Including Sexuality in Your Nursing Practice

Differences in the Sexual Function and Sexual Healthcare Needs of Pregnant Women Who Underwent in Vitro Fertilization and Women Who Conceived Naturally at Each Trimester: A Prospective Cohort Study

Introduction

Infertility may negatively impact sexual function. Women with fertility problems usually prioritize treatment for infertility, but their sexual function in each trimester of pregnancy is poorly researched.

Aim

To compare the sexual function and sexual healthcare needs of women who underwent successful in vitro fertilization (IVF group) and women who conceived naturally (CN group) during each trimester.

Methods

Longitudinal prospective cohort study was conducted from August 2016 to July 2018. The IVF group (n = 100) was recruited from a leading reproductive treatment center; the CN group (n = 100), at the prenatal clinic of a medical center in central Taiwan. Questionnaires were mailed to women in the 10th–11th gestational week; 70 women in the IVF group and 75 in the CN group completed all 3 questionnaires, during the 10th–11th, 20th–21st, and 30th–31st gestational weeks.

Main Outcome Measures

Female Sexual Function Index and Nursing Intervention on Sexual Healthcare needs were compared between groups in each trimester.

Results

Most participants reported sexual dysfunction concerns during pregnancy. In the first trimester, the Female Sexual Function Index score was significantly lower in the IVF group than in the CN group (18.13 ± 6.27 vs 20.34 ± 5.87, respectively; P < .05). Sexual healthcare needs at the permission level were significantly lower in the IVF group than in the CN group (10.78 ± 2.41 vs 11.79 ± 2.67, respectively; P < .05).

Conclusion

The IVF group had lower sexual function in the first trimester than the CN group. Sexual function improved in the second trimester in the IVF group but decreased throughout pregnancy in the CN group. The CN group had a greater need for sexual healthcare nursing intervention at the permission level than the IVF group.

Huang C-Y, Liou C-F, Lu Y-C, et al. Differences in the Sexual Function and Sexual Healthcare Needs of Pregnant Women Who Underwent In Vitro Fertilization and Women Who Conceived Naturally at Each Trimester: A Prospective Cohort Study. Sex Med 2020;8:709–717.

Medical and Health Care Professionals' Sexuality Education: State of the Art and Recommendations

Sexuality is considered an important aspect of holistic care, but research has shown that it is often not considered, as it should be, in health services. Addressing clients' sexuality requires a multidisciplinary approach and is not the responsibility of a single professional. The literature underlines that university students or those working in hospitals and other health care facilities are not adequately prepared to meet patients' needs regarding sexuality. The objective of this study was, therefore, to review the scientific literature addressing training courses for health professionals in sexuality between 2000 and 2020. Several studies have shown enhancement in health care professionals' ability to deal with patients' sexuality issues after participating in sexuality education programs, regardless of the course load and modality, even if the long-term effects have still to be proved. Health care professionals therefore require education in the area of sexuality, regardless of their discipline. According to the articles reviewed, in order to improve the performance and comfort level of health care professionals to deal with patients' sexuality, investments in training are necessary. Further evaluations of interdisciplinary sexuality education programmes should use larger samples and explore the differences across disciplines.

Identifying and addressing sexual health in serious mental illness: Views of mental health staff working in two National Health Service organizations in England

People with serious mental illness (service users) have needs related to sexual health and sexuality, yet these have been poorly addressed in mental health services. In the present study, we report the current practice of mental health professionals in relation to sexual health. Focus groups conducted in two mental health trusts explored routine practice in relation to discussing, assessing, and planning care in relation to sexual health. A thematic analysis identified seven themes: (i) sexual health provision is a complex issue; (ii) mental health staff are aware of sexual health needs; (iii) current provision regarding sexual health is 'neglected'; (iv) barriers to sexual health provision; (v) enabling a discussion around sexual health; (vi) sexual health provision is a role for mental health professionals; and (vii) training needs. Mental health staff are aware of complex issues related to sexual health for service users, but this is mainly seen through the lens of risk management and safeguarding. We need to develop the mental health workforce to be able to incorporate sexual health into routine health care.

Discussing sexuality with cancer patients: oncology nurses attitudes and views

BACKGROUND

Sexual health and function frequently are overlooked by healthcare professionals despite being identified as an essential aspect of patient care. Patients with cancer have identified sexuality issues as being of equal importance to other quality-of-life issues.

OBJECTIVES

The aim of this study was to determine the views and attitudes of oncology nurses caring for cancer patients regarding sexual counseling.

PARTICIPANTS AND METHODS

A descriptive cross-sectional study was conducted on the web site of the Turkish Oncology Nurses Association. With the participation of 87 nurses from oncology departments, the study determined that most nurses do not evaluate and counsel patients regarding their sexual problems and many difficulties prevent them from focussing on sexual health. The most important reasons for ignoring sexual counseling were the absence of routine regarding sexual counseling in oncology departments, the belief that the patient may become ashamed and the nurses' self-evaluation that they have insufficient skills and education to counsel in this subject.

CONCLUSIONS

The most important variables in sexual evaluation and counseling are long years of service in the profession and a postgraduate degree.

Talking about sexuality with consumers of mental health services

PURPOSE

To explore nurses' perceptions of how consumers of mental health services have responded to mental health nurses discussing sexuality with them.

DESIGN AND METHODS

Qualitative exploratory design including in-depth individual interviews with 14 mental health nurses in Australia on two occasions. Nurse participants were taught the BETTER model in the first interview and were asked to use this in their practice.

FINDINGS

In the second interview nurse participants described the model as useful and consumer responses as very positive.

PRACTICE IMPLICATIONS

The findings suggest the BETTER model is a simple and effective intervention that can assist mental health nurses to include sexuality as part of nursing care.

The 5-As framework for including sexual concerns in mental health nursing practice

Available evidence informs us that sexual health concerns of consumers are commonly avoided within mental health services. This paper describes the findings of a qualitative exploratory research project. This research was conducted in three stages, all involving in-depth interviews with 14 nurses working in a mental health setting. Stage 1 involved an exploration of participants' views about including sexual concerns in their practice and included an educational intervention designed to encourage sexual inclusivity in practice. Stage 2 involved follow up interviews 4-6 weeks later to discuss the effectiveness of the intervention and whether practice change had resulted. Stage 3 was conducted two years later with the aim of determining the extent to which practice changes had been sustained. The themes emerging throughout the research emphasised five main stages in the nurses' experience: avoidance; awareness; applying; approval; and acknowledgement. Avoidance of the topic was commonly noted in the early stages of the research. The education program led to awareness raising of sexual concerns and approval towards the importance of this area to which lead to applying it to practice. This ultimately resulted in acknowledgement of the need for sexual concerns to become part of mental health nursing practice. These five stages are represented in the Five A's for including sexual concerns in mental health nursing practice, the framework developed by the first author.

Getting BETTER: breaking the ice and warming to the inclusion of sexuality in mental health nursing care

Discussing sexual issues with consumers is considered a nursing role, yet it is commonly avoided. Research suggests that sexual issues and difficulties are particularly evident in mental health settings, and failure to address these issues represents a significant gap in care and treatment. Specific models for raising sexual issues have been used in oncology and cardiac care settings to assist clinicians. A descriptive, exploratory study was conducted with mental health nurses from Queensland, Australia. The aim of this research was to explore whether a specific model, the BETTER model (bring up, explain, tell, time, educate, record) was useful in assisting mental health nurses in raising the topic of sexuality with consumers. In-depth interviews explored participants' attitudes and experiences of discussing sexuality. Participants were introduced to the BETTER model, and were asked to trial the approach with consumers. They were then interviewed a second time. Two main themes emerged: greater awareness and becoming part of practice. Participants described a transformation of their practice from one of avoiding issues of sexuality with consumers, to a position of inclusion, which became embedded within practice. Participants did not tend to use the model in a structured way, and it appears that knowledge and awareness were more useful than the model itself.

Opportunity lost? Psychiatric medications and problems with sexual function: a role for nurses in mental health

AIM

To explore patients' non-adherence to psychiatric medication with mental health nurses.

BACKGROUND

The ability of consumers to maintain normal sexual behaviours is complicated by abnormally high incidence of sexual problems arising from the medications they are prescribed. Sexual side effects of psychiatric medications are identified as a major reason for non-adherence to psychiatric medication regimes yet it remains an issue mental health nurses tend to avoid in their practice with consumers.

DESIGN

An exploratory, descriptive qualitative approach.

METHOD

Individual interviews were conducted with 14 nurses currently working with adult consumers of mental health services. Data analysis followed the framework approach developed by Ritchie and Spencer as the process for identification of the main themes.

RESULTS

Problems with sexual function in relation to psychiatric medication issues was one major theme to emerge from this research. More specifically the participants referred to: assessment of sexual function, the side effects of psychiatric medication, consumer embarrassment, and, the pros and cons of information. Participants recognised that sexual side effects were likely to have an impact on adherence to medication and that this was an important consideration but most did not discuss this issue with consumers. Consumer embarrassment and the belief that knowledge itself might cause non-adherence were the two main reasons for not discussing this topic.

CONCLUSIONS

Problems with sexual function of consumers presents an important practice consideration for nurses working in mental health settings. There is an urgent need for strategies to enhance awareness and confidence among nurses in exploring this topic with consumers.

RELEVANCE TO CLINICAL PRACTICE

Mental health nurses can adopt a leadership role in recognising the relevance of sexuality in care and treatment for consumers of mental health services. Strategies to assist in developing skill and confidence in this domain are required as a matter of priority.

Sexual dysfunction in multiple myeloma: survivorship care plan of the International Myeloma Foundation Nurse Leadership Board

The World Health Organization describes sexuality as a "central aspect of being human throughout life and encompasses sex, gender identities and roles, sexual orientation, eroticism, pleasure, intimacy, and reproduction. Sexuality is influenced by the interaction of biological, psychological, social, economic, political, cultural, ethical, legal, historical, religious, and spiritual factors." Currently, no research has been conducted regarding sexual dysfunction in patients with multiple myeloma; therefore, information related to the assessment and evaluation of sexual dysfunction is gleaned from other malignancies and diseases. In this article, members of the International Myeloma Foundation's Nurse Leadership Board discuss the definition, presentation, and causes of sexual dysfunction; provide recommendations for sexual assessment practices; and promote discussion among patients with multiple myeloma, their healthcare providers, and their partners.

Addressing sexuality issues of women with gynaecological cancer: Chinese nurses' attitudes and practice

AIM

This paper reports a study conducted to describe Chinese nurses' attitudes and practice in addressing the sexuality concerns of people with gynaecological cancer.

BACKGROUND

Women with gynaecological cancer face numerous challenges to their sexuality. The importance of addressing sexuality concerns of people with cancer is emphasized by a growing body of literature in Western countries.

METHODS

This is a descriptive and correlational study. An inventory was adopted to explore Chinese nurses' attitudes and practice related to sexuality care in nursing. Data were collected from December 2009 to February 2010.

RESULTS

A sample of 202 nurses working in gynaecological units in China was recruited. Study results revealed that the majority (77·7%) held the attitude that 'sexuality is too private an issue to discuss with patients'. Only 34·2%'make time to discuss sexual concerns with patients'. Regression analysis revealed that nurse' marital status and hospital type in which they were working influenced their practice in sexuality care. Nurses' conservative attitudes towards sexuality, their prejudices about gynaecological cancer, the lack of availability of private environment, the lack of sexuality care training and the failure to include sexuality care in routine nursing care, were found to be factors that significantly influenced sexual care and nursing practice (adjusted R(2) = 0·542, P < 0·001).

CONCLUSIONS

The study findings contribute to the understanding of Chinese nurses' attitudes and practice in addressing the sexuality concerns of people with gynaecological cancer. There is a need to increase Chinese nurses' awareness of their roles and the importance of equipping themselves with relevant skills in sexuality care in nursing practice.

Sexuality and consumers of mental health services: the impact of gender and boundary issues

The importance of sexuality to humanity is clearly acknowledged. However, for consumers of mental health services, it tends to be a neglected topic. Although nurses are at the forefront of mental health service delivery, evidence suggests they are reluctant to include sexuality as part of their care. This article describes the findings from a qualitative exploratory research project that examined mental health nurses' attitudes to discussing sexuality with consumers. Fourteen mental health nurses from a service in Queensland participated in this study. Data analysis revealed two main themes: the impact of gender, and professional boundary issues. In terms of gender, participants referred to the impact of sexual dysfunction experienced by young adult male consumers. For female consumers the discussion centred on vulnerability to sexual exploitation and the need to exercise protective measures to ensure safety. Participants indicated concerns about being professionally compromised when discussing sexuality with consumers of the opposite sex. These findings highlight the need for further exploration of mental health nurses' attitudes towards discussing sexuality with consumers as part of their practice.