A patient comes in for a repeat pill script, a blood pressure check, or a pre-travel consult. Nothing about the presentation suggests a sexual health conversation is needed. This is exactly the type of consult where the conversation is most likely to be skipped, and exactly the type of consult research suggests it should not be.
The evidence on missed opportunistic windows
An Australian survey of GPs in Victoria found that while 92 per cent would take a sexual history from a patient presenting as a known contact of an STI, fewer than a third would do the same for a patient presenting for a routine contraceptive pill script, a Pap smear, or pre-travel vaccination advice. The gap is not about clinical judgement. It reflects a habit of only raising sexual health when the presenting complaint makes it feel relevant, rather than when the visit type makes it a genuine opportunity.
That gap matters because these routine, non-sexual-health visits are often the only regular contact a patient has with a GP. If sexual health is only discussed when a patient already has an obvious sexual health complaint, the many patients experiencing something they have not yet connected to a medical conversation, low libido after starting a new medication, pain they have assumed is normal, erectile changes they have put down to stress, are never asked at all.
How to fold it in without derailing the consult
The routine consult is actually an easier entry point than a dedicated sexual health visit, because it can be framed as a small, expected add-on rather than the main event.
"While we're going through the general check-up side of things, I usually also check in on sexual health, is that going okay for you at the moment?"
This works because it borrows the credibility of the visit that is already happening. The patient does not have to interpret the question as a signal that you have noticed something concerning, because it is explicitly framed as part of the standard review, not a response to anything in front of you.
Where this is most worth building into habit
A few consult types are worth deliberately building the question into, given how consistently they are missed: repeat contraceptive scripts, cervical screening, pre-travel consults, new antihypertensive or antidepressant starts, and any chronic disease review where medication or the condition itself is known to affect sexual function. None of these need to run long. The question adds perhaps thirty seconds if the answer is a simple "all good," and only extends the consult when the patient actually has something to raise, which is exactly when the extra time is worthwhile.
The habit is the intervention
The single biggest predictor of whether sexual health gets discussed is not a particular patient's presentation. It is whether the clinician has built the habit of asking regardless of presentation. That habit is what turns an occasional, awkward conversation into a routine, comfortable one, for both the doctor and the patient.
This is exactly the scenario we role-play in the CPD course, with an AI-simulated patient who responds the way real patients do.
