Takeaway
Make talking about sexual health a routine part of care—explain why you’re asking and avoid assumptions. If it feels awkward, name it to build trust and show patients that sexual well-being matters.
Lifelong Learning in Clinical Excellence | November 3, 2025 | 4 min read
By Barbara Wilgus, MSN, CRNP, Johns Hopkins Medicine
“I always have such a hard time figuring out how to talk about this,” she said with a sigh. The general internal medicine Fellow I was newly seeing for a routine annual physical did something completely unexpected: she admitted her own feelings of awkwardness while simultaneously acknowledging she really wanted to address an important part of my health—the “this” in question being my sexual history.
For the entirety of my career, talking about sex has been my specialty. I am a sexual health provider, treating sexually transmitted infections, providing comprehensive HIV primary care as well as PrEP, and providing general women’s healthcare. I’m also the program administrator for the STD/HIV Prevention Training Center at Johns Hopkins, a CDC funded program tasked with teaching providers in the Mid-Atlantic and Greater Appalachian region how to diagnose, manage, treat, and prevent STIs. Over many decades I’ve become somewhat of a “secret shopper” when it comes to how healthcare professionals address sexual health. My own patient experience in having sexual health addressed—in my single 20s, married and then divorced 30s, a very different single life in 40s and beyond, and now at 55—has been extremely lacking for the most part, which makes me an even more dedicated provider for my patients and educator for my colleagues.
Why is a sexual history important, and why is sexual health important to address?
In a 2006 position statement, the World Health Organization defined sexual health as:
“. . . a state of physical, emotional, mental and social well-being in relation to sexuality; it is not merely the absence of disease, dysfunction or infirmity. Sexual health requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination and violence. For sexual health to be attained and maintained, the sexual rights of all persons must be respected, protected and fulfilled.” (WHO, 2006)
Addressing your patient’s sexual health opens the door to understanding your patient’s sexuality—certainly their healthcare needs, but also what gives them their best and most healthy life as a sexual being. This can look markedly different from person to person. We all have desires and needs, be it physical, emotional, spiritual, or relational, and as the unique individuals we all are, sexual health requires a very individualized approach. For some patients, you’re assessing their likelihood of sexually transmitted infection so that you can provide appropriate testing, treatment, and prevention. For others, you’re assessing other reproductive health needs such as contraception or preconception counseling. For others, you’re assessing physical and mental limitations. The universe of sexual health is vast, and that’s understandably daunting sometimes!
Tips for addressing sexual health with patients
Talking about sexual health with patients will look different according to who you’re caring for and what their individual needs may be. There isn’t a “one size fits all” approach, but here are some general tips that have served me well over the decades:
1 .Examine your own feelings about sex and sexuality.
Everyone has a values system when it comes to sexuality, and it’s important to acknowledge why you may be feeling a certain way when addressing sexual health with your patient. Acknowledge how you feel and then consider how that affects your patient care.
2. Have a framework in mind for what you need to know and why.
The CDC has a very useful “5 P’s” approach to taking a sexual history that can help guide you through the major aspects of a comprehensive sexual history. I teach this to providers and use it myself.
3. Address sexual health and sexuality with ALL patients.
Avoid making assumptions about who best benefits—this is an important part of everyone’s health and well-being! Remember, taking a sexual history isn’t just about addressing risk of infection, there’s a whole universe more to a healthy sex life (though, certainly test for STIs when recommended).
4. Let patients know why you’re addressing their sexual health.
Study after study has shown that the majority of patients aren’t asked a sexual history at routine visits, so this may be new to them as well. Letting them know this is an important part of routine care for everyone will help the patient not feel “singled out.”
And finally, if you’re newly integrating sexual history taking and sexual health into your routine practice, it’s ok to feel a little awkward! And it’s ok to pause and admit it.
That one sentence—“I always have such a hard time figuring out how to talk about this”—said to me by the GIM Fellow, who proceeded to become one of the best primary care providers I ever had, let me know how important it was for her to get “this” right. For the first time, I actually felt that my sexual health was important to a clinician. It mattered, and I as a whole person mattered. And that felt great.
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This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.