CCFP priority topic 87 of 105
Sex on the CCFP exam
6 key features, the mistakes that cost marks, and a practice question.
Checked by a Canadian family physician, MD, CCFP. Updated October 20, 2026.
What the exam tests
Key features
The CFPC’s 6 key features for Sex. Each one below has how the exam asks it, the common mistakes and the approach.
Practice question
Try one before you read
A real case from the bank, in the new short-menu format. Answer it first. Then read the key features.
Key feature 1 of 6
Ask, don't assume
Raise sex gently when an illness, a drug or a stage of life puts it at risk.
CFPC skill Clinical reasoningPhase HistorySources Health Canada
On the exam
A 71-year-old widower with diabetes comes in for a refill. Expect a short menu (pick several from a list).
Pick when to ask about sex.
Common mistakes
Skipping the question because the patient is old, widowed, single or disabled. Waiting for the patient to raise it is wrong too: many never do.
Approach
- Ask when an illness can harm sex: diabetes, heart disease, and after a heart attack or stroke.
- Ask when a drug could be the cause. Review the whole list, not just the newest one.
- Ask at the big stages of life: the teen years, pregnancy, after a birth, menopause and older age.
- Never assume a person is not having sex. Age, a disability or having no spouse tells you nothing.
- Make it routine and ask permission: "I ask everyone about sex. Is that okay?" The patient may say no.
- After a heart attack, sex carries a heart risk too. Use sildenafil with caution within 6 months of a heart attack, a stroke or a dangerous heart rhythm.
Key feature 2 of 6
Safer sex and consent
Teach safer sex and consent in words that fit the patient's age and culture.
CFPC skill Clinical reasoning, communicationPhase TreatmentSources Public Health Agency of Canada
On the exam
The same widower has a new partner, and they use no condoms. Expect a short menu (pick several from a list) of what to offer.
Pick what to offer him today.
Common mistakes
Skipping tests because neither partner has symptoms, or booking them for his next physical. A prostate-specific antigen (PSA) test is no help: it finds no infection.
Approach
- His sexual history and risk decide when to test, not the date of his yearly visit. Offer it today.
- Many sexually transmitted and blood-borne infections cause no symptoms. That is why you test people who feel well.
- Past partners on both sides carry risk.
- Talk about condoms at every age, not just with the young.
- Teach consent in plain words: anyone can say no, at any time, and silence is not a yes.
- Teens, people with an intellectual disability and people who depend on others are easier to exploit. Teach them what is not okay and who to tell.
- A patient who would rather not be examined can often collect urine or swabs on their own.
Key feature 3 of 6
Confidentiality
Tell a patient with a sexual concern, above all a teen, what stays private.
CFPC skill Communication, professionalismPhase TreatmentSources Public Health Agency of Canada
On the exam
A 15-year-old comes alone and asks about sex and birth control. Expect one best answer for what to say first.
Pick what to say before the history.
Common mistakes
Promising that nothing will ever be shared, or telling the parent without the teen's consent. Both break trust, and the first is a promise you cannot keep.
Approach
- Say it before the history: what the teen tells you stays between you.
- Name the limits: a serious risk of harm to self or others, and child abuse, which you must report.
- See every teen alone for part of each visit. Make it routine, so it singles no one out.
- Worry about privacy keeps people from getting tested. Say it again before you order tests.
- Have the same talk with anyone who depends on others, such as a person with a disability or one whose partner controls them.
Key feature 4 of 6
Sexual problems
Work up a sexual problem across body, mind, drugs, substances and the relationship.
CFPC skill Clinical reasoningPhase History, hypothesis generationSources Health Canada, Choosing Wisely Canada
On the exam
A man of 71 with diabetes has had weak erections for a year. Expect a short menu (pick several from a list) of history.
Pick the history that finds the cause.
Common mistakes
Stopping at his age as the cause. Giving testosterone when levels are normal is wrong too: it does not improve erections.
Approach
- Look for the cause with a full medical assessment. Age raises the risk but explains nothing you can treat.
- Ask about diabetes control, heart and blood vessel disease, nerve damage and pelvic surgery.
- Ask about mood, anxiety, alcohol, cannabis and other drugs. Review every medicine he takes.
- Ask about the relationship: what has changed, and how each partner feels about it.
- Take a sexual history that covers good and bad experiences. A past assault can explain fear and pain with sex.
- Order testosterone only when signs or symptoms suggest low levels. Do not give it when levels are normal: it does not improve erections.
- In a woman, pain on entry with muscle clamping and dread points to genito-pelvic pain and penetration disorder. Endometriosis hurts deep in the pelvis instead.
| Point | The rule | Why |
|---|---|---|
| Starting dose | Consider 25 mg | Drug levels run about 40% higher at 65 or older |
| Usual and top dose | 50 mg as needed; 100 mg at most | Lower to 25 mg if side effects are a problem |
| How often | Once a day at most | Taken as needed before sex, not on a daily schedule |
| When | About 30 to 60 minutes before sex | It can be taken from half an hour to 4 hours before |
| Never with | Any nitrate, such as nitroglycerin, or riociguat (a drug for high blood pressure in the lungs) | Blood pressure can fall to dangerous levels |
Key feature 5 of 6
Gender and orientation
Care for gender or sexuality concerns without stigma or bias, and without mixing them up.
CFPC skill Communication, patient-centred approach, professionalism, clinical reasoning, selectivityPhase History, treatment, referral
On the exam
A 24-year-old, assigned male at birth, now uses she and her and has a new partner. Expect a short menu (pick several from a list).
Pick what to say, do and offer.
Common mistakes
Treating gender identity, attraction and sexual function as one question: knowing one tells you nothing about the others. Sending every gender question straight to a specialist is wrong too.
Approach
- Use the name and pronouns the patient uses. Ask if you are unsure, and correct yourself if you slip.
- Say partner until you know more. Ask the partner's gender rather than guessing.
- Keep three things apart. Gender identity is who a person is. Orientation is who they are drawn to. Sexual function is how sex works for them.
- Notice your own reactions. If a belief would change the care, name it and make sure the patient still gets full care.
- Refer for what you cannot provide yourself, such as surgery or a gender clinic assessment.
- Point the patient to local support groups and services, including ones for family members.
Key feature 6 of 6
When an exam upsets
If an exam brings on distress, stop, name it, talk with care and plan jointly.
CFPC skill Professionalism, communication, patient-centred approachPhase Physical, treatmentSources Public Health Agency of Canada
On the exam
A woman of 31 clamps and cries as the speculum goes in for overdue screening. Expect a short menu (pick several from a list).
Pick what to do now, and next.
Common mistakes
Pushing on with reassurance, a smaller speculum or a nurse's hand to hold. Asking about past trauma while she is still exposed is wrong too.
Approach
- Name what you see, kindly: "You seem upset. I am stopping now."
- Stop at once. Remove the speculum gently, and let her cover up and sit up.
- Talk once she is dressed, at eye level. Let her lead, and do not press for the reason.
- If she tells you about a past assault, believe her and thank her. Go at her pace.
- Plan together. A swab she collects herself can test for infections without an exam.
- Sedation or a quick second try can repeat the harm. Offer pelvic floor physiotherapy or counselling, and retry only when she is ready.
- Keep her cervical screening on track, and book it for when she is ready.
Flashcards
Answer it first, then check.
KF 1A single 68-year-old woman uses a wheelchair. Do you ask about sex?
Yes. Being older, disabled or single does not mean a person is not having sex.
KF 2New partner, no condoms, no symptoms. Test now or at the yearly visit?
Now. Risk, not the calendar, decides testing, and many of these infections cause no symptoms. Source: Public Health Agency of Canada
KF 3You promise a teen confidentiality. Which limits do you name?
A serious risk of harm to self or others, and child abuse, which you must report.
KF 4His testosterone is normal and his erections are weak. Prescribe testosterone?
No. With normal levels, testosterone does not improve erections, though it may raise desire. Source: Choosing Wisely Canada
KF 4Sildenafil 50 mg gave him headache and flushing at 71. What dose next?
25 mg as needed, once a day at most. Drug levels run higher at 65 or older. Source: Health Canada
KF 4Which drugs rule out sildenafil?
Any nitrate, in any form, and riociguat. Together they can drop blood pressure dangerously. Source: Health Canada
KF 5Gender identity, orientation and sexual function: how do they differ?
Who a person is, who they are drawn to, and how sex works for them.
KF 6She clamps and cries as the speculum goes in. What do you do first?
Say what you see, stop, and remove the speculum. Talk once she is covered.
FAQ
Do I have to ask every patient about sex?
Not at every visit. Make it a routine part of care. Always ask when it matters: an illness or drug that affects sex, a new partner, a stage of life.
Can a teen get sexual health care without a parent?
Often, yes. In most provinces, a teen who understands the care can consent to it. A few provinces, such as Quebec, set an age in law. Know your own province's rule.
Is genito-pelvic pain and penetration disorder the same as vaginismus?
Close. The newer name joins vaginismus with pain on penetration and fear of that pain. Clamping, dread and pain often come together, so one name now covers them.
Sources
Written from the CFPC Assessment Objectives and Canadian guidelines first. Checked by a Canadian family physician, MD, CCFP.
Last reviewed October 20, 2026For exam study. Not advice for a patient in front of you.
- Assessment Objectives for Certification in Family Medicine, 2nd editionCollege of Family Physicians of Canada · 2020
- Drug Product DatabaseHealth Canada
- STBBI screening and diagnostic testingPublic Health Agency of Canada
- Choosing Wisely recommendationsChoosing Wisely Canada