1. Sexual History Ejay Harris

2. Where to start? WIPE Open ended question……vaginal discharge

3. Vaginal discharge ….now what? Causes; Physiological STI – Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis Infective – Bacterial vaginosis, candidal infection Anatomical - fistulae Malignancy - – cancer of cervix, uterus, ovaries Inflammatory – Vulval dermatitis Others – cervical polyps, foreign body, erosive lichen planus, allergy

4. How to start a sexual history Make it routine Share your knowledge of incidence/prevalence Ask the patient what they think Offer resources

5. 5 P’s of a Sexual History Partners Practices Protection from STIs Past history of STIs Prevention of pregnancy Failing all that…….who, what, when, with protection?

6. Symptoms…Vaginal discharge How has it changed? Onset Duration Colour Odour Consistency --------------------------------------------------------------------- Dyspareunia/dysuria/abdominal pain/pyrexia Menstrual history PMHx Medications Dyspareunia/dysuria/abdominal pain/pyrexia

7. Vaginal discharge ….now what? Causes; Physiological STI – Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis Infective – Bacterial vaginosis, candidal infection Anatomical - fistulae Malignancy - – cancer of cervix, uterus, ovaries Inflammatory – Vulval dermatitis Others – cervical polyps, foreign body, erosive lichen planus, allergy