My doctor asked me if I was sexually active, and I didn’t know how to respond. What does that mean?

Great question! The phrase “sexually active” is a bit vague, and you’re definitely not the first person to be confused by it.

Many people think that being sexually active means that they’ve had penis-in-vagina (PIV) sex. But being sexually active can include a variety of sex acts, including oral sex (blow job, giving head, going down on, eating out), anal sex, and manual sex (giving or receiving a hand job, or fingering someone else or being fingered).

Medical providers ask whether you’re sexually active in order to figure out whether you’re at risk for sexually transmitted infections (STIs) and/or pregnancy.

They want to know if they should test you for STIs, talk about birth control (including condoms), or give you a Pap smear (if you have a uterus and are over 21 years old). Remember: PIV, anal and oral sex put you at the highest risk for STIs. However, some (like HPV and herpes) can also be spread by manual sex. PIV sex also puts you or your partner at risk of getting pregnant.

If you’ve had manual, oral, PIV or anal sex, you should tell your healthcare provider that you’re sexually active.

You can explain up front exactly what you mean (“Yes, but I’ve only had oral sex”). You should also tell your healthcare provider if you’re not sexually active now, but might be soon. If you’ve had sex, but not recently, clarify this with your medical provider.

They’ll probably ask some follow-up questions. This is also your chance to ask any questions you have about birth control, STIs, and sexual health in general.

It may feel awkward to talk about sex, but it’s important to communicate openly and honestly with your health care provider.

Remember: They want you to be the healthiest version of yourself, and that includes being informed about sex.

Even though masturbation counts as a sex act, it carries no STI or pregnancy risk (assuming that you’re not in contact with someone else’s bodily fluids). So if you touch yourself for pleasure, but haven’t been sexual with someone else, you don’t need to tell your healthcare provider.

Talking about sex can be especially nerve-wracking if you’re trans, lesbian, gay, bi, or queer.

It may be hard to come out to your medical provider, but it’s still a good idea if you feel comfortable. This information helps your health care provider figure out your STI risk, and whether they should talk to you about birth control.

If you’re 10-26 years old and live near NYC, you can make a free, confidential appointment at Mount Sinai Adolescent Health Center to talk about any sexual health questions or concerns you have. Our care is non-judgmental, trauma-sensitive, and LGBTQ-inclusive.

A version of this article was originally published in May, 2017.