Sexuality as an aspect of nursing care for women receiving chemotherapy for breast cancer in an Irish context

Healthcare providers' experiences in providing sexual health care to breast cancer survivors: A mixed-methods systematic review

AIMS

To analyse healthcare providers' (HCPs) experiences in sexual health care through the mixed-methods systematic review (MMSR).

BACKGROUND

Sexual health for breast cancer survivors (BCSs) is becoming increasingly important as survivors live longer. HCPs are critical in providing sexual health care.

DESIGN

A mixed-methods systematic review.

METHODS

Literature searches were conducted in databases MEDLINE, CINAHL, Psychology & Behavioral Sciences Collection, Web of Science, Cochrane Library, Scopus, ClinicalTrials.gov and reference lists were searched from inception to 30 December 2022. Two independent reviewers extracted and analysed the data using the JBI guidelines for MMSR.

RESULTS

After screening for 2849 citations, 19 studies were eligible for MMSR, involving 2068 HCPs. Most HCPs believe that sexual health care is their responsibility. However, sexual health was not adequately addressed. A lack of knowledge was the most significant barrier to providing sexual health care. Moreover, HCPs would like to acquire more knowledge and felt that current sexual healthcare training was inadequate.

CONCLUSIONS

Findings suggest that HCPs did not frequently address sexual health in BCSs and that lack of knowledge was the most common barrier. Healthcare session administrators should allocate resources for sexual healthcare training that offer multiple formats, accessible content and convenience. They should also be multifaceted and proactive, meet the diverse needs of BCS at different stages and focus on effective communication.

RELEVANCE TO CLINICAL PRACTICE

This study highlights the importance of addressing sexual health in BCSs and the need for HCPs to receive training in this area. Training should be multifaceted, proactive and meet the diverse needs of BCSs at different stages, with a focus on effective communication. By addressing this issue, HCPs will be better equipped to support the sexual health needs of BCSs, ultimately improving their overall well-being and quality of life. PROSPERO Registration Number: CRD42022327018 (https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=327018).

A practice model of sexuality nursing care: a concept mapping approach

PURPOSE

The aim of this study is to develop a practice model to enhance the provision of sexuality nursing care for patients with gynaecological cancers.

METHODS

A concept mapping approach with three phases was adopted, with phase I involving individual interviews, phase II producing a concept map, and phase III evaluating the applicability of the concept map to clinical practice. A sample of 80 participants, consisting of patients with gynaecological cancers, their spouses/partners, and registered nurses and physicians, was recruited from the gynaecological oncology unit of two acute hospitals in Hong Kong. The participants were involved in all three phases.

RESULT

In phase I, 50 statements were generated from the interviews. In phase II, we applied statistical techniques to produce a concept map illustrating the relationships and clustering between the statements. The map depicted seven clusters of statements in descending level of importance: discussion about sexual impact of treatment, organisational support, information-giving, attitude towards sexuality care, personnel involved in sexuality care delivery, timing of sexuality care delivery, and mode of sexuality care delivery. Finally, in phase III, the concept map was used to inform the development of a practice model which is adapted from the extended PLISSIT model. The feedback from participants supported the acceptability and appropriateness of the newly developed practice model to guide the delivery of sexuality care in the local clinical context.

CONCLUSION

The newly developed practice model could serve as a reference point for other countries with Chinese populations in matters concerning sexuality care.

Effectiveness of postpartum sexual health education programme structured according to Levine's conservation model: An interventional study

AIM

This study aimed to determine the effects of a postpartum sexual health education programme structured according to Levine's conservation model on postpartum women.

METHODS

The interventional study was completed with 67 postpartum women. The intervention group was given the postpartum sexual health education programme structured according to Levine's conservation model. The control group received routine discharge training. The data were collected using a personal information form, The Index of Female Sexual Function, Arizona Sexual Experience Scale and Golombok-Rust Inventory of Sexual Satisfaction.

RESULTS

It has been determined that the decrease in sexual arousal and desire is the first among postpartum sexual problems experienced by women. This study demonstrated that sexual function, sexual satisfaction and sexual response were higher in nonbreastfeeding women, women who had sexual intercourse one to three times a week and women who could talk to health care professionals on sexual matters. After the programme, the intervention group had more adequate sexual function, and they developed a strong, easy and satisfactory sexual response than the control group (p < 0.05).

CONCLUSION

This programme was effective in increasing the sexual functions and satisfaction of the postpartum women. Models provide guidance to nurses for provision of care in a systematic manner.

Healthcare professional perceived barriers and facilitators to discussing sexual wellbeing with patients after diagnosis of chronic illness: A mixed-methods evidence synthesis

OBJECTIVES

To explore healthcare professional perceived barriers and facilitators to discussing sexual health and wellbeing with patients after diagnosis of chronic illness.

METHODS

Five databases were searched and included data were synthesised using a meta-ethnographic approach. Confidence in findings was assessed using the GRADE-CERQual framework. Searches, extraction and quality assessment procedures were conducted independently by at least two authors.

RESULTS

Concepts extracted from 30 included studies were used to develop a conceptual framework based on five overarching themes. These were [1] individual and societal attitudes to sex and sexual wellbeing [2], patient specific factors [3], organizational and professional factors [4], strategies to overcome barriers in practice and [5] perceived training needs. Healthcare professionals acknowledged the importance of discussing and providing support for sexual wellbeing needs, but recognized it is not routinely provided.

CONCLUSIONS

While patient specific factors and organizational issues such as lack of time were frequently identified as barriers, intra-personal and social perceptions appear to have the strongest influence on healthcare professional perspectives.

PRACTICE IMPLICATIONS

Brief education and tools to support healthcare professionals to have effective conversations with patients are required. These should address social barriers, normalise sexual issues, and support healthcare professionals to initiate discussions around sexual concerns.

Health-care professionals' perspective on discussing sexual issues in adult patients after haematopoietic cell transplantation

The majority of adult patients have sexual concerns after post-haematopoietic cell transplantation. Even so, health-care professionals (HCP) do not routinely discuss these problems. We, therefore, surveyed all the members of the European Society for Blood and Marrow Transplantation to evaluate the barriers and facilitators to discussing sexual issues. The 73-item web-survey was completed by 166 registered nurses (RNs) and 126 medical doctors (MDs). Sixty-eight percent reported that they seldom discussed sexual issues. Younger MDs (p < 0.001) and those who work in non-western European countries (p = 0.003), RNs with probably less sexual education themselves (p = 0.002), MDs and RNs who have limited knowledge about sexual complications (p < 0.001) and MDs and RNs who feel uncomfortable discussing sexual issues (p < 0.001) are all less likely to discuss these matters. The major perceived barriers were that patients might be embarrassed if sexual issues were discussed in the presence of a relative (60% RNs, 67% MDs) and that professionals prefer patients to raise sexual issues themselves (54% RNs, 44% MDs). The most important perceived facilitator was for the patient to initiate discussion (≥ 90% for RNs and MDs). Overall, haematopoietic cell transplantation survivors may not be receiving the support on sexual issues they probably need.

The Sexual Adjustment Process of Cancer Patients and Their Partners: A Qualitative Evidence Synthesis

When confronted with cancer, a prominent challenge for patients and their partners is their changed sexual relationship. An empirically based theoretical model of the sexual adaptation process during cancer might be helpful in guiding the development of adequate interventions for couples who struggle with their sexual relationship. Therefore, the purpose of this study was to synthesize evidence from primary qualitative research studies and to arrive at a detailed description of the process of sexual adjustment during cancer. We conducted a qualitative evidence synthesis of a purposeful sample of 16 qualitative papers, using the meta-ethnography approach to synthesis. We found that the subsequent studies used different theoretical approaches to describe the sexual adaptation process. This led to three divergent sexual adaptation processes: (1) the pathway of grief and mourning, depicting sexual changes as a loss; (2) the pathway of restructuring, depicting the adjustment process toward sexual changes as a cognitive process with a strong focus on the social and cultural forces that shape the values and experiences of sexuality; and (3) the pathway of sexual rehabilitation, depicting sexual changes as a bodily dysfunction that needs treatment and specific behavioral strategies. All three pathways have their own opportunities and challenges. A greater awareness of these different pathways could help healthcare providers to better understand the ways a particular couple might cope with changed sexuality, offering them opportunities to discover alternative pathways for sexual adjustment.

Changes in Sexuality, Body Image and Health Related Quality of Life in Patients Treated for Hematologic Malignancies: A Longitudinal Study

Longitudinal studies exploring sexuality, body image and health-related quality of life (HRQoL) are lacking in patients treated with chemo- or chemoimmuno-therapy for hematologic malignancies. The aim was to describe and explore changes in sexuality, body image and HRQoL in patients treated for hematologic malignancies, from baseline until 6 months after treatment. Twenty patients above 45 years (median age 62) treated for DLBCL, CLL or AML participated. Data were collected at baseline, 1- and 6-months after treatment by means of three instruments: SAQ-S, BIS and EORTC QLQ-C30. The results showed that patients' sexuality was negatively affected 1 month after treatment, but after 6 months the patient reported scores had returned almost entirely to baseline scores. Body image was slight negatively affected after 1 month and after 6 months, 50 % reported that body image was not affected at all. Regarding HRQoL, patients reported gradually improved scores during the study period. Regression analysis showed that changes in sexuality and body image seemed to influence changes in HRQoL. This study has shown changes in sexuality, body image and HRQoL over time in patients above age 45 treated for hematologic malignancies. One month after treatment all three areas becomes negatively affected, and thereafter the patients' scores recovered to a great extent regarding these issues within 6 months. Sexuality and body image seem to be important aspects of HRQoL for these patients and need to be integrated in the cancer rehabilitation during and after treatment.

Sexual Behavior Pattern and Related Factors in Women with Breast Cancer in Iran

BACKGROUND

Despite the most of treatment team efforts focused on the maintaining patient's life, attention to sexual issues don't be considered. This stud is designed to determine the sexual behavior pattern and related factors in women with breast cancer.

METHODS

This descriptive- correlation study was performed on 90 women that diagnosed with breast Cancer that was admitted to sayed-al- shohada hospital of Isfahan in 2010. Sampling method was available (non- random sampling) and Sexual Behavior Pattern determined with 3 domains: sexual identity, sexual role and sexual function. Data collection tools, was a questionnaire that made by the researcher and was used after determining the validity and reliability. For data analysis, was used of Descriptive- analytic statistics, frequency and ANOVA and Pearson correlation analytical tests in the SPSS statistical software (version 16).

RESULTS

Cases had 60% of Desirable sexual identity, 50% of Desirable sexual role, 40% Desirable sexual function and were be able to play 47.61% Desirable sexual behavior. Participants that their husbands had Elementary education had more desirable sexual behavior (p<0.031). Cases that were homemaker had more desirable Sexual behavior than of were working and retired (p<0.023). Non-surgical treatment with chemotherapy, radiotherapy and hormone therapy had a negative impact on sexual behavior (p<0.014).

CONCLUSION

Study of sexual behavior pattern that is one of the important aspects of health, Provide valuable information to nurses and medical team and will be enhance the quality of provided services. Adopt appropriate strategies and interventions to promote sexual health, breast cancer is recommended.

Sexualidade e câncer de mama: uma revisão sistemática da literatura

O objetivo deste estudo foi compreender como o câncer de mama e seus tratamentos afetam a vivência da sexualidade da mulher acometida. Foi realizada uma revisão sistemática qualitativa de artigos científicos, publicados entre 2000 e 2010, disponíveis nas bases de dados PubMed, Web of Science, LILACS e SciELO. Foram obtidos 50 artigos cujos textos foram categorizados segundo análise de conteúdo temática. Foram identificadas seis categorias temáticas: a cirurgia mamária e os demais tratamentos para o câncer de mama; a experiência da mulher acometida; o relacionamento afetivo-sexual; estudos sobre relação entre sexualidade e características específicas do câncer; os profissionais de saúde e a atenção à sexualidade; e propostas para amenizar as consequências negativas dos tratamentos na sexualidade. Há necessidade de novos estudos a respeito dos aspectos culturais da sexualidade, diversidade sexual, relacionamento com o parceiro, formação do profissional de saúde e intervenções em sexualidade no contexto do câncer de mama.

Development and psychometric evaluation of a sexual health care knowledge scale for oncology nurses

OBJECTIVE

The purpose of this study was to develop a sexual health care knowledge scale for oncology nurses and to evaluate its psychometric properties using Rasch analysis and the known-groups technique.

BACKGROUND

Although sexual oncology has become a popular topic and sexual health care is now promoted, there has been a lack of instruments supported by psychometric evaluations to measure nurses' knowledge of sexual health issues.

METHODS

The initial 72 items were compiled to form the Sexual Health Care Scale - Knowledge (SHCS-K) for oncology nurses using a literature review and analysis of existing research tools. After a specialist panel verified content validity, the questionnaire was shortened to 58 items. The data were analyzed using a Rasch model to investigate the items with respect to unidimensionality of fit and difficulty and reliability distribution. Discriminant validity was examined using the known-groups technique.

RESULTS

Two items did not fit with the Rasch model. Person and item separation-index ratios were 3.33 and 9.45, respectively, which confirmed that the SHCS-K functioned well. The reliability was good, at 0.99. Significant differences in marital status, levels of education, and participation in SHC training were observed between groups. The final version of the questionnaire consisted of 55 items, with a total score range of 0-55.

CONCLUSIONS

The SHCS-K was found to be a valid and reliable measure for evaluating levels of sexual health care knowledge among this sample of oncology nurses.

Representations of nurses regarding sexuality of women treated for breast cancer in Brazil

The development of new treatments has improved survival and quality of life among cancer patients. Nurses are expected to answer questions and to provide orientation regarding patients' sexuality since it is an important aspect of life. The main objective of this paper is to understand the representations of sexuality among nurses working with women who survive breast cancer after diagnosis and during treatment assuming that their representations may affect communication with the patient. This is a qualitative study using an in-depth guideline which involved interviews with 28 nurses living and working in the southeast of Brazil. The narratives were submitted to a content analysis and categories of representations were identified and are discussed here. Several representations of sexuality were found in the nurses' discourses. Some of the nurses' representations may be expected to hinder their ability to provide helpful orientation regarding the sexual lives of these patients.

Sexuality is not a priority when disease and treatment side effects are severe: conceptions of patients with malignant blood diseases

AIMS AND OBJECTIVES

To describe how patients with malignant blood diseases conceive the influence of chemo- or chemoimmunotherapy on sexuality, and their need of support related to this issue.

BACKGROUND

Sexuality is often negatively affected in cancer patients with sex-specific diagnoses. For patients with malignant blood diseases, the research is limited with regard to the effect on sexuality. Knowledge about their need for support related to sexuality is also needed as nurses are found to often avoid this area of their responsibility.

DESIGN

Qualitative design.

METHODS

Twelve patients treated for malignant blood diseases were interviewed twice. Phenomenography was used for the analysis.

RESULTS

The analyses revealed an outcome space consisting of two main categories: 'Sexuality is overshadowed by the cancer experience' and 'No need of support but timely information might be helpful', both comprehensively related to three interrelated description categories 'Affected strength', 'Affected sexual desire' and 'Affected body image', which describe conceptions of how sexuality was affected.

CONCLUSION

Patients experienced negative effects on sexual function and sexual relationship during and after treatment period due to affected strength, sexual desire and negatively body image. However, when disease and side effects were experienced as severe, thoughts and interest of sexuality were overshadowed, and the need or wish for support related to this issue was very low. It is important to note that some patients expressed that pre- or post-treatment information might have been helpful.

RELEVANCE TO CLINICAL PRACTICE

It is acknowledged in the cancer care of today that cancer follow-up should address psychosocial support in which sexuality is an important area. Therefore, it is imperative that cancer care is organised in a patient centred way, with adequate time for nurses to provide continuity in the nurse-patient relation and supportive care also during cancer rehabilitation.

Discussing sexual concerns with chronic low back pain patients: barriers and patients' expectations

This study aims to explore patient's concerns when discussing sexual problems caused by chronic low back pain with their healthcare provider. It also aims to identify factors influencing and limiting such communication. A cross-sectional analysis of 100 consenting chronic low back pain sexually active patients was carried out. Patients answered questions on their disease characteristics and sex life. They also mentioned prohibitions of discussing sex with their healthcare provider and their expectations of such discussion. Factors influencing patient's experiences were analyzed. Median of chronic low back pain duration was 36 (24-72) months and back pain intensity using visual analogical scale (0-100 mm) was 50 ± 10.7 mm. Eighty-one percent of our patients complained of sexual problems, 66 % have never discussed the subject with their healthcare provider. Barriers which prevent discussion on sex include the taboo character of the topic, inappropriateness of visit conditions, and patient disinterest in sex. Ninety-three percent of patients expressed the need of sexual problems' management in chronic low back pain consulting. Seventy-four percent expected information and advice from their healthcare provider about recommended intercourse positions so as to avoid pain. Thirty-three percent of patients wanted their partner to be involved in the discussion and 81 % preferred talking with a healthcare provider of the same gender. Ability to communicate on the topic was associated with the decrease of patient sexual satisfaction and limited by patient illiteracy. Our study evidences that sex discussion between patient and healthcare provider is restricted by several barriers and that patients expect more involvement from their healthcare provider on the subject. Illiteracy and level of sexual satisfaction seem to be the strongest factors influencing this communication.

[Evaluation and application of the Korean version of the sexuality attitudes and beliefs survey for nurses]

PURPOSE

This study was conducted to evaluate the validity and reliability of the Korean version of the Sexuality Attitudes and Beliefs Survey (SABS) and to assess SABS for Korean nurses.

METHODS

The Korean version of SABS was developed through forward-backward translation techniques. Internal consistency reliability and construct validity using confirmatory factor analysis were conducted using PASW+ PC Win (18.0) and AMOS (18.0). Data were collected from 567 nurses who worked in one of six general hospitals across the country.

RESULTS

The Korean version of SABS showed a reliable internal consistency with Cronbach's α of subscales ranging from .59 to .73. Factor loadings of the 10 items of three subscales ranged from .38 to .83. The three subscales model were validated by confirmatory factor analysis (GFI>.97, RMSEA<.05). Sexuality attitudes and beliefs for Korean nurses were more negative than that of European or American nurses. The SABS scores for Korean nurses were significantly different according to age, marriage, education, clinical experiences, and feeling about sexuality.

CONCLUSION

The Korean version of SABS has satisfactory construct validity and reliability to measure Korean nurses' attitudes and belief toward sexuality. Education is essential to enhance importance and self-efficacy and to relieve barriers to addressing patients' sexuality.

Descriptive Study on Sexuality for Women with Gynecological Cancer

PURPOSE

This study aimed to identify sexuality for women with gynecological cancer.

METHODS

A total of seven women with gynecological cancer agreed to participate in this study. The data were collected utilizing in-depth semi-structured interviews style. A descriptive study design was used in this study. The interviews were analyzed using inductive content analysis methodology.

RESULTS

Three themes identified were: 'women with gynecological cancer who give up their sexual life due to misunderstanding and fear', 'women with gynecological cancer who control their body and mind for recovery', 'women with gynecological cancer resume their sexual life with their partner's will'.

CONCLUSION

To improve sexual health and quality of life for women with gynecological cancer, we need to develop programs related to sexual health. An adjusted sexual health program will contribute to increased sexual health and quality of life for women with gynecological cancer.

Development of a Sexual Health Care Scale-Practice (SHCS-P) for Oncology Nursing Care

PURPOSE

The purpose of this study was to develop and validate the Sexual Health Care Scale-Practice (SHCS-P) for oncology nurses to use in nursing care.

METHODS

Apreliminary version of the SHCS-P of 32 items was developed based on the literature and opinion of experts. A panel of eight experts reviewed the preliminary questionnaire for content validity and consolidated the instrument, which was, then, tested with data from 342 oncology nurses in Korea.

RESULTS

Exploratory factor analysis showed that the SHCS-P explained 70.49% of the total variance. The instrument revealed four factors that were named: (1) Practice for sexual function (8 items), (2) Practice for psychological factors (6 items), (3) Practice for social problems and records (4 items), and (4) Practice for reproductive care (3 items). Internal consistency was good, asassessed by the KR 20 value of 0.91. The coefficients for the sub-factors were between 0.81 and 0.93.

CONCLUSION

This scale shows validity and reliability in evaluating the practice of oncology nurses in providing sexual health care and can be used to evaluate the level of practice well as test effects of educational interventions to improve sexual health care competency.

Sexuality and quality of life of breast cancer patients post mastectomy

AIM

To evaluate the sexual functioning of breast cancer patients post mastectomy and its association with their quality of life, the personal characteristics of women and their partners, breast reconstruction, cancer staging and adjuvant therapies.

METHODS

A cross-sectional study was carried out in a University hospital located in the SouthEast of Brazil. A total of 100 women were included in the study. The parameters evaluated were sexual functioning, which was assessed based on the Sexual Quotient - Female Version (SQ-F), quality of life (QoL), evaluated by the Medical Outcomes Study 36-item Short Form (SF-36), cancer staging, breast reconstruction, adjuvant therapies and the personal characteristics of patients (age, years of study and years of marriage) and their partners (age, years of study).

RESULTS

The majority (40.48%) of women had an unfavorable to regular SQ-F score. A significant positive correlation (p<0.05) was found between the SQ-F score and years of education (p=0.03), and the following SF-36 domains: functional capacity (p=0.03), vitality (p=0.06), emotional limitations (p=0.00) and mental health (p=0.03). A significant negative correlation was found between SQ-F score and the age of the partners (p=0.03). SQ-F mean value was significantly higher (p=0.04) among women who underwent breast reconstruction.

CONCLUSIONS

Women with low educational level, who have older partners, and who did not have a breast reconstruction should receive special attention with respect to their sexuality, and the effects of mastectomy on the sexuality of patients should be assessed. Oncology nurses are best qualified to recognize issues related to sexuality and quality of life, and can offer specific and meaningful support for breast cancer patients.

The asthma/COPD nurses' experience of educating patients with chronic obstructive pulmonary disease in primary health care

The number of patients with chronic obstructive pulmonary disease (COPD) is increasing. These patients need nursing care, including education in self-care, which has a positive effect on their physical and psychoemotional well-being. The aim of this study was to describe the experiences of asthma/COPD nurses' in primary health care (PHC) of educating patients with COPD. A descriptive, qualitative study was conducted, with interviews of 12 asthma/COPD nurses. The data were analysed using qualitative content analysis. The findings are presented in two themes: Theme 1, receiving support results in a feeling of security, which enables the development of patient education; and Theme 2, a lack of support results in a feeling of insecurity, which makes it difficult to develop patient education. The asthma/COPD nurses were individual orientated with individualization of care, but the patient's mood, the varying support of those around and the nurses' varying degrees of security affected the education. The conclusion is that the asthma/COPD nurses' experience of patient education fluctuated between insecurity and security. The nurses' feeling of insecurity in their patient education can be strengthened through support from colleagues and by increased knowledge in promoting the learning of others. Collaborative teamwork with a well-functioning asthma/COPD clinic in PHC can facilitate and improve patient services; these initiatives can enable the asthma/COPD nurses to reach their full potential.

Nurses' knowledge, attitudes, and practices regarding provision of sexual health care in patients with cancer: critical review of the evidence

BACKGROUND

The experience of living with cancer is associated with a variety of consequences in several central aspects of a patient's quality of life, including intimacy, body image, human relationships, sexuality, and fertility. Despite their importance, incidence, and impact on psychosocial well-being, sexual health care (SHC) is a matter not frequently dealt with by nurses in daily practice.

GOALS OF WORK

The purpose of this study was to gather evidence regarding knowledge, attitudes, and behaviors of oncology nurses toward sexual health issues and to identify salient and latent key factors which influence provision of SHC in the context of cancer.

MATERIALS AND METHODS

A critical review of the literature was conducted over a period of three decades and 18 original research articles were retrieved and analyzed.

RESULTS

A comprehensive data analysis revealed that, although oncology nurses hold relatively liberal attitudes and recognize provision of sexual health care as an important nursing role, they possess limited sexual knowledge and communication skills, while often avoid or fail to effectively respond to patients' sexual concerns. Nine possible influential key factors have been studied: incorrect assumptions toward sexual issues, comfort, sexual knowledge, professional nursing role, patient- and nurse-related issues, work environment-related issues, continuing education activities, and society-related factors. Conflicting findings are reported.

CONCLUSIONS

The findings of the present study propose that there is an evident need of dispelling the myths about sexual health in cancer care. Besides, continuing education activities and availability of education materials could assist nurses to adequately address sexual concerns while caring for patients with cancer.

Iatrogenic sexual dysfunction and the protective withholding of information: in whose best interest?

In recent years a growing body of evidence has highlighted the impact of neuroleptics and antidepressants on sexual function. Research from a service user's perspective suggested that service users are dissatisfied with the information that they received on drugs, and would like more education, in particular, on the side effects of medication that impact on sexual function. This paper reports some of the findings of a grounded theory study that explored how psychiatric nurses responded to issues of sexuality in practice. Emphasis within the paper is given to how nursing staff addressed the side effects of drugs that impact on sexual function. Findings suggested that nurse addressed the issue of prescribed medication and sexual function in practice, using a 'Veiling Sexualities Cycle', which had three subcategories: 'Hanging the Veil', 'Lifting the Veil' and 'Re-veiling'. In the light of contemporary mental health policy, findings from the study are discussed and recommendations for practice and education made.