Sexual Health as a Part of Physiotherapy: The Voices of Physiotherapy Students

'There's Nothing Wrong With You; You Just Need to Lose Weight'-A Qualitative Exploration of Pelvic Floor Dysfunction Among Women With Multiple Sclerosis and Their Interaction in Seeking Pelvic Healthcare

INTRODUCTION

Within 10 years of multiple sclerosis (MS) progression, nearly all women will have experienced symptoms associated with bladder, bowel and/or sexual health. Yet despite the impact these symptoms have on physical, psychological and social well-being, it remains an underserved area within the UK healthcare system.

STUDY AIM

This research employs a participatory research approach framed within the principles of intersectional feminism to collaboratively investigate the lived experiences of pelvic floor dysfunction (PFD) and healthcare interactions among UK-based women with MS.

SETTING AND PARTICIPANTS

Women residing in the United Kingdom with MS were invited to participate in online interviews facilitated by the primary author.

ANALYSIS

A thematic framework analysis offering a structured yet adaptable approach to data collection and interpretation.

RESULTS

One focus group involving four women with MS and seven individual, one-to-one interviews with women with MS provided insights into the challenges associated with navigating both MS and PFD. Four main themes included: Navigating MS and PFD; Cycles of Control; Mind, Mobility and Bladder Embodiment; Silenced Voices: The Impact of Taboos/Stigma/Dismissal on Preventing Access and Resistance through Collective Community. Six subthemes were also identified. Taken together, these themes cumulatively reflect PFD as an unmet healthcare need.

CONCLUSION

Our findings underscore negative healthcare experiences, inadequate information provision and unmet needs related to PFD, emphasising the compounding effects of gender and disability biases.

IMPACT

We hope that these insights can lay the groundwork for developing tailored therapeutic interventions and improved PFD healthcare for women with MS. Potential solutions include using existing MS support communities.

PUBLIC CONTRIBUTIONS

Women with MS were actively involved in co-producing interview scripts for one-to-one interviews. The primary author shared study findings at an MS group event, engaging in discussions with over 30 individuals, including people with MS and their loved ones. MS advocates played a pivotal role in contextualising the study within the broader lived experience of MS.

A conceptual model for managing sexual pain with somatocognitive therapy in women with provoked vestibulodynia and implications for physiotherapy practice

Somatocognitive therapy is a multimodal physiotherapy treatment developed in the early 2000s to alleviate the burden of chronic pelvic pain. In recent years, somatocognitive therapy has been further developed to treat women with provoked vestibulodynia. This prevalent gynecological pain condition is a subgroup of chronic pelvic pain and the most common form of vulvodynia. Provoked vestibulodynia is a neglected multifactorial pain condition of unknown cause, adversely affecting women's sexual life, relation to their partners and their psychological health. Pain is located at the vulvar vestibule and is provoked by touch or pressure such as sexual intercourse. In the management of sexual pain, somatocognitive therapy combines bodily exploration, pain education, cognitive coping strategies and structured homework to improve sexual function and reduce pain. To support these processes, developing a sound therapeutic alliance with the patient is essential. The aim of this article is to provide a conceptual model for managing provoked vestibulodynia with somatocognitive therapy, including a theoretical rational for this treatment. We base our conceptual model on the biopsychosocial model, i.e., considering the complex interplay of biomedical, emotional/cognitive, psychosexual and interpersonal factors in provoked vestibulodynia management. In addition, implications for practice and a detailed description of somatocognitive therapy for provoked vestibulodynia will be provided, to allow replication in clinical practice and in clinical trials.

The provision of healthcare services to older LGBT adults in the Nordic countries: a scoping review

OBJECTIVES

Our objectives were to examine what is known about the provision of healthcare services to older LGBT adults in the Nordic countries, identify knowledge gaps, map implications of this research for the education of healthcare professionals and delivery of healthcare, and identify key future research priorities to advance policy and practice for older LGBT adults in this region.

DESIGN

We conducted searches in nine databases. Peer-reviewed articles and PhD theses published in and after 2002 written in English, Norwegian, Swedish or Danish languages were included. 41 studies met our inclusion criteria. However, only eight of these studies focused specifically on older LGBT adults. Therefore, to answer all research questions, five book chapters about older groups were also included.

RESULTS

There were few studies from countries other than Sweden and few quantitative studies. Bisexual people represented a neglected group in research. The studies included showed that healthcare personnel lack knowledge on LGBT issues, particularly about older LGBT adults and non-binary gender identification. Older LGBT adults frequently reported being met with cis- and heteronormative expectations in healthcare encounters. For transgender people, access to medical treatment has been managed by gatekeepers influenced by a binary understanding of gender.

CONCLUSIONS

Relevant measures to enhance practices are increased attention on LGBT issues in education; training of healthcare professionals; measures at the institutional level; and ensuring that transgender people identifying as non-binary receive the same quality of care as individuals identifying in a binary way.

Content validity and reliability of the danish version of health care students' attitudes towards addressing sexual health: a psychometric study

BACKGROUND

The Danish version of Health Care Students' Attitudes towards Addressing Sexual Health (SA-SH-D) is a questionnaire for measuring the attitudes of health care professional students' towards addressing sexual health in their future professional practice and care.

AIM

To assess content validity and reliability of the SA-SH-D.

METHOD

Following COSMIN guidelines, the study consisted of a cognitive interview study and a questionnaire study. Health care students from nursing, physiotherapy and occupational therapy programmes participated; seven were interviewed following the 'Think Aloud' method and 111 responded to two paper-based SA-SH-D administered with a two-week interval.

RESULTS

The SA-SH-D was found to be relevant, comprehensive and comprehensible. Three suboptimal wordings were identified. Floor and ceiling effects were found for six items. Cronbach's α for the total scale was 0.84 indicating good internal consistency. After a two-week interval, the percentage of agreement per item ranged from 88.2% to 100% when allowing for a one-point difference. The mean agreement percentage for the overall scale was 95.2% when allowing for a one-point difference.

CONCLUSION

The Danish version of Health Care Students Attitudes towards Addressing Sexual Health is a valid and reliable questionnaire for measuring health care professional students' attitudes towards addressing sexual health in their future professional practice and care.

Social educator students' readiness to address sexual health in their future profession

BACKGROUND

Norwegian social educator students' attitudes towards addressing sexual health are unknown, even if their future clients often have needs related to sexual issues.

PURPOSE

To investigate social educator students' readiness to address sexual health in their future profession.

METHODS

In 2019, 213 social educator students (response rate 34%) responded to the Students' Attitudes towards addressing Sexual Health Extended online questionnaire.

RESULTS

Most of the social educator students felt comfortable and ready to address sexual health in their future profession, but thought they had insufficient competence and education concerning sexual health. There were gender and age differences when discussing sexual health among persons with intellectual disabilities.

CONCLUSION

Despite most Norwegian social educator students feeling ready to address sexual health, they needed additional competences and education. Further research is needed concerning the effectiveness of educational interventions targeting competence in sexual health, to ensure sufficient support for clients in this field.

Danish Health Professional Students' Attitudes Toward Addressing Sexual Health: A Cross-Sectional Survey

Introduction

Danish health professional (HP) students' attitudes toward addressing sexual health are unknown.

Aim

To investigate Danish HP students' attitudes toward addressing sexual health in their future professions, and to assess differences in perceived competences and preparedness between professional programs.

Methods

A Danish national survey of nursing, occupational therapy, and physiotherapy students was conducted. Totally, 1,212 students were invited to respond to an online questionnaire “The Students' Attitudes toward Addressing Sexual Health.”

Main Outcome Measure

The main outcome measures investigated were Danish HP students' attitudes toward addressing sexual health in their future professions, and differences in perceived competences and preparedness depending on the professional program.

Results

A total of 584 students (48%; nursing 44%, occupational therapy 70%, physiotherapy 43%) responded. Mean total score ranged between 63.7 and 66.3 (±8.3–8.8) classifying students in the low-end of the class: “comfortable and prepared in some situations.” No clinically relevant differences were determined between the professional programs with respect to perceived competences and preparedness to address sexual health.

Conclusion

In the field of addressing sexual health, most Danish HP students reported positive attitudes and a need for basic knowledge, competences, communication training, and education.

H Gerbild, C M Larsen, T. Junge, B. S. Laursen, K. Areskoug-Josefsson. Danish Health Professional Students' Attitudes Toward Addressing Sexual Health: A Cross-Sectional Survey. Sex Med 2021;9:100323.

Experiences of sexual health in persons with hip and knee osteoarthritis: a qualitative study

Background

Osteoarthritis (OA) is the world’s most common form of arthritis and a common cause of musculoskeletal pain and disability. Persons living with chronic diseases often have affected sexual health because of pain and limited function. Osteoarthritis is a chronic disease but there is scarce knowledge about how sexual health is experienced. The aim of this study was to explore the experience of sexual health in persons who have seen a physiotherapist for their hip and/or knee OA.

Methods

This study has a qualitative design. Participants were recruited from the Swedish Quality Register Better Management of Patients with Osteoarthritis (BOA). To reach a variety of experiences and strengthen credibility, a purposeful sampling strategy based on age, sex and hip and knee OA was used. Semi-structured telephone interviews were held with 20 persons with hip and/or knee OA. Data were analysed with qualitative content analysis and inductive category development was applied.

Results

The analysis resulted in two main categories. The first category, Individual differences in how sexual health is affected by hip and knee OA, comprises of two sub categories: Pain limits sexual health; and Strategies for sexual health in the relationship. The second main category, Varying needs for communication about sexual health, is supported by the sub categories: Physiotherapists do not ask about sexual health; and Relevance of communicating about sexual health.

Conclusions

Painful hip and knee OA limit sexual health to varying degrees, and individuals make adjustments or develop strategies to maintain sexual life. Sexual health is not talked about during consultations with physiotherapists or other health care professionals, indicating that patients with OA may have unmet needs regarding their sexual health. Further research is needed on how to provide support and information about sexual health in OA.

Does a 2-Week Sexual Health in Rehabilitation Course Lead to Sustained Change in Students' Attitudes?-A Pilot Study

This pilot study aimed to explore if healthcare professional students participating in a 2-week elective course, Sexual Health in Rehabilitation (SHR), led to significant and sustained change in experienced competence and attitudes towards addressing sexual health in their future professions, when measured with the Students’ Attitudes towards Sexual Health-Danish version (SA-SH-D). Comparison-group design, using the SA-SH-D at baseline, after the 2 weeks course and 3 months after completing the course. Participation in the SHR course significantly changed the students’ attitudes; decreasing their fears of offending the patients and increasing their feelings of comfort in communicating about sexual health, and the results sustained during the follow-up period of 3 months. The results of the intervention suggest that a 2-week elective SHR course leads to sustained change healthcare students’ attitudes towards addressing sexual health in their future profession. Sexual health education positively changed the students’ attitudes, decreased their fears of offending the patients and increased their feelings of comfort in communicating about sexual health. The SA-SH-D is a useful tool to measure results of educational interventions aiming to change healthcare students’ attitudes towards addressing sexual health in their future profession. Future research is recommended regarding students’ attitudes towards addressing sexual health with persons living with disabilities. There is also a need to further research the effect of elective versus compulsory sexual health education in healthcare programs, to lessen the risk that healthcare students in their future profession will not be able to give equal care due to variation in competence and attitude.

Ethics and sexual health: Exploration of the ethical code of conduct for physiotherapists concerning sexual health in clinical practice

Physiotherapists have an important role in sexual health, but there are specific ethical considerations regarding sexuality and the practice of physiotherapy which require serious consideration. This article aims to illustrate how the professional ethical code of physiotherapy can serve as a tool for ethical clinical reasoning regarding sexual health in clinical physiotherapy practice. We analyse the ethical codes for physical therapy, in relation to a definition of sexual health and the declaration of sexual rights. The analysis outlines several ethical considerations crucial in dealing with sexual health, while also acknowledging the critical role of cultural context in any ethical analysis. We conclude that physiotherapists need to practise ethical reasoning and that the ethical code of physiotherapy can act as a point of departure for reflection on thought-provoking ethical dilemmas to improve the practice of physiotherapy and support clients' overall health.

Occupational therapy students' views on addressing sexual health

BACKGROUND

Sexual health is an important issue in daily life, but little is known about occupational therapy (OT) students' views on these matters.

AIM

To explore occupational therapy students' views on addressing sexual health in their future professional role.

MATERIAL AND METHODS

A descriptive qualitative study involving 37 OT students in 5 focus groups was performed and analyzed using content analysis.

RESULTS

Three categories: 'Sexual health is part of occupational therapy and but not of the OT educational program'; 'Need for knowledge to identify and intervene related to sexual health problems'; and finally, 'Communication about sexual health-unknown, untried, but necessary', formed the theme, 'Willing to try, wanting to know more, and recognizing not only the difficulties and challenges but also the importance of sexual health in OT practice'.

CONCLUSIONS

OT-students consider sexual health as part of OT-practice, but experience lack of knowledge of sexual health related to disease/disability, cultural diversity, and age and sexual orientation. Educational programs need to cover these matters, including how to address sexual health in OT-practice, to enhance OT's future competence related to promotion of sexual health for clients.

SIGNIFICANCE

Knowledge on students' views are vital to guide education on this important, rather neglected, area.