Sexual History Taking Should Be Tau...

Sexual History Taking Should Be Taught in Medical School

TO THE EDITOR: We were delighted to diocese and enjoyed reading the article entitled, "The Proactive Sexual Health History," (1) in American Family Physician. We set it to be highly informative and important for physicians, especially for those taking care of adolescents and young adults who have the highest rates of sexually transmitted diseases (STDs) Sexual history taking is an important part of a comprehensive history. It affords the physician the opportunity to evaluate for STD contraceptive history, sexual abuse, and sexual dysfunction. In addition, it gives the physician the opportunity to administer appropriate diagnostic touchstones treatment, and prevention counseling.

The article (1) reports that sole a small percentage of primary care physicians in the United States actually elicit sexual histories. There are many potential barriers to sexual history taking, including embarrassment, inadequate training, time constraints, and a belief that a sexual history is not relevant. (2) The barrier we would like to address further is inadequate training of medical pupils and residents on how to elicit a sexual history.

It is imperative for medical observers and residents to receive accurate instruction on how to elicit a sexual history. This includes didactic as well as clinical instruction onward taking a sexual history. Modeling is a valuable tool in the learning proces and it is important that medical bookish mans and residents observe their preceptors eliciting a sexual history. This modeling is necessary for instructional senses and for validation of the importance and relevance of taking a sexual history.

In our experience, the majority of medical pupils and residents are not look fored to obtain a sexual history as a regular part of a comprehensive examination if there is no chief complaint that warrants a history. Their barely opportunity to obtain a sexual history may arise when a patient has a chief complaint that requires a sexual history, and many times they are not supervised when they elicit those histories to make sure they do so appropriately. Increased training of practicing physicians, medical pupils and residents on sexual history taking has the potential to have a positive impact upon the number of physicians that elicit sexual histories. Sexual history taking and increased interaction between the physician and patient are vital to potentially decreasing the rate of transmission of STD in the United States.

YOLANDA WIMBERLY, MD MSC

SANDRA MOORE, MD

720 Westview Dr SW

Atlanta, GA 30310

REFERENCES

(1) Nusbaum MR Hamilton CD The proactive sexual health history. Am Fam Physician 2002;66:1705-12

(2) Merrill JM Laux LF Thornby JI. to what end doctors have difficulty with sex histories. southward Med J 1990;83: 613-7.

Should Pelvic Examination Be Continued After Hysterectomy?

TO THE EDITOR: I read with near interest the editorial (1) onward the American Cancer Society guidelines for the early detection of cervical cancer in American Family Physician and fix it generally well written. However, the following statement caused me an concern: "...vaginal cuff smears after hysterectomy for benign conditions appear to be a general clinical practice, accounting for untold medical preciousnesss and patient discomfort." Does this imply that after hysterectomy, no further pelvic examinations are necessary because they are the painful part of the deed rather than the swab of the box with a tongue blade, cotton-tipped swab, or brush? I do not believe that the smear accounts for "patient discomfort," moreover if this has been clinically documented I would appreciate the appropriate literature references

I do not believe there is any support for implying that the pelvic examination, including the looking-glass examination of the vagina and the bimanual examination, should be discontinued after total hysterectomy, with or without ovaries present

CLARK SMITH, MD

UT-Saint Francis Family Practice

1301 Primacy Pkwy

Memphis, TN 38119

REFERENCE

(1) Mahoney MC Saslow D Cohen CJ ACS guideline for the early detection of cervical cancer (editorial). Am Fam Physician 2003;67:1677-80

IN REPLY: If the hysterectomy was complet for a benign indication, the yield from vaginal blow smear is exceedingly low, and is, in fact, transcended by issues of false positive work-ups and patient discomfort. This is the basis for our recommendations. There are no data to support utility (or lack thereof) from bimanual examinations in this subset of patients, and I would postpone to clinical judgment.

MARTIN C MAHONEY, MD PHD

Roswell Park Cancer Institute

Elm & Carlton Streets

Buffalo, NY 14263

Diagnostic Testing for HIV Infection

TO THE EDITOR: I would like to point on the outside a minor, but potentially significant, error in the article "Lymphadenopathy and Malignancy" (1) in American Family Physician. The authors appropriately include primary human immunodeficiency virus (HIV) infection in the differential diagnosis of lymphadenopathy. However, in Table 1 they list "HIV antibody" as the diagnostic trial of choice.