Components of Sexual History in Obstetric History Taking
All pregnant women should be asked about their sexual history during prenatal care, including screening for sexually transmitted infections (STIs), history of physical/sexual/emotional abuse, contraception plans, and reproductive goals 1.
Essential Components to Address
STI Risk Assessment and Screening
- Assess STI risk factors and provide testing as indicated for all women of reproductive age and their partners 1
- Provide counseling and immunizations to prevent STI acquisition
- Offer treatment if infections are identified
- Many STIs are asymptomatic yet highly infectious, making routine screening critical 2
Violence and Trauma Screening
- Screen all women of reproductive age for current, recent past, or childhood physical, sexual, or emotional interpersonal violence 1
- This is particularly crucial in obstetric care, as women with sexual abuse history may experience:
- Dissociative behavior during labor
- Increased anxiety during prenatal examinations
- Re-traumatization during physical examinations 3
- Women with sexual violence history and PTSD report significantly higher distress and pain during pelvic examinations 4
- Refer to appropriate resources when abuse is identified
Reproductive Planning
- Discuss reproductive goals and issues at each visit 1
- When pregnancy is not desired, discuss safe sex and effective contraceptive methods
- Counsel on the importance of birth spacing
- Offer full range of contraceptive options tailored to patient preference
Social and Behavioral History
- Screen all women for alcohol consumption, tobacco use, and drug use 1
- Assess lifestyle and behavioral issues that may affect pregnancy
- Evaluate social history factors
Critical Implementation Points
Use a trauma-informed, patient-centered approach with nonstigmatizing language 5. For women with sexual abuse history, create a detailed treatment plan that gives them control over the situation, anticipate triggers during examinations, and provide "tailor-made" care 3.
The sexual history should be approached with sensitivity and inclusivity, recognizing that comprehensive sexual histories are rarely obtained in practice 6, making intentional, systematic questioning essential.