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Pretorius D, Mlambo MG, Couper ID. "We Are Not Truly Friendly Faces": Primary Health Care Doctors' Reflections on Sexual History Taking in North West Province. Sex Med 2022; 10:100565. [PMID: 36122542 PMCID: PMC9780778 DOI: 10.1016/j.esxm.2022.100565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 07/29/2022] [Accepted: 08/02/2022] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Doctors experience barriers in consultations that compromise engaging with patients on sensitive topics and impede history taking for sexual dysfunction. AIM The aim of the study was to identify barriers to and facilitators of sexual history taking that primary care doctors experience during consultations involving patients with chronic illnesses. METHODS This qualitative study formed part of a grounded theory study and represents individual interviews with 20 primary care doctors working in the rural North West Province, South Africa. The doctors were interviewed on the barriers and facilitators of sexual history taking they experienced during 151 recorded consultations with patients at risk of sexual dysfunction. Interviews were transcribed and line-by-line verbatim coding was done. A thematic analysis was performed using MaxQDA 2018 software for qualitative research. The study complied with COREQ requirements. OUTCOME Doctors' reflections on sexual history taking. RESULTS Three themes identifying barriers to sexual history taking emerged, namely personal and health system limitations, presuppositions and assumptions, and socio-cultural barriers. The fourth theme that emerged was the patient-doctor relationship as a facilitator of sexual history taking. Doctors experienced personal limitations such as a lack of training and not thinking about taking a history for sexual dysfunction. Consultations were compromised by too many competing priorities and socio-cultural differences between doctors and patients. The doctors believed that the patients had to take the responsibility to initiate the discussion on sexual challenges. Competencies mentioned that could improve the patient-doctor relationship to promote sexual history taking, include rapport building and cultural sensitivity. CLINICAL IMPLICATIONS Doctors do not provide holistic patient care at primary health care settings if they do not screen for sexual dysfunction. STRENGTH AND LIMITATIONS The strength in this study is that recall bias was limited as interviews took place in a real-world setting, which was the context of clinical care. As this is a qualitative study, results will apply to primary care in rural settings in South Africa. CONCLUSION Doctors need a socio-cognitive paradigm shift in terms of knowledge and awareness of sexual dysfunction in patients with chronic illness. Pretorius D, Mlambo MG, Couper ID. "We Are Not Truly Friendly Faces": Primary Health Care Doctors' Reflections on Sexual History Taking in North West Province. Sex Med 2022;10:100565.
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Affiliation(s)
- Deidré Pretorius
- Division Family Medicine, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa,Corresponding Author: Deidré Pretorius, Division Family Medicine, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, Room 412 4th Floor, The Phillip Tobias Health Sciences Building, 29 Princess of Wales Street (corner York Road), Parktown, 2193, South Africa. Tel: +27825553597
| | - Motlatso G. Mlambo
- Division Family Medicine, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa,Department of Institutional Intelligence, University of South Africa, Pretoria, South Africa
| | - Ian D. Couper
- Division Family Medicine, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa,Ukwanda Centre for Rural Health, Department of Global Health, Stellenbosch University, Stellenbosch, South Africa
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Pretorius D, Couper ID, Mlambo MG. Sexual history taking by doctors in primary care in North West province, South Africa: Patients at risk of sexual dysfunction overlooked. Afr J Prim Health Care Fam Med 2022; 14:e1-e9. [PMID: 35695443 PMCID: PMC9210157 DOI: 10.4102/phcfm.v14i1.3238] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 01/12/2022] [Accepted: 01/14/2022] [Indexed: 11/22/2022] Open
Abstract
Background Sexual history taking seldom occurs during a chronic care consultation and this research focussed on consultation interaction factors contributing to failure of screening for sexual dysfunction. Aim This study aimed to quantify the most important barriers a patient and doctor experienced in discussing sexual challenges during the consultation and to assess the nature of communication and holistic practice of doctors in these consultations. Setting The study was done in 10 primary care clinics in North West province which is a mix of rural and urban areas. Methods One-hundred and fifty-five consultation recordings were qualitatively analysed in this grounded theory research. Doctors and patients completed self-administered questionnaires. A structured workplace-based assessment tool was used to assess the communication skills and holistic practice doctors. Template analysis and descriptive statistics were used for analysis. The quantitative component of the study was to strengthen the study by triangulating the data. Results Twenty-one doctors participated in video-recorded routine consultations with 151 adult patients living with hypertension and diabetes, who were at risk of sexual dysfunction. No history taking for sexual dysfunction occurred. Consultations were characterised by poor communication skills and the lack of holistic practice. Patients identified rude doctors, shyness and lack of privacy as barriers to sexual history taking, whilst doctors thought that they had more important things to do with their limited consultation time. Conclusion Consultations were doctor-centred and sexual dysfunction in patients was entirely overlooked, which could have a negative effect on biopsychosocial well-being and potentially led to poor patient care.
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Affiliation(s)
- Deidre Pretorius
- Division of Family Medicine, School of Clinical Medicine, University of the Witwatersrand, Johannesburg.
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Gender differences in the professional experiences of Iran specialists in American academia. SN SOCIAL SCIENCES 2022; 2:272. [PMCID: PMC9735136 DOI: 10.1007/s43545-022-00585-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 11/30/2022] [Indexed: 12/14/2022]
Abstract
The work on gender differences in academic life spans a wide array of colleges and universities, scholarly disciplines, and countries. Using a survey conducted in 2016 to capture “the state of the field” in Iranian Studies as US–Iran relations were in a brief thaw, this paper draws on some of these perspectives and explores gender differences in the professional experiences of Iranian Studies scholars working in the USA. Iranian Studies has grown and diversified in the USA since the 1960s. This expansion occurred despite disruptions in Iran itself and in US–Iranian relations since 1979, with many US-based Iran specialists having heritage connections to Iran. The survey, which is the first of its kind conducted among this particular academic community, covered a range of topics related to respondents’ academic and professional experiences, career outlook, and political activities. The results spotlight some notable differences—statistically significant differences in several cases—in the professional experiences of men and women in this academic field. Women respondents were more likely to be of junior rank or graduate students and were more likely than men to feel that gender identity influenced their professional milestones. Women were more likely to list the desire for social impact as a professional motivation than men. Women tended to feel less sanguine about the state of their careers, their professional environment, their career prospects, and the state of the Iranian Studies field as a whole. Some of these attitudes varied depending on their self-identification as Iranian, Iranian-American or American, while some held true across self-identification. These results mostly confirmed expectations based on similar research discussed in our literature review.
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Community Pharmacists' Perceptions, Barriers, and Willingness for Offering Sexual and Reproductive Health Services. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182010735. [PMID: 34682503 PMCID: PMC8535476 DOI: 10.3390/ijerph182010735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 09/25/2021] [Accepted: 10/04/2021] [Indexed: 11/17/2022]
Abstract
The role of community pharmacists is crucial for promoting health and providing consultation related to sexual and reproductive health. This study measured the perception of community pharmacists in the Kingdom of Saudi Arabia (KSA) towards the provision of counselling services on sex education and reproductive health, including barriers to and proficiency in the delivery of services. A cross-sectional survey was developed and distributed electronically to pharmacists, and responses were analyzed using SPSS version 26. Graphical representations for various opinions on perception, proficiency and barriers were created. More than 80% of pharmacists placed a high value on counselling patients on sex and reproductive health, about 90% counselled their patients very often (74.6%) or often (22.2%), and 3.2% of pharmacists did not counsel patients. Most respondents believed counselling was very important (65.3%) or important (15.1%), with only 19.6% of respondents indicating it was not important. Barriers to offering services included fear from responsibility and liability (M = 4.8), lack of information about patient health (M = 4.7), gender differences (M = 4.7), and lack of social acceptability (M = 4.6). Community pharmacists in KSA possessed positive attitudes, professional education, and willingness to provide counselling to patients on sex education and reproductive health. Apart from the existing barriers that require augmented community pharmacists’ soft skills, clear policies and authorization for offering this type of service are also needed.
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Pretorius D, Couper ID, Mlambo MG. Sexual history taking: Doctors' clinical decision-making in primary care in the North West province, South Africa. Afr J Prim Health Care Fam Med 2021; 13:e1-e9. [PMID: 34636612 PMCID: PMC8517797 DOI: 10.4102/phcfm.v13i1.2985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 07/02/2021] [Accepted: 07/08/2021] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Clinical reasoning is an important aspect of making a diagnosis for providing patient care. Sexual dysfunction can be as a result of cardiovascular or neurological complications of patients with chronic illness, and if a patient does not raise a sexual challenge, then the doctor should know that there is a possibility that one exists and enquire. AIM The aim of this research study was to assess doctors' clinical decision-making process with regards to the risk of sexual dysfunction and management of patients with chronic illness in primary care facilities of the North West province based on two hypothetical patient scenarios. SETTING This research study was carried out in 10 primary care facilities in Dr Kenneth Kaunda health district, North West province, a rural health district. METHODS This vignette study using two hypothetical patient scenarios formed part of a broader grounded theory study to determine whether sexual dysfunction as comorbidity formed part of the doctors' clinical reasoning and decision-making. After coding the answers, quantitative content analysis was performed. The questions and answers were then compared with standard answers of a reference group. RESULTS One of the doctors (5%) considered sexual dysfunction, but failed to follow through without considering further exploration, investigations or management. For the scenario of a female patient with diabetes, the reference group considered cervical health questions (p = 0.001) and compliance questions (p = 0.004) as standard enquiries, which the doctors from the North West province failed to consider. For the scenario of a male patient with hypertension and an ex-smoker, the reference group differed significantly by expecting screening for mental health and vision (both p = 0.001), as well as for HIV (p 0.001). The participating doctors did not meet the expectations of the reference group. CONCLUSION Good clinical reasoning and decision-making are not only based on knowledge, intuition and experience but also based on an awareness of human well-being as complex and multidimensional, to include sexual well-being.
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Affiliation(s)
- Deidré Pretorius
- Division of Family Medicine, School of Clinical Medicine, University of the Witwatersrand, Johannesburg.
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Qaderi K, Geranmayeh M, Farnam F, Sheikh Hasani S, Mirmolaei ST. Understanding HPV-positive women's needs and experiences in relation to patient-provider communication issues: a qualitative study. BMC Health Serv Res 2021; 21:286. [PMID: 33784992 PMCID: PMC8011207 DOI: 10.1186/s12913-021-06283-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 03/15/2021] [Indexed: 11/29/2022] Open
Abstract
Background HPV testing has been integrated in cervical cancer screening program. Patient-providers relationship is extremely important to improve cervical cancer screening outcomes. This qualitative study aims to understand HPV-positive women’s needs and preferences about HCPs and patient-provider communication based on their experiences of accessing primary and specialized care. Methods We conducted 40 semi-structured interviews with HPV-positive women. Recorded interviews transcribed and analyzed using conventional content analysis approach. Results The analysis of the data led to the extraction of three main categories, including: provider’s communication and counseling skills, commitment to professional principles, and knowledgeable and competent provider. Women needed understandable discussion about HPV, emotional support and acceptance, receiving HPV-related guidance and advice, and some considerations during clinical appointments. Women needed HCPs to treat them respectfully, gently and with non-judgmental attitude. “Precancerous” and “high-risk” words and watching colposcopy monitor during procedure had made women anxious. Weak referral system and limited interactions among gynecologists and other HCPs highlighted by participants. Conclusion The results of this study, based on the experiences and perceptions of HPV women receiving health care, contain messages and practical tips to healthcare providers at the primary and specialized levels of care to facilitate patient-provider communication around HPV. Providers need to approach the discussion of HPV with sensitivity and take individual needs and preferences into account to improve the HPV-positive women’s healthcare experience. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06283-w.
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Affiliation(s)
- Kowsar Qaderi
- Reproductive Health Department, School of Nursing and Midwifery, Tehran University of Medical Sciences, Eastern Nosrat st. Tohid sq, Tehran, 141973317, Iran
| | - Mehrnaz Geranmayeh
- Reproductive Health Department, School of Nursing and Midwifery, Tehran University of Medical Sciences, Eastern Nosrat st. Tohid sq, Tehran, 141973317, Iran
| | - Farnaz Farnam
- Reproductive Health Department, School of Nursing and Midwifery, Tehran University of Medical Sciences, Eastern Nosrat st. Tohid sq, Tehran, 141973317, Iran
| | - Shahrzad Sheikh Hasani
- Gynecology Oncology Department, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Seyedeh Tahereh Mirmolaei
- Reproductive Health Department, School of Nursing and Midwifery, Tehran University of Medical Sciences, Eastern Nosrat st. Tohid sq, Tehran, 141973317, Iran.
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Leyva‐Moral JM, Aguayo‐Gonzalez M, Palmieri PA, Guevara‐Vasquez G, Granel‐Grimenez N, Dalfó‐Pibernat A. Attitudes and beliefs of nurses and physicians about managing sexual health in primary care: A multi-site cross-sectional comparative study. Nurs Open 2021; 8:404-414. [PMID: 33318848 PMCID: PMC7729806 DOI: 10.1002/nop2.641] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 08/20/2020] [Accepted: 09/08/2020] [Indexed: 11/12/2022] Open
Abstract
Aim To understand the attitudes and beliefs of nurses and physicians about managing the sexual health of patients during office visits in primary care centres. Design A questionnaire-based, cross-sectional multi-centre study. Methods The study was performed in 15 primary care centres in Barcelona (Spain), from December 2017-February 2018. Obtained data were analysed with descriptive and bivariate statistics. Results Nearly half the participants believed they should manage sexual health in primary care, but a third of them disagreed this is a priority. Participants also believed patients are not comfortable speaking with them about sex. Statistically significant differences were observed between the professions as nurses more often reported receiving sexual health questions from patients and believed they had enough knowledge to appropriately respond. Most participants wanted additional education to speak with patients more comfortably and confidently about sex.
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Affiliation(s)
- Juan M. Leyva‐Moral
- Department d'InfermeriaUniversitat Autonoma de Barcelona Facultat de MedicinaBarcelonaSpain
- Grupo de Investigación Enfermera en Vulnerabilidad y Salud (GRIVIS)Universitat Autònoma de BarcelonaBarcelonaSpain
- Nursing Research GroupEBHC South America: A Joanna Briggs Institute Affiliated GroupLimaPerú
- Center for Global NursingTexas Woman's UniversityHoustonTXUSA
| | - Mariela Aguayo‐Gonzalez
- Department d'InfermeriaUniversitat Autonoma de Barcelona Facultat de MedicinaBarcelonaSpain
- Grupo de Investigación Enfermera en Vulnerabilidad y Salud (GRIVIS)Universitat Autònoma de BarcelonaBarcelonaSpain
| | - Patrick A. Palmieri
- Nursing Research GroupEBHC South America: A Joanna Briggs Institute Affiliated GroupLimaPerú
- Center for Global NursingTexas Woman's UniversityHoustonTXUSA
- Office of the Vice Chancellor for ResearchUniversidad Norbert WienerLimaPeru
- College of Graduate Health StudiesA. T. Still UniversityKirksvilleMOUSA
| | - Genesis Guevara‐Vasquez
- Nursing Research GroupEBHC South America: A Joanna Briggs Institute Affiliated GroupLimaPerú
- Department of ResearchHospital Regional LambayequeChiclayoPerú
| | - Nina Granel‐Grimenez
- Department d'InfermeriaUniversitat Autonoma de Barcelona Facultat de MedicinaBarcelonaSpain
- Grupo de Investigación Enfermera en Vulnerabilidad y Salud (GRIVIS)Universitat Autònoma de BarcelonaBarcelonaSpain
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Leyva-Moral JM, Feijoo-Cid M, Torrella Domingo A, Planas Ribas B, Badia Royes R, Martín Castillo M, Navarro Mercadé J, Aguayo-Gonzalez M. Exploration of clients living with HIV needs for reporting on experiences with sex. Nurs Health Sci 2020; 22:570-576. [PMID: 32104950 DOI: 10.1111/nhs.12696] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 02/07/2020] [Accepted: 02/19/2020] [Indexed: 11/28/2022]
Abstract
Talking about sex with people living with HIV receives insufficient attention in health care. A cross-sectional and exploratory study describes the preferences of people living with HIV to talk about sex with specialized HIV physicians and nurses in a clinic in Barcelona (Spain). A 27-item self-administered questionnaire was used between June 2017 and May 2018. One hundred fourteen people agreed to participate. Data were analyzed using multivariate logistic regression. Most of the participants reported "never or almost never" having been asked about sex practices in visits with the HIV specialist physician (n = 65 [57.0%]) or nurse (n = 74 [64.9%]). Older participants stated that neither physicians nor nurses talked about sex during visits. Women felt that physicians hardly ever asked about their sexual practices. Men who had sex with other men indicated that their physicians always asked about their sex practices compared with heterosexuals living with HIV. Health professionals should reformulate how to talk about sex with people living with HIV to facilitate communication and provide adequate care.
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Affiliation(s)
- Juan M Leyva-Moral
- Center for Health Sciences Research, Universidad María Auxiliadora, Lima, Peru.,Grupo de Investigación Enfermera en Vulnerabilidad y Salud (GRIVIS), Nursing Department, Faculty of Medicine, Universitat Autonoma de Barcelona, Spain
| | - Maria Feijoo-Cid
- Nursing Department, Faculty of Medicine, Universitat Autonoma de Barcelona, Spain
| | - Ariadna Torrella Domingo
- Infectious Disease Unit, Hospital Universitari de la Vall d'Hebron, Barcelona, Spain.,Institut de Recerca Vall d'Hebron, Barcelona, Spain
| | - Bibiana Planas Ribas
- Infectious Disease Unit, Hospital Universitari de la Vall d'Hebron, Barcelona, Spain.,Institut de Recerca Vall d'Hebron, Barcelona, Spain
| | - Rosa Badia Royes
- Infectious Disease Unit, Hospital Universitari de la Vall d'Hebron, Barcelona, Spain.,Institut de Recerca Vall d'Hebron, Barcelona, Spain
| | - Mario Martín Castillo
- Infectious Disease Unit, Hospital Universitari de la Vall d'Hebron, Barcelona, Spain.,Institut de Recerca Vall d'Hebron, Barcelona, Spain
| | | | - Mariela Aguayo-Gonzalez
- Grupo de Investigación Enfermera en Vulnerabilidad y Salud (GRIVIS), Nursing Department, Faculty of Medicine, Universitat Autonoma de Barcelona, Spain
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Rashidian M, Minichiello V, Knutsen S, Ghamsary M. Western, Asian, and Middle Eastern Societies’ Cultural Attitudes and Barriers Impacting the Management of Sexual Health Care. ACTA ACUST UNITED AC 2020. [DOI: 10.1007/978-3-030-36222-5_10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
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Sexual Health in the Era of Cancer Genetic Testing: A Systematic Review. Sex Med Rev 2020; 8:231-241. [PMID: 31928932 DOI: 10.1016/j.sxmr.2019.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 10/24/2019] [Accepted: 11/05/2019] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Genetic testing for germline cancer mutations allows individuals to gain specific knowledge of their hereditary cancer risks. Although risk-reducing strategies such as increased screening, prophylactic surgeries, and chemoprevention may be potentially lifesaving, these options can also significantly impact sexual health and function. AIM This study overviews current challenges at the intersection of cancer genetic testing and sexual health and describes a systematic review that summarizes this evidence, identifies methodological limitations, and provides future research directions. METHODS Articles on the intersection of genetic testing and/or family history of cancer, cancer risk, and sexual health were searched in Medline, PsycINFO, and PsycARTICLES databases. MAIN OUTCOME MEASURE The main outcome measure was sexual health in women who pursued risk-reducing surgery. RESULTS On the basis of the inclusion criteria, 32 studies were reviewed. 31 contained empiric data from 3,367 participants; one was a conceptual study. All studies were published between 2000 and 2019. Mean ages ranged from 38 to 51.2. CONCLUSION Given the prevalence of sexual dysfunction after risk-reducing surgery, evidence-based interventions are needed. Furthermore, quality of life that includes sexual health, in at-risk women who pursue preventive surgery, remains an understudied aspect of cancer genetic testing. Yusufov M, Bober SL. Sexual Health in the Era of Cancer Genetic Testing: A Systematic Review. Sex Med Rev 2020;8:231-241.
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Komlenac N, Hochleitner M. Predictors for Low Frequencies of Patient-Physician Conversations Concerning Sexual Health at an Austrian University Hospital. Sex Med 2019; 8:100-106. [PMID: 31680029 PMCID: PMC7042158 DOI: 10.1016/j.esxm.2019.09.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 08/28/2019] [Accepted: 09/29/2019] [Indexed: 11/26/2022] Open
Abstract
Introduction Studies concerning barriers to patient-physician conversations about sexual health or, specifically, sexual functioning fail to go beyond descriptive analyses of such barriers. Aim To identify barriers that predict the frequency of patient-physician conversations concerning sexual health or sexual functioning. Methods An online survey among physicians was conducted at an Austrian university hospital. Self-constructed questionnaires assessed physicians’ sociodemographic information, frequency of holding a discussion on sexual health or sexual dysfunctions with their patients, and self-perceived barriers to asking patients about sexual health. Stepwise logistic regression models determined barriers that predicted the frequency of patient-physician conversations concerning sexual health or sexual dysfunctions in everyday clinical practice. Main Outcome Measure The outcome variables in the structural equation models were frequency of patient-physician conversations concerning sexual health or sexual dysfunctions in everyday clinical practice. Results One hundred two physicians (53.9% women, 46.1% men; mean age = 41.3 years; SD = 10.6) provided full responses. Of these physicians, 61.8% reported having a discussion on sexual health or sexual dysfunctions with their patients at least rarely in their everyday clinical practice. The barriers most influencing the frequency of such patient-physician conversations were not feeling responsible for this health issue and expecting the patient to initiate such a conversation. Fear of offending the patient and the physician’s own feelings of shame and discomfort were additional factors influencing the frequency of these patient-physician conversations. Clinical Implications Future physician training should address physicians’ responsibilities that include sexual health. Future physician training should also help physicians in overcoming fears of offending a patient, and one’s own feelings of shame and discomfort when addressing patients’ sexual health. Strengths & Limitations This study included physicians across a range of disciplines, who may encounter patients with sexual problems and with their treatments influence a patient’s sexual health and sexual functioning. However, the low response rate and the limited number of participants prevented generalization of findings. Conclusions At an Austrian university hospital, patient-physician conversations concerning sexual health are seldom part of a physician’s everyday clinical practice. Future training for physicians should focus on demonstrating the relevance of sexual health in the physician’s medical discipline and should tackle a physician’s feelings of shame or how to handle patients’ negative reactions during patient-physician conversations concerning sexual health. Komlenac N, Hochleitner M. Predictors for Low Frequencies of Patient-Physician Conversations Concerning Sexual Health at an Austrian University Hospital. Sex Med 2019; 8:100–106.
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Affiliation(s)
- Nikola Komlenac
- Gender Medicine Unit, Medical University of Innsbruck, Innsbruck, Austria.
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Khadivzadeh T, Ghazanfarpour M, Latifnejad Roudsari R. Cultural Barriers Influencing Midwives' Sexual Conversation with Menopausal Women. J Menopausal Med 2019; 24:210-216. [PMID: 30671415 PMCID: PMC6336569 DOI: 10.6118/jmm.2018.24.3.210] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 08/28/2018] [Accepted: 09/09/2018] [Indexed: 12/05/2022] Open
Abstract
Objectives The present study aimed to determine the barriers influencing the sexual conversation. Methods In this descriptive cross-sectional study, 200 midwives were selected through convenience sampling method from private and public clinics in Mashhad, North East of Iran. A self-structured questionnaire was used to collect the study data. Results The mean age of subjects was 39.58 ± 8.12 years with 13.49 ± 7.59 years of work experience. A number of cultural conditions act as an inhibitory force for the midwives to address sexual issues with menopausal women. Menopausal women visit a doctor at the acute stage when emotional and physical problems make sexual discussion difficult for the midwives (86.5%). Other related causes for not having proper sexual conversation were insufficient knowledge (51.4%), inadequate education provided via public media through health providers (83.5%), midwives or their patient's shame (51.5%), and attempt to get help from traditional healers, friends, relatives and supplicants instead of midwifery staff (78.5%). Also, we found that sexual workshops, communication workshops, and work experiences had a significant influence in changing the views of midwives. Conclusions Cultural barriers prevent the patients and providers from communicating effectively with each other, thus highlighting the need for sexual and communication workshops for the health care providers.
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Affiliation(s)
- Talat Khadivzadeh
- Evidence-Based Care Research Center, Department of Midwifery, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Masumeh Ghazanfarpour
- Department of Nursing and Midwifery, Razi School of Nursing and Midwifery, Kerman University of Medical Sciences, Kerman, Iran
| | - Robab Latifnejad Roudsari
- Evidence-Based Care Research Center, Department of Midwifery, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
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Rashidian M, Minichiello V, Knutsen SF, Ghamsary M. Effect of attitudes towards patients on sexual history taking: a survey of Iranian-American physicians in California, USA. Sex Health 2017; 14:514-522. [PMID: 28618248 DOI: 10.1071/sh17016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 04/22/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND Although obtaining sexual history from patients is essential, the attitudes of physicians can become a barrier to sexual health care. Iranian-American physicians may face particular challenges because talking about sexuality is considered a taboo within their culture. Our study examined these physicians' attitudes when taking a sexual history from their patients. METHODS In 2013, a self-administrated questionnaire was sent to 1550 Iranian-American physicians in California, USA. Using factor analysis, the principal components approach with a Varimax rotation was used on a set of 12-item questions (five-point Likert scales) to detect latent factors that explain attitudes affecting sexual history taking. Scores are generated to determine physicians' attitudes towards sexual history taking. RESULTS In total, 354 questionnaires were returned (23% response rate). Three factors were identified as internally consistent (Cronbach's α=0.84 - 0.94): (1) attitude towards various patients; (2) female sexuality; and (3) age and marriage. Significant association were found between these three factors and some variables such as physicians' gender, country of medical graduation, religion, birthplace and age. CONCLUSIONS Results revealed that cultural attitudes are important factors affecting physicians' involvement in sexual history taking. Additional studies from this population and other subpopulations of US physicians are needed. New strategies that reflect on physicians' attitude on sexual healthcare delivery is needed. If confirmed in other studies, our findings could have implications for the training of medical graduates globally.
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Affiliation(s)
- Mitra Rashidian
- Collaborative Research Network, University of New England, School of Health, Armidale, NSW 2351, Australia
| | - Victor Minichiello
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
| | - Synnove F Knutsen
- Department of Biostatistics and Epidemiology, Loma Linda University, School of Public Health, Loma Linda, California, 92350, USA
| | - Mark Ghamsary
- Department of Biostatistics and Epidemiology, Loma Linda University, School of Public Health, Loma Linda, California, 92350, USA (Retired)
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