This sexual history must be documented as carefully as any other part of the medical history. The physician should ask every patient the same basic questions. Even if a woman is self-identified as homosexual, she should be counseled to ensure that she understands the options for contraception and reproductive health. These matters may not be of immediate concern to her, yet many male and female homosexuals do enter into heterosexual relationships to conceive children or as a variant on their usual sexual activity. It is also important to ask self-identifed heterosexuals about homosexual activity. This is especially important for prisoners who may engage in homosexual activities in prison but self-identify as heterosexuals and have only heterosexual relationships outside prison.The physician's duty to ask about a patient's sexual activity must be balanced against the patient's right of privacy. If a patient denies sexual activity and there is no objective evidence to the contrary, the physician should treat this information like any other patient-reported information. As with other changeable behavior, however, the physician has a duty to reexplore the area on future visits. Given the general unreliability of self-reported information about behavior that the patient may wish to conceal, the physician should continue to consider pregnancy and venereal diseases when indicated by the patient's objective medical condition. This is especially important if the physician is considering prescribing a drug that is a known teratogen. ACOG: Technical Bulletin 169, Human Immune Deficiency Virus Infections. (June 1992).
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