Taking a sexual history

Clients that enter sex therapy typically have concerns about their sexual functioning or their sexual relationships, and these concerns are usually related to or influenced by the life story of the individuals involved. Unfolding your story is an important step in understanding the problem you seek to solve, so in the beginning of sex therapy, we will often focus on taking a sexual history. While my work with each client is individualized, I follow a similar path of inquiry when collecting this background information from clients.

Taking a sexual history starts with exploring your family background.

I begin the process with questions about your family. I ask about your parents, your grandparents, your siblings, your partner(s) and your children. I am interested in learning about the path your family has taken and the quality of the relationships that exist between various family members. This information gives me some idea of the patterns that might repeat in your family and the kinds of tendencies you might have in relationships.

We explore the messages you received about sex early in your life.

After this initial introduction to your family, I gather information about how and what you learned about sex. I ask about the kinds of messages you received from family, friends, society and peers, and what your family environment was regarding sex and sexual information. If you have had cultural or religious influences that affect how you grew up thinking about sex, that is important for me to know. Understanding how you were raised to think about sex informs me about the beliefs and attitudes that you might bring to your issues in the present.

Your past sexual experiences play a role in your sexuality.

From there, I explore your early experiences of being a sexual person. I ask about your memories and experiences of masturbation and sexual interactions with other people. I want to know how you felt about the experiences you had and how they shape the way you express yourself sexually now. I ask about whether you have had experiences that were coercive or non-consensual, how you have processed these experiences, and how they have affected your sexuality. I ask about your significant relationships, your history with intimacy and sex, and whether you have yet experienced a relationship the way you want to.

Sexual orientation and identity are important topics.

I ask questions about your journey with gender identity and sexual orientation. Some people have a complicated path on the way to understanding themselves and others have a very straightforward experience and clarity about who they are. Your experience of yourself on the male-female continuum and your sexual experiences with same and opposite sex partners can shed light on how you experience and express your sexuality. Throughout this exploration, I gain an understanding of who you are and whether you are carrying confusion, shame, or self-rejection that could impact your well-being.

Medical issues are relevant to your sexual history and functioning.

Lastly, I ask about your overall medical history. It is important for me to understand your physical condition and whether there are illnesses or issues that affect you and your sexual expression. I want to know if you are taking prescribed medications, using alcohol or using drugs. I will ask about mental health concerns and how these are impacting your relationships and your sexual expression.

Taking a sexual history can be time consuming, but this forms the starting point of our work together. Understanding your physical, emotional, relational and sexual story helps me know what you bring with you as we sit in our sessions together and gives me access to the things that influence your issues and your approaches to them. From this point, we can form a plan together about how best to address the issues that have brought you into therapy.