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:

1. Presenting sexual concern

• What brings the client in now?

• Who sees this as the problem?

• What would improvement look like?

2. Current sexual functioning

• Desire, arousal, lubrication/erection, orgasm, pain, satisfaction, pleasure, avoidance

• Solo sex and partnered sex, when clinically relevant

3. Partners and relationship context

• Current partner(s), relationship structure, agreements, communication, safety

• Monogamy, consensual non-monogamy, infidelity, secrecy, coercion

4. Practices and sexual behavior

• Types of sexual activity, frequency, changes over time, wanted/unwanted experiences

• Distinguish behavior from identity and desire

5. 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.

6. Medical and pelvic health history

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

• Referral indicators

7. Family of Origin and Attachment History

• Childhood and early attachment, parental relationships

• Early messages about puberty/masturbation/sex

8. Previous relationships

• Early sexual experiences

• Sexual play/experimentation 

• Previous sexual relationships and encounters

• Betrayals/break ups

9. Trauma, coercion, and safety

• Asked carefully, with consent and pacing

• Current safety before detailed trauma narrative

10. Culture, religion, values, and meaning

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

11. 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:

1. Desire discrepancy in a long-term couple

2. Pain with penetration and avoidance

3. Erectile difficulty with performance anxiety

4. Shame after religious or cultural messages about sex

5. Postpartum sexual changes

6. 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?”