Collecting
A Sexual Health History from Adolescents
Check out these protips
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At every adolescent annual visit
When discussing relationships, puberty, mood, identity, prescribing contraception, PrEP, or treating STIs.
Revisit history regularly, identity, anatomy, and partners can change over time.
Provide dedicated one-on-one time with the adolescent without a parent/guardian present.
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Begin by explaining confidentiality and the limits of disclosure before history taking.
Offer the parent/guardian a brief explanation of private time with the adolescent.
Normalize: “I ask these questions with all my teen patients to support their health.”
Ask and document the patient’s name and pronouns at the start and confirm later privately.
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Name and pronouns used by the patient.
Gender identity and sexual orientation (self-described).
Anatomy inventory: body parts relevant to sexual health.
Sexual behaviors: types of contact (oral, anal, genital, digital).
Partners: genders, number, relationship dynamics.
Protection methods: condoms, barriers, PrEP, and contraception.
STI testing/treatment history; pregnancy risk and reproductive goals (if applicable).
Gender-affirming care: hormones, surgeries, chest/bottom procedures (if relevant).
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Provide a short narrative for parent/guardian: “We routinely spend part of the visit one-on-one with teens to support their health independence.”
After the parent leaves the room, repeat the name/pronoun check and invite open discussion of sexual health topics.
Re-assure: “What we discuss is confidential unless I’m concerned about your safety or someone else’s.”
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Ask about coercion, pressure, or unwanted sexual contact.
Screen for bullying, harassment, or family rejection.
Assess for intimate partner violence (including digital/online)
Evaluate safety at home and school.
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Explore comfort with identity and existence of affirming support (friends, school, community).
Screen for depression, anxiety, trauma, suicidality.
Ask about substance use in sexual situations.
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Base STI/sexual-health screening on anatomy and behavior rather than identity labels.
Review barrier methods and offer supplies in the clinic (condoms, internal condoms, dental dams).
Consider PrEP/PEP for eligible adolescents.
Ensure HPV and Hepatitis A/B vaccinations are up to date.
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Record self-reported identity and pronouns each visit.
Avoid assumptions in notes, document behaviors using the patient’s own words.
Be aware of portals or Explanation of Benefits (EOB) visibility for minors.
If needed, discuss confidential testing or alternate billing pathways, per local policy.
Ensure intake forms/EHR fields include SOGI (sexual orientation, gender identity) and pronouns.