Talking About Sexuality With Youth: A Taboo in Psychiatry?

"No one told me how this could be pleasurable" A Qualitative Focus Group Study into Experiences and Needs of Transgender People in Addressing Sexuality in the Context of Gender-Affirming Medical Care in The Netherlands

Various studies show that transgender people may experience diverse challenges to attaining sexual well-being. Receiving gender-affirming medical care (GAMC) may influence one's sexual experiences, but there is little insight into the way sexuality is addressed in GAMC. We conducted a qualitative focus group study among transgender individuals on their experiences and needs related to the way sexuality is addressed in the GAMC context. We included 28 participants (aged 21-60) who were assigned to six groups based on their GAMC trajectories and treatment goals. Each group convened twice for two hours (12 focus groups in total). We analyzed the data using reflexive thematic analysis and identified three main themes. Regarding sexuality in GAMC, participants articulated the need for 1) personalized and balanced information, 2) insight into the experiences of others, and 3) the opportunity for support and guidance concerning sexuality by a healthcare provider. This study highlights the necessity to improve information provision and guidance to promote sexual well-being of people receiving GAMC. Such information ought to transcend cis- and heteronormative sexual assumptions and needs to be tailored to an individual's experiences. Finally, GAMC organizations and their healthcare providers should foster an environment where questions and concerns related to sexuality can be discussed.

Sex talks-experiences with and barriers to communication about sexuality with healthcare staff among patients with anxiety disorder in Denmark

BACKGROUND

Previous research among diverse patient populations suggests that healthcare staff routinely do not talk about sexuality with their patients even when such talks are highly indicated and relevant.

AIM

In this study we sought to investigate how patients at outpatient anxiety clinics in Denmark experience sexual communication with healthcare staff and what barriers they encounter in this connection.

METHODS

We employed a survey design from January 1, 2018, to June 30, 2019. In collaboration with 11 outpatient anxiety clinics in Denmark, patients with a primary diagnosis of panic disorder, social phobia, generalized anxiety, or obsessive-compulsive disorder were invited to participate in the study. The final sample included 272 patients. Survey questions were related to sociodemographic characteristics, sexual activity and dysfunctions, pharmacological treatment adherence, anxiety and depression symptoms, and experience with and barriers to sexual communication. For each participant, clinicians at the clinics provided the International Classification of Diseases, 10th revision, diagnostic codes, medications, and dosage. Study inclusion criteria were not having an organic disorder that may cause anxiety, not having a previous diagnosis of bipolar affective disorder or schizophrenia, and the ability to speak and read Danish.

OUTCOMES

Outcomes included patients' experiences with and barriers to sexual communication with healthcare staff.

RESULTS

In total, 61% of the patients in this sample group found it relevant to talk to healthcare staff about sexuality but only 28% of the study patients had done so, of whom 83% reported this communication to be a positive experience. The most frequently reported patient barriers to communication with healthcare professionals regarding sexual concerns were a belief that if sexual matters were relevant, the healthcare staff would bring it up (94%), fear of transgressing their own boundaries (94%), embarrassment (92%), and lack of knowledge as to how to start a conversation about sex (91%).

CLINICAL IMPLICATIONS

The study results indicated a need for healthcare staff to routinely map out and address sexual matters in their clinical work with anxiety patients while bearing in mind the common patient barriers for this topic.

STRENGTHS AND LIMITATIONS

This study included a large clinical outpatient sample of anxiety patients and an extensive survey. However, the results may not be generalizable across all anxiety patients or patients in general.

CONCLUSION

The results of this study strongly indicate that a majority of anxiety patients find it both relevant and beneficial to discuss sexual matters with healthcare staff in connection with their anxiety treatment, and therefore healthcare staff should be educated and equipped to routinely address these matters while bearing in mind the most common patient barriers for conversations about sexuality.

Let's (not) talk about sexual health: How sexual communication apprehension with healthcare providers and peer communication influence intentions to protect sexual health

OBJECTIVE

This study examined how patients' clinical and peer interactions may affect their communication apprehension with healthcare providers, a major communication barrier to sexual health protective behaviors (SHPB).

METHODS

Between January 2022 and February 2023, we conducted an online survey with 310 participants recruited through snowball sampling. Using structural equation modeling (SEM), we explored relationships among patient-provider interactions, peer communication about sex, communication apprehension with providers, and SHPB intentions.

RESULTS

Significant predictors of SHPB intentions included lower communication apprehension and more peer communication. Communication apprehension was a significant mediator in paths from peer communication and three types of patient-provider communication to SHPB intentions.

CONCLUSIONS

Our study indicates the need to address communication barriers to increase patients' SHPB intentions. Active patient involvement and patient-centered communication may open up discussions about sex in the clinical setting. Peer interactions, informed by scientific guidance, may reduce patients' apprehension, leading to better health outcomes.

PRACTICE IMPLICATIONS

Communication interventions are needed to promote collaborative patient-provider environments and peer sexual communication. Active involvement and evidence-based discussions can help patients navigate difficult conversations (e.g., like sex), improving SHPB.

Does loneliness mediate the association between social media use disorder and sexual function in Lebanese university students?

Research on the association between social media use disorder (SMUD) and face-to-face sexual function remains controversial, surprisingly scarce and even non-existing in certain vulnerable populations such as university students. We aimed to explore the mediating role of loneliness between SMUD and two dimensions of sexual function (sexual arousal and desire) in a sample of Lebanese university students. A total of 363 university students participated in a cross-sectional survey. Sexual Dysfunction Questionnaire, Jong-Gierveld Loneliness Scale and Social Media Use Disorder scale were used to measure sexual function (desire and arousal), loneliness and SMUD respectively. The mediation analysis results showed that loneliness mediated the association between SMUD and sexual arousal (but not sexual desire). Higher SMUD was significantly associated with more loneliness, whereas more loneliness was significantly associated with less sexual arousal. Subsequently, higher SMUD was significantly associated with less sexual arousal. The present findings edge the university staff, clinicians, and researchers towards the psychological mechanisms that may help university students improve their sexual function, and calls for additional research in this area. Attention should be given to the possible potential role of moderating social media use in tackling loneliness and improving students' sexual function. In addition, routine sexual counseling should be considered when assessing and intervening with students having SMUD.

Knowledge, practices and barriers to access sexual health of women in the menopausal stages: a cross-sectional study with Brazilian gynecologists

BACKGROUND

Sexual health access and care for women in the menopausal stages face significant barriers, presenting deficits in relation to diagnosis and treatment. Although epidemiological data indicate high prevalence of problems related to sexual health in this population, traditionally, the theme is not discussed in health care settings. This study aimed to analyze knowledge, practices and barriers to access sexual health of women in the menopausal stages in the context of women's health care in Brazil.

METHODS

With a cross-sectional design, a questionnaire was distributed electronically, encompassing variables related to knowledge; practices; and barriers to access sexual health of women in the menopausal stages. The data obtained were subjected to analysis using both descriptive and inferential statistics. Specifically, we employed multivariate analysis, employing multiple linear regression models, to discern potential factors associated with outcomes concerning the level of knowledge and the frequency of addressing the topic in professional practice.

RESULTS

The sample included 70 physicians with specialization in obstetrician/gynecologists who work in health care with women in the menopausal transition or postmenopausal women. A high level of self-reported knowledge about sexual health was identified. Regarding the practices, most of them reported directly proposing the subject and not using instruments. Although they reported frequently addressing the topic in general, topics related to vaginal lubrication, dyspareunia, and sexual dysfunction have been more present in the clinic compared to sexual orientation and women's relationship with themselves. The main barriers were time limitation and patient discomfort with the topic. The multivariate models indicated that female gynecologists and professionals with higher levels of knowledge on the subject had a higher frequency of addressing sexual health in clinical practice with women in menopausal stages.

CONCLUSIONS

Sexual health access and care for brazilian women in the menopausal stages presents discrepancies in the frequency of approach between the various topics, in addition to the predictive character of technical knowledge in the practices of professionals. To ensure universal access to sexual health services for this population, an active approach through specific instruments is important, as well as the reinforcement of strategies to improve the level of knowledge of professionals.

Assessment of sexual function before medically assisted procreation: A mixed-methods study among a sample of infertile women and men cared for in a fertility center

A mixed-methods study was conducted to investigate sexual function among infertile patients undergoing medically assisted procreation for the first time. The study employed an interview and content analysis approach, involving 45 infertile patients prior to their medically assisted procreation procedures. The findings revealed that infertile patients are a group at risk for sexual distress. Furthermore, patients with sexual dysfunctions exhibited lower levels of sexual activity, potentially diminishing their chances of achieving pregnancy. Participants faced challenges in openly discussing their sexual problems and demonstrated limited knowledge of sexual functioning. Among infertile women with sexual dysfunctions, the most frequently reported issues were sexual interest/arousal disorders, with a majority also experiencing pain during sexual activity and associated genital-pelvic pain disorders. In contrast, delayed ejaculation and erectile disorder seem to be more common in infertile men, while sexual desire and excitement disorders and premature ejaculation disorders appeared to be as common as in the general population. While the relationship between infertility and sexuality is complex, our study suggests that sexual dysfunctions or the absence of sexual activity may explain infertility. Therefore, it is imperative for clinicians to evaluate the sexual functioning of both men and women undergoing medically assisted procreation treatment, to increase their chances of procreation and offer them sexological support if needed. Future studies should expand their scope to include a larger sample size and delve into the potential etiological factors associated with sexual dysfunctions.

Nurses' and auxiliary nurses' beliefs and attitudes regarding the sexual health of patients with severe mental illness: A qualitative study

INTRODUCTION

Sexual health is essential to the overall health. People suffering from severe mental illness (SMI) experience a deterioration in their sexual health. These patients and their caregivers seem unwilling to engage in a dialogue concerning sexual health within the context of mental health care.

AIM

The study investigated nurses' and care assistants' beliefs and attitudes regarding the sexual health of people with SMI on the psychiatric care pathway.

METHODS

Twenty semi-structured interviews were conducted with nurses and care assistants. Data were subject to a thematic analysis.

RESULTS

Three main themes emerged: (1) The formalization of the care approach towards people with a SMI in hospitals; (2) the place given to sexual health in psychiatry units; (3) nurses and care assistants are not equipped to deal with patients' sexual health.

DISCUSSION

Caregivers consider that sexual health is a fundamental right and an indicator of good health. They nevertheless believe that the psychiatric hospital remains a place of acute care where sexual health is not considered.

IMPLICATION FOR PRACTICE

This research justifies that it is necessary to question the representations of nurses and care assistants before implementing a tailored intervention that integrates the consideration of sexual health into the holistic care of the patient on the psychiatric care pathway.

Help-seeking challenges for female sexual concerns: a qualitative study from Iran

BACKGROUND

To effectively manage sexual health, people must have access to sexual health services. A small percentage of women with sexual concerns seek professional help. Hence, the need to explain the help-seeking challenges is felt from the perspective of women and health care providers.

METHODS

This study explored Iranian women's challenges when seeking help for sexual concerns. Using a purposive sampling method, 26 in-depth interviews were conducted in Rasht in 2019-2020. The participants included sexually active women of reproductive age over 18 years old and 8 health care providers. The recorded interviews were transcribed and analyzed through content analysis.

RESULTS

From the description of 17 subthemes provided by the participants, two main themes were achieved, "Unfavorable sexuality development context" and "Inefficient sexual health services."

CONCLUSIONS

According to the results, it is suggested that policymakers pay more attention to the challenges women and health care providers face in help-seeking and promote sexuality education and sexual health services to achieve a higher level of help-seeking among women.

Barriers to the management of sexual dysfunction among people with psychosis: analysis of qualitative data from the REMEDY trial

BACKGROUND

More than half of people who use antipsychotic medication for psychosis report having sexual dysfunction. The REMEDY trial aimed to find out if switching antipsychotic medication provides an effective way to reduce sexual dysfunction among people with psychosis. We set out to recruit 216 participants over a two-year period, but recruitment was stopped after an extended 12-month pilot phase, during which we recruited only 10 participants. As part of a nested process evaluation, we conducted qualitative interviews with front-line clinicians to examine barriers to recruitment to the trial.

METHODS

We developed a semi-structured interview schedule to explore staff views on factors that influenced whether they referred potential participants to the study. We interviewed a purposive sample of 51 staff from four National Health Service (NHS) Trusts in England, ensuring a range of different backgrounds, seniority, and levels of involvement in the trial. Audio recordings of interviews were transcribed for verbatim, and data were analysed using an inductive approach to thematic analysis.

RESULTS

Nine interconnected themes were generated. Six themes concerned barriers to recruitment; including; prioritising patients' mental stability, mutual discomfort and embarrassment about discussing a "taboo" subject, and concerns about unintended consequences of asking people with psychosis about their sexual functioning. Three themes, including the quality of treatment relationships and strategies for opening dialogue suggested ways to improve recognition of these "hidden" side effects.

CONCLUSION

The identification and management of sexual dysfunction among people with psychosis are not priorities for mental health services in England at this time. Many staff working in front-line services feel unprepared and uncomfortable asking people with psychosis about these problems. While greater use of screening tools may improve the identification of sexual dysfunction among people with psychosis, the evaluation and implementation of interventions to manage them will continue to be challenging unless NHS leaders and senior clinicians demonstrate greater commitment to changing current clinical practice.

TRIAL REGISTRATION

Current Controlled Trials ISRCTN12307891.