to determine the influence of cultural differences, Hill says.
Researchers also hope to look at how responses might be shaped depending on the person asking the question, says Hill. Scientists hypothesize that the answer to "Have you had sex?" might be different when it is asked by a health care provider, rather than by a peer, he notes.
- Sanders SA, Hill BJ, Yarber WL, et al. Misclassification bias: diversity in conceptualisations about having 'had sex'. Sex Health 2010; 7:31-34.
- Jones KP. Helping patients communicate about sexuality issues: the power of good sexual health history taking. Presented at the 2003 Contraceptive Technology conference. San Francisco; March 2003.