WHAT YOU NEED TO KNOW
Sexual History Questions for Perimenopausal Women

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Despite the importance of sexual history taking for perimenopausal women, only a small percentage of new patient visits include an adequate sexual history. Patients often do not specifically discuss sexual concerns unless prompted by their clinician, but a patient’s failure to mention a sexual problem does not mean that he or she has no sexual concerns. The clinician may be reluctant to raise the issue of sexual concerns, but has a responsibility to do so. By increasing the patient’s comfort level, mutual respect, and trust, most health care providers can become skilled at obtaining a basic sexual history and making appropriate decisions about diagnosis and treatment or referral to other clinicians with specialized training.

LEVEL I:
Initial Screening Questions

Level I are designed to assist clinicians in taking a sexual history. If a patient’s reply indicates that further discussion of that issue is warranted, then the clinician should follow up with related LEVEL II questions on the next page.

Menstrual History

1. Have you ever had a menstrual period?
2. How old were you when you had your first period?
3. When was your last period?
4. Do you have your periods every 25 to 35 days or so?
5. Do you have bleeding that requires more than 4 to 6 tampons or pad changes per 24 hours? Do you have menstrual cramping that is debilitating and requires you to miss work, school, or daily activities?

Obstetric History

1. Do you use birth control? Which type?
2. Have you ever been pregnant? If so, how many pregnancies have you had?
3. Have you had any miscarriages or pregnancy terminations? If so, how many?
4. How many living children do you have? Have you lost any living children?
5. (For women who have never been pregnant) Are you childless by choice or have you and your partner had a fertility problem?

Gynecologic History

1. Have you ever been diagnosed with a sexually transmitted infection (STI) such as herpes, genital warts, gonorrhea, syphilis, chlamydia, hepatitis B, or HIV?
2. Have you ever had an abnormal Pap smear finding?
3. Have you ever had gynecologic surgery?
4. Have you had recurrent, chronic, or persistent vaginal infections?

Drug-Related Sexual Effects

Sexual dysfunction can result from a drug/drug interaction or from an untoward effect of the medication. For example, a selective serotonin reuptake inhibitor may cause anorgasmia.

1. Which medications are you taking now?
2. Has your sexual functioning changed since you started taking the new medication? If so, please explain.
3. Have you ever taken medication to treat depression? If so, which drug?

Relationship History

1. Are you sexually active?
2. How old were you when you had your first sexual encounter?
3. How many sexual partners have you had? How long have you been with your current partner?
4. Have you ever experienced unwanted sexual contact?
5. Do you have any pain or bleeding with intercourse?
6. Do you experience orgasms? If not, is being orgasmic a goal for you?
7. What is your sexual orientation?

Substance Abuse and Alcohol History

1. Have you ever used prescription pain medication for longer than 2 to 4 weeks for any single problem?
2. Have you ever used nonprescription pain medication for longer than 2 to 4 weeks for any single problem?
3. Do you drink alcoholic beverages? If so, how often?

Psychosocial Issues

1. Are your sexual needs being met?
2. Do you and your partner enjoy a mutually satisfying sexual relationship?
3. Have you been troubled by any chronic or recent mood changes?
4. Have you experienced depression or anxiety?
5. Does your partner support you emotionally?

Age-Related Issues

1. Since you entered the perimenopause, have you and your partner experienced a change in the frequency with which you have sexual intercourse?
2. Have you ever experienced painful intercourse?
3. Has your enjoyment of sexual intercourse changed since you entered the perimenopause?
4. Are you and your partner in good physical health? Have any health issues affected your sexual activity?
5. Are you or your partner distressed by any age-related changes in your sexual relationship?

LEVEL II:
Complaint-Specific History

If a patient’s reply to any of these questions warrants further discussion and/or treatment, the clinician may consider referral to an appropriate specialist.

Menstrual History

1. Have you been diagnosed with amenorrhea? If so, was the diagnosis primary amenorrhea or secondary amenorrhea?
2. Do you have any unwanted hair on your body—for instance, on your chin, arms, back, or buttocks?
3. Do you have abdominal pain on a cyclical basis-or at the same time each month?

Obstetric History

These questions serves as follow-up for women who have never been pregnant.

1. Have you had a serious heterosexual relationship?
2. Did you ever desire an intimate relationship to produce children?
3. Are you disturbed about not having children? Does this affect your sex life with your partner?

Gynecologic History

1. Are you aware of how STIs are transmitted, and what the signs and symptoms of these diseases are?
2. Are you selective in your choice of sexual partners? Do you feel that you make wise choices in this regard?
3. Do you feel that you need more protection against pregnancy, STIs, or HIV?
4. Have you ever had anal intercourse? Oral sex?
5. Have you had vaginal penetration with fingers, vibrators, or other objects?

Drug-Related Sexual Effects

1. What specific sexual problems have you had since you started the new medication?
2. How were you evaluated before you were prescribed the new medication? How long do you expect to be on the medication?

Relationship History

1. What was the nature of the unwanted sexual contact? How does this affect you at this time?
2. When did the vaginal bleeding begin? Is it persistent?
   Questions 3-7 serve as follow-up for women who may be bisexual or homosexual:
3. Are you uncomfortable with your sexual orientation?
4. Are you pressured to maintain a facade regarding your sexual preference?
5. Has your sexual preference led to any conflicts with your current partner, your peers, or your family?
6. Would you like to discuss these issues further with me? Would you feel more comfortable talking about these issues with a psychotherapist?

Substance Abuse and Alcohol History

1. Which prescription drug have you taken most recently? Which nonprescription drug have you taken most recently? How frequently have you taken these drugs?
2. Have you ever used illicit or recreational drugs? If so, which ones and how frequently?
3. Have you ever been charged with driving while intoxicated or with public intoxication?
4. Do you think you have a problem with alcohol? Does anyone in your family suffer from alcoholism?
5. Might you benefit from counseling in any of these areas?

Psychosocial Issues

1. What would make your relationship more satisfying-both sexually and emotionally-for you?
2. Do you feel sexually inadequate?
3. Do you have sexual fantasies? Are you upset about them?
4. Do you feel coerced into performing sexually?
5. Do you ever get angry, fearful, or anxious about your partner’s sexual demands?

Age-Related Issues

If these problems could be solved, would you be receptive to professional intervention?

Updated November 2006