Barriers to sexual history taking in adolescent girls with abdominal pain in the pediatric emergency department

Pilot Test of A Gender-conscious Sexual Health Intake Questionnaire: Increasing Inclusivity and Mitigating Bias in Sexual History Taking

Background

Sexual health is critical to overall health, yet sexual history taking is challenging. LGBTQ+ patients face additional barriers due to cis/heteronormativity from the medical system. We aimed to develop and pilot test a novel sexual history questionnaire called the Sexual Health Intake (SHI) form for patients of diverse genders and sexualities.

Methods

The SHI comprises four pictogram-based questions about sexual contact at the mouth, anus, vaginal canal, and penis. We enrolled 100 sexually active, English-speaking adults from a gender-affirming surgery clinic and urology clinic from November 2022 to April 2023. All surveys were completed in the office. Patients also answered five feedback questions and 15 questions from the Patient-Reported Outcomes Measurement Information System Sexual Function and Satisfaction (PROMIS-SexFS) survey as a validated comparator.

Results

One hundred patients aged 19-86 years representing an array of racial/ethnic groups, gender identities, and sexuality completed the study. Forms of sexual contact varied widely and included all possible combinations asked by the SHI. Feedback questions were answered favorably in domains of clinical utility, inclusiveness of identity and anatomy, and comprehensiveness of forms of sexual behavior. The SHI captured more positive responses than PROMIS-SexFS in corresponding questions about specific types of sexual activity. The SHI also asks about forms of sexual contact that are not addressed by PROMIS-SexFS, such as penis-to-clitoris.

Conclusions

SHI is an inclusive, patient-directed tool to aid sexual history taking without cisnormative or heteronormative biases. The form was well received by a diverse group of participants and can be considered for use in the clinical setting.

Let us integrate sexual health-do psychiatrists integrate sexual health in patient management?

The high prevalence of sexual dysfunction and the importance of sexual health issues in general stress the need for a physician to integrate sexual health issues in patient management. In this study, we evaluate the frequency of psychiatrists addressing sexual health issues as well as their attitude towards sexual health. Plus, we want to evaluate the multi-professional network for patient treatment that is needed by physicians for collaboration with other medical specialists and health care professionals. At total 100 psychiatrists (age range 30-60 years), participating at the annual meeting of the Austrian Society of Psychiatry, Psychotherapy, and Psychosomatics, were invited to self-assess their caring for patients' sexual health issues and answer a self-report questionnaire. The return rate was 74%. A third of the participating psychiatrists and psychotherapists stated to address sexual health in patients in daily routine. Twenty-five percent of the physicians suspected sexual health problems in 60-100% of their patients but did not ask the patients about this topic. Mentioned reasons why patients would not actively address sexual problems were rated by the survey participants "a different problem was more important", "lack of time", and "embarrassment". Only few of the participating psychiatrists stated to offer a consultation in sexual health to the patients, none to offer sexual therapy. A mentioned reason was "lack of competence regarding sexual health". Twelve percent referred the patients with sexual issues to a physician with another medical specialization, especially to experts in gynaecology and obstetrics, to experts in urology, or to andrologists. However, a need for a network in the field of sexual medicine was stated and an unawareness of a sexual health care network: where to refer the patients in need. Our data showed an increased need in the routine treatment and management of sexual health care in psychiatrists and psychotherapists. Plus, the data stresses the need for professional sexual medicine qualification and for extended cooperation between different medical fields and health care professionals in order to integrate sexual health topics professionally in daily routine.

A Novel Pediatric Emergency Department Intervention to Improve Adolescent Sexual Health Care

OBJECTIVE

The aim of this study was to evaluate a novel educational intervention for physician trainees to improve sexual health care provision, including condom distribution, in the pediatric emergency department.

METHODS

Resident physicians and medical students in an urban pediatric emergency department viewed an evidence-based educational video on sexual health care provision. It featured role-plays and a description of the condom distribution process, and targeted trainees who provide health care to patients aged 14 years or more with potential genitourinary complaints. Trainees completed pre- and postintervention surveys to assess attitudes, motivation, and confidence for 4 recommended practices (Likert scale, 1 = not at all to 4 = extremely). We used Wilcoxon signed rank tests to assess differences in paired responses to motivation and confidence statements. A subset of 33 trainees completed a brief survey to assess condom distribution during emergency department clinical encounters.

RESULTS

Of 56 trainees, 51 (91%) participated: 53% female, 58% from pediatrics. At baseline, participants reported high levels of confidence and motivation to provide sexual health care. Postintervention, there were significant increases in the proportion of participants who reported greater motivation and confidence to (1) ask a parent to step out of the room, (2) obtain sexual history, (3) discuss condom use, and (4) offer condoms (all P < 0.05). Postintervention, fewer participants "agreed/strongly agreed" that there is inadequate time to obtain sexual histories (22% vs 45%; P < 0.05). Most (60%) sexually active patients accepted condoms during clinical care.

CONCLUSION

In this pediatric emergency department, a low-cost intervention showed promise to improve trainee attitudes, motivation, and confidence toward adolescent sexual health care provision. These data may inform strategies to improve access to care for this population.

Older adolescent presentations to a children's hospital emergency department

OBJECTIVES

To describe the characteristics, diagnoses and outcomes of older adolescents, aged 16-19 years, presenting to a paediatric ED.

METHODS

A retrospective review of total ED presentations by older adolescents to a tertiary paediatric hospital between 2010 and 2012, inclusive, was undertaken to determine if behavioural or mental health problems were common.

RESULTS

A total of 1184 ED presentations by 730 older adolescents were identified. Injury and abdominal pain were the most common complaints for presentations by older adolescents to the ED. The median length of stay in ED was 241 (range: 0-3873) min. More than 60% of the older adolescent ED presentations were triaged urgent or semi-urgent, and 39% of all these presentations resulted in hospital admission. Two-thirds of these older adolescents had a chronic illness, which accounted for 77% of all ED presentations by older adolescents. The history of chronic illness was considered related or relevant in the evaluation and management of over 80% of older adolescents. Of all the ED presentations by older adolescents with chronic illness, only one quarter had transition planning documentation.

CONCLUSIONS

A high prevalence of chronic illness was found in older adolescents attending the paediatric ED. There was no evidence that behavioural and mental health issues dominated. These findings reflect admission policy.