Pearls

Know your BIOTEACHERS when you assess sexual health

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Psychiatrists often are required to obtain basic sexual information as part of a thorough clinical assessment.1 Although a detailed sexual health assessment comprises multiple elaborate domains,2 it’s important that mental health professionals remember a set of topics and related questions (Table) that can help investigate, diagnose, and treat sexual dysfunction, and contribute to a biopsychosocial formulation of your patient’s sexuality. The BIOTEACHERS mnemonic can remind you what to ask when taking a patient’s sexual history; it is not intended to be an alternative to a comprehensive sexual health evaluation.

Each letter stands for a component of the sexual assessment. The grouped letters of the acronym break down into different relevant areas that aid in remembering each category.

BIO

Background of the problem or the patient’s biophysical state

Identity

Orientation

BIO gathers basic medical information, then creates an opportunity to understand the patient’s gender identity. This step allows for nonjudgmental discussions about the patient’s sexual orientation.

TEACH

Thoughts of a sexual nature

Erotic desire or sexual interest

Arousal

Climax during sex

How often

TEACH incorporates a common chronology of sexual response and activity, starting with sexual thoughts, feelings of erotic desire, development of sexual arousal, ability and quality of a patient’s orgasm, as well as frequency of sexual activity.

ERS

Education

Repertoire or relationship dynamics

Self-stimulation

ERS comprises somewhat more complicated subjects: education (questions about a person’s sexual awareness and communication style); formal sexual knowledge; and health practices. These areas of questioning also normalize discussion of the patient’s sexual repertoire (what activities he [she] does and avoids), reviews qualities of the sexual relationship, and broaches the issue of self-stimulation.

Remember: All discussions of sexuality should be appropriate to the clinical context and considerate of the deeply personal nature of the information.

Disclosure

The authors report no financial relationships with any company whose products are mentioned in this article or with manufacturers of competing products.

Acknowledgement

The authors thank Sallie Foley, LMSW, Daniela Wittmann, LMSW, and the University of Michigan Sexual Health Certificate program for their assistance.

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