Sexual history taking is the clinical practice of collecting information about patients’ sexual health. Despite the availability of guidelines for conducting a sexual history, variability in the documentation of sexual histories exists. In addition to documentation, the literature on sexual histories is limited to their content, barriers to collecting them, and interventions to improve their documentation and health care providers’ comfort and confidence in taking them. Additionally, the methods used to explore sexual history taking have been homogeneous. Absent from this literature is an in-depth understanding of the contextual factors affecting the collection of sexual history data as well as how health care providers evaluate and use sexual history data. To address these gaps in the literature, a focused ethnography of one health center was conducted. Guided by the theoretical perspectives of symbolic interactionism and the theory of culture care diversity and universality, data were collected primarily through passive observations of health care encounters between patients and health care providers and through individual interviews with health care providers. Over the course of approximately eight months of fieldwork, no specific sexual history taking was observed during health care encounters; this was likely influenced by the characteristics of the patients, communication between patients and health care providers, the prioritization of patients’ basic needs, and time constraints imposed upon encounters. By using a methodology not previously employed to study sexual history taking, this study adds to the evidence that sexual history taking may not routinely occur in a primary care practice setting. Given that the organization studied serves many patients who are homeless and who have concomitant mental health and opioid dependence concerns, the findings illuminate areas for future inquiry into a patient population at risk for adverse sexual health outcomes, and reinforces the need for routine sexual history taking.