0:00–0:15 — Opening, Frame, and Ethics of Sexual Inquiry

Content:

Why sex history belongs in therapy assessment
Difference between curiosity, voyeurism, and clinically indicated inquiry
Confidentiality, informed consent, mandated reporting, and scope of practice
Therapist self-awareness: discomfort, values, assumptions, and countertransference
Normalizing sexual questions without forcing disclosure

0:15–0:35 — The Biopsychosocial Model in Sex Therapy

Content:

Biological factors: hormones, pain, medications, medical conditions, pelvic floor function, disability, pregnancy/postpartum, menopause, aging, substances
Psychological factors: desire, arousal, shame, anxiety, depression, trauma, body image, religious or moral conflict, compulsivity concerns
Relational factors: attachment, communication, conflict, betrayal, desire discrepancy, sexual scripts, emotional safety
Social/cultural factors: culture, religion, gender norms, minority stress, racism, disability stigma, sexual education, community values
Developmental factors: early messages about sex, puberty, first sexual experiences, sexual milestones, identity development
Protective factors: pleasure, intimacy, communication strengths, resilience, supportive partner(s), spiritual resources, self-knowledge

0:35–1:00 — Structure of a Comprehensive Sex History

Content:
Core sex history domains:

Presenting sexual concern

What brings the client in now?
Who sees this as the problem?
What would improvement look like?

Current sexual functioning

Desire, arousal, lubrication/erection, orgasm, pain, satisfaction, pleasure, avoidance
Solo sex and partnered sex, when clinically relevant

Partners and relationship context

Current partner(s), relationship structure, agreements, communication, safety
Monogamy, consensual non-monogamy, infidelity, secrecy, coercion

Practices and sexual behavior

Types of sexual activity, frequency, changes over time, wanted/unwanted experiences
Distinguish behavior from identity and desire

Protection and sexual health risk

STI history, contraception, pregnancy intentions, testing, safer sex practices
CDC’s commonly used “5 Ps” model includes partners, practices, protection, past STI history, and pregnancy intention.

Medical and pelvic health history

Pain, surgeries, medications, hormonal changes, urologic/gynecologic issues, chronic illness
Referral indicators

Family of Origin and Attachment History

Childhood and early attachment, parental relationships
Early messages about puberty/masturbation/sex

Previous relationships

Early sexual experiences
Sexual play/experimentation
Previous sexual relationships and encounters
Betrayals/break ups

Trauma, coercion, and safety

Asked carefully, with consent and pacing
Current safety before detailed trauma narrative

Culture, religion, values, and meaning

Sexual guilt, modesty, marital values, community norms, spiritual conflict

Strengths, pleasure, and goals

What works?
What has helped?
What kind of sexual life does the client want?

1:00–1:20 — Language, Permission, and Trauma-Informed Interviewing

Content:

Asking before asking
Using client language while maintaining clinical clarity
Avoiding assumptions about gender, orientation, anatomy, relationship structure, or sexual goals
Responding to embarrassment, silence, humor, shame, or disclosure of trauma
How to slow down when the client becomes dysregulated
What not to ask in an intake unless clinically necessary

1:20–1:30 — Knowledge Check and Transition

Activity: Short quiz or group polling
Sample questions:

Name two biological factors that can affect desire.
What is one way to ask permission before taking a sexual history?
What is the difference between sexual behavior and sexual identity?

1:30–1:55 — Case Conceptualization: Predisposing, Precipitating, Maintaining, Protective Factors

Content:
Students learn to organize sex history data into a working formulation:

Predisposing factors:

Early sexual shame
Trauma history
Chronic illness
Restrictive sexual education
Attachment insecurity

Precipitating factors:

Childbirth
Menopause/perimenopause
New medication
Affair disclosure
Pain episode
Religious transition
Relationship rupture

Maintaining factors:

Avoidance
Performance anxiety
Partner pressure
Pain-fear cycle
Lack of communication
Medical issue not evaluated
Shame and secrecy

Protective factors:

Motivation
Partner support
Good communication
Prior positive sexual experiences
Access to medical care
Flexible sexual scripts

1:55–2:20 — Role Play: Taking the Sex History

Activity: Triad or dyad role play

Roles:

Therapist
Client
Observer

Scenario options:

Desire discrepancy in a long-term couple
Pain with penetration and avoidance
Erectile difficulty with performance anxiety
Shame after religious or cultural messages about sex
Postpartum sexual changes
Sexual trauma history emerging during intake

Observer checklist:

Did the therapist ask permission?
Did the therapist use neutral language?
Did the therapist assess biological, psychological, relational, and cultural factors?
Did the therapist avoid premature interpretation?
Did the therapist identify next-step referrals or assessments?

2:20–2:40 — Interdisciplinary Collaboration and Referral

Content:

When to refer to pelvic physical therapy
When to refer to gynecology, urology, endocrinology, psychiatry, primary care, pain medicine, or sexual medicine
Medication side effects and sexual functioning
Pelvic pain, erectile dysfunction, vaginismus/genito-pelvic pain, low desire, orgasm concerns
Staying within clinical scope
How to explain referrals without implying “it is all in your body” or “it is all in your head”

2:40–2:55 — Documentation, Risk, and Clinical Decision-Making

Content:

What to document from a sex history
Clinical relevance and minimal necessary detail
Consent, coercion, intimate partner violence, exploitation, compulsive behavior concerns
Risk assessment: suicidality, self-harm, abuse, assault, unsafe sexual situations
How to document sensitive sexual information respectfully
Treatment planning after assessment

2:55–3:00 — Wrap-Up and Post-Test

Activity:

Final questions
Post-test
Course evaluation
Self-reflection: “What part of sex history taking do I need to practice most?”

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