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Kokay W, Power E, McGrath M. Mixed Study Systematic Review and Meta-analysis of Sexuality and Sexual Rehabilitation in LGBTQI+ Adults Living With Chronic Disease. Arch Phys Med Rehabil 2023; 104:108-118. [PMID: 35973583 DOI: 10.1016/j.apmr.2022.07.018] [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: 01/11/2022] [Revised: 07/19/2022] [Accepted: 07/29/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To systematically review how sexuality is experienced by lesbian, gay, bisexual, transgender, queer or questioning, intersex plus (other gender identifies and sexual orientations) (LGBTQI+) persons living with chronic disease. DATA SOURCES PsycINFO, Embase, MEDLINE, Scopus, Cumulative Index to Nursing and Allied Health, and Web of Science were searched from date of inception to November 2021 for English language publications. Reference lists of relevant publications were also searched. STUDY SELECTION Eligible studies reported on sexuality among LGBTQI+ persons living with chronic disease. The search yielded 12,626 records; 665 full texts were assessed for eligibility and 63 documents included (59 unique studies). Study quality was rated using the Mixed Methods Appraisal Tool. DATA EXTRACTION Characteristics of included studies were recorded independently by 2 authors. Differences were resolved through discussion or with a third author. DATA SYNTHESIS A sequential, exploratory mixed-studies approach was used for synthesis. Pooled analysis indicated that among gay and bisexual men living with prostate cancer, 68.3% experienced erectile dysfunction and 62.9% had insufficient quality of erection to engage in anal sex. Among gay and bisexual men living with HIV or AIDS, 29.3% experienced loss of libido and 25.3% experienced erectile dysfunction. Although sexual dysfunction was common, LGBTQI+ persons had difficulty accessing appropriate sexual counseling and identified negative attitudes and heteronormative assumptions by health care providers as significant barriers to sexual health. Interventions to address sexuality focused entirely on reduction of risky sexual behavior among men living with HIV or AIDS. Women, transgender persons, and intersex persons were largely excluded from the research studies. CONCLUSIONS Current understandings of the effect of chronic disease on LGBTQI+ sexuality are limited and mostly focus on the male sexual response. LGBTQI+ persons who experience difficulty with sexuality struggle to identify appropriate services, and there is an absence of evidence-based interventions to promote sexual health and well-being in this population.
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Affiliation(s)
- William Kokay
- Sydney School of Health Sciences, University of Sydney, Sydney.
| | - Emma Power
- Graduate School of Health, University of Technology Sydney, Sydney
| | - Margaret McGrath
- Sydney School of Health Sciences, University of Sydney, Australia
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Mgopa LR, Ross MW, Lukumay GG, Mushy SE, Mkony E, Massae AF, Mwakawanga DL, Leshabari S, Mohamed I, Trent M, Wadley J, Bonilla ZE, Rosser BRS. Perceptions of Sexual Healthcare Provision in Tanzania: a Key Informant Qualitative Study. SEXUALITY RESEARCH & SOCIAL POLICY : JOURNAL OF NSRC : SR & SP 2022; 19:849-859. [PMID: 36172532 PMCID: PMC9514134 DOI: 10.1007/s13178-021-00607-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/11/2021] [Indexed: 06/16/2023]
Abstract
INTRODUCTION Sexual health care services must be standard and unbiased, guided by a structured health care system. There is a scarcity of data on how sexual health care is delivered in Tanzania. METHODS To address this gap, in July 2019 we interviewed eleven key informants: cultural and public health experts, and political, religious, and community leaders, selected from different organizations in Dar es Salaam, Tanzania. Participants were asked for their opinions about clinical practices of health care professionals when providing care to patients, with an emphasis on sexual health. RESULTS Participants' responses were classified into three subcategories: strengths, barriers, and gaps in sexual health care. Availability of services, service delivery to adults, and code of conduct were among the strengths observed in clinical care services. Barriers included the health care provider's attitudes, moral values, and inadequacy in health policies and treatment guidelines. Vulnerable populations including youth were frequently reported to face most challenges when seeking sexual health care services. In terms of gaps, informants emphasized gender equity in sexual health services provision within care settings. CONCLUSION AND IMPLICATION Data indicate that lack of training in sexual health and guidelines for dealing with sexual issues are a barrier to comprehensive health care. These findings can inform the main areas for curriculum developers to focus on, when developing an Afro-centric sexual health curriculum suitable for students in health care professional courses. Moreover, these findings can be useful when developing treatment guidelines and policies that are beneficial to the sexual health wellbeing of individuals.
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Affiliation(s)
- Lucy R. Mgopa
- Department of Psychiatry and Mental Health, School of Medicine, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - Michael W. Ross
- Program in Human Sexuality, Department of Family Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Gift Gadiel Lukumay
- Department of Community Health Nursing, School of Nursing, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - Stella Emmanuel Mushy
- Department of Community Health Nursing, School of Nursing, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - Ever Mkony
- Department of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Agnes F. Massae
- Department of Community Health Nursing, School of Nursing, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - Dorkas L. Mwakawanga
- Department of Community Health Nursing, School of Nursing, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - Sebalda Leshabari
- Department of Community Health Nursing, School of Nursing, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - Inari Mohamed
- Department of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Maria Trent
- Department of Adolescent and Young Adult Medicine, Johns Hopkins University Schools of Medicine and Public Health, Baltimore, MD, USA
| | - James Wadley
- Department of Counselling and Health Services, Lincoln University, Philadelphia, PA, USA
| | - Zobeida E. Bonilla
- Department of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - B. R. Simon Rosser
- Department of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
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Research on Cognition and Training Needs of Sex Education during Pregnancy among Obstetricians and Obstetric Nurses in Guangdong Province Based on Mixed Research Perspective. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:2536849. [PMID: 36072407 PMCID: PMC9444429 DOI: 10.1155/2022/2536849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 07/24/2022] [Accepted: 07/26/2022] [Indexed: 11/25/2022]
Abstract
Objective The purpose of this study was to understand the current status and existing responses of obstetricians and obstetric nurses in Guangdong Province regarding sex education during pregnancy and to understand their acceptance of sex education during pregnancy and the knowledge and information they would like to obtain in sex education courses. Methods A phenomenological research method was used to conduct in-depth interviews with 12 obstetricians and obstetric nurses in a tertiary hospital in Guangdong Province to understand their perceptions and attitudes toward providing sex education to pregnant women. A self-designed questionnaire was used to survey 462 obstetricians and obstetric nurses in Guangdong Province to understand their needs for sex education. Results Three themes were summarized: insufficient awareness of sex education during pregnancy; negative attitudes of obstetricians and obstetric nurses toward sex education during pregnancy; and the need for a long-term process for the development and popularization of sex education during pregnancy. We obtained the required scores of obstetricians and obstetric nurses on 11 aspects of sex education during pregnancy with a coefficient of variation ≤25%. Conclusion There is an urgent need to improve the awareness and related competencies of obstetricians and obstetric nurses about sex education during pregnancy, and the purpose and content of sex education courses should be in line with the clinical reality.
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Sheddan AJ, Wood F. Use of an Evidence-Based Teaching Strategy to Improve Sexual Health Assessment Among Nurse Practitioners in the Retail Health Environment. J Nurse Pract 2021. [DOI: 10.1016/j.nurpra.2020.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Wilschut VFC, Pianosi B, van Os-Medendorp H, Elzevier HW, Jukema JS, den Ouden MEM. Knowledge and attitude of nursing students regarding older adults' sexuality: A cross-sectional study. NURSE EDUCATION TODAY 2021; 96:104643. [PMID: 33152640 DOI: 10.1016/j.nedt.2020.104643] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 10/05/2020] [Accepted: 10/17/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Although older adults are sexual, sexuality is infrequently discussed with them by health care professionals. Nursing students, as future professionals, can make an important contribution by developing competences in discussing intimacy and sexuality with older adults to increase quality of life and to prevent sexual problems. In order to improve these competences, current levels of knowledge and attitude need to be explored. OBJECTIVES To investigate i) knowledge and attitudes of nursing students regarding intimacy and sexuality of older adults, ii) the difference in knowledge and attitudes of nursing students in different years of study and iii) frequency of discussing intimacy and sexuality with older adults. DESIGN Cross-sectional. SETTINGS A University of Applied Sciences in the Netherlands. PARTICIPANTS Nursing students, ≥16 years who were able to read and write in Dutch. METHODS The Ageing Sexual Knowledge and Attitudes Scale was used among nursing students. Furthermore, demographic information and frequencies were collected. Data was analyzed using SPSS. RESULTS In total, 732 students participated. The mean knowledge-score was 43.9 (SD = 8.9), the mean attitude-score 64.3 (SD = 16.0). Unlike attitude, the level of knowledge differed significantly per year of study: first year students had the lowest and third year students the highest knowledge. Most students stated they 'never' (54.1%) or 'once' (13.2%) discussed intimacy and sexuality with older adults. Reasons to avoid talking about intimacy and sexuality were feelings of 'not being the right person' (17.3%) and 'incompetence' (14.0%). CONCLUSIONS Nursing students had moderate knowledge and positive attitudes toward older adults' intimacy and sexuality. The knowledge-level differed per year of study, the attitude level did not. Only a minority discussed intimacy and sexuality with older adults. Moderate knowledge and positive attitudes do not mean that intimacy and sexuality is discussed. To ensure students feel responsible and competent, interventions should focus on continuous knowledge dissemination, role clarification and role modelling.
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Affiliation(s)
- Vivian F C Wilschut
- Health Sciences, University Utrecht, Utrecht, the Netherlands; Center of Nursing, Saxion, University of Applied Sciences, Deventer/Enschede, the Netherlands
| | - Birgit Pianosi
- Gerontology Department, Huntington University, Sudbury, Canada
| | | | - Henk W Elzevier
- Department of Medical Decision Making, Leiden University Medical Center, Leiden, the Netherlands
| | - Jan S Jukema
- Center of Nursing, Saxion, University of Applied Sciences, Deventer/Enschede, the Netherlands
| | - Marjolein E M den Ouden
- Center for Technology, Health & Care, Saxion University of Applied Sciences, Deventer/Enschede, the Netherlands; Center for Health and Technology, ROC of Twente, Hengelo, the Netherlands.
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Tsai LY, Liou CF, Huang LH, Huang CY. Correlation Between Needs Satisfaction and Behavioral Intentions of Sexual Health Care. J Contin Educ Nurs 2020; 51:457-464. [PMID: 32976614 DOI: 10.3928/00220124-20200914-07] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 05/04/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND This study aimed to evaluate correlations between female nurses' needs satisfaction and behavioral intentions for providing sexual health care and to assess moderating effects of learning needs on that correlation. METHOD A total of 300 female RNs were enrolled. Two validated instruments were used to collect information on participants' learning needs, needs satisfaction, and behavioral intentions for providing sexual health care. RESULTS Adjusted multivariable regression analysis revealed significant moderating effects of medium and low learning needs on correlations between needs satisfaction and behavioral intentions (medium learning needs: β = 0.282, 95% CI = 0.075, 0.490; p = .008; low learning needs: β = 0.293, 95% CI = 0.033, 0.553; p = .027), while no moderating effect was observed in those with high learning needs. CONCLUSION Needs satisfaction was significantly correlated with behavioral intentions of sexual health care in medium and low learning needs groups. [J Contin Educ Nurs. 2020;51(10):457-464.].
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Amerstorfer EE, Grano C, Verhaak C, García-Vasquez A, Miserez M, Radleff-Schlimme A, Schwarzer N, Haanen M, de Blaauw I, Jenetzky E, van der Steeg A, van Rooij IALM. What do pediatric surgeons think about sexual issues in dealing with patients with anorectal malformations? The ARM-Net consortium members’ opinion. Pediatr Surg Int 2019; 35:935-943. [PMID: 31278477 PMCID: PMC6677844 DOI: 10.1007/s00383-019-04506-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/20/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE Since pediatric surgeons aim to follow their patients with anorectal malformations (ARM) into adulthood the aim of this study was to investigate how pediatric surgeons deal with sexual issues related to ARM. METHODS In 2018, a questionnaire was developed by the working group "Follow-up and sexuality" of the ARM-Net consortium and sent to all consortium-linked pediatric surgeons from 31 European pediatric surgical centers. Obtained data were statistically analyzed. RESULTS Twenty-eight of 37 pediatric surgeons (18 males/10 females) answered the questionnaire. The majority of pediatric surgeons (82%) think they should talk about sexual issues with their patient. More than 50% of pediatric surgeons do not feel at all or only moderately confident discussing the topic of sexuality. Most pediatric surgeons require more support (96%) and wish to be trained in sexuality and sexual issues (78%) to feel confident towards their ARM-patients/parents. For optimal care, sexual issues with ARM-patients should be managed by a multidisciplinary team. CONCLUSIONS Pediatric surgeons feel that sexuality is an important issue for their ARM-patients, which they are primarily responsible of but should be managed in concert with a multidisciplinary team. A training in sexuality is wished to feel more confident about this specific issue.
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Affiliation(s)
- Eva Elisa Amerstorfer
- Department of Pediatric and Adolescent Surgery, Medical University of Graz, Auenbruggerplatz 34, 8036 Graz, Austria
| | - Caterina Grano
- Department of Psychology, Sapienza University of Rome, Rome, Italy
| | - Chris Verhaak
- Department of Medical Psychology, Radboudumc Nijmegen, Nijmegen, The Netherlands
| | | | - Marc Miserez
- Department of Abdominal Surgery, University Hospital Gasthuisberg, KU Leuven, Belgium
| | | | - Nicole Schwarzer
- German Self-help Organization for Anorectal Malformations SoMA e.V., Munich, Germany
| | - Michel Haanen
- VA-Dutch Patient Organization for Anorectal Malformations, Huizen, The Netherlands
| | - Ivo de Blaauw
- Department of Surgery-Pediatric Surgery, Amalia Children’s Hospital-Radboudumc Nijmegen, Nijmegen, The Netherlands
| | - Ekkehart Jenetzky
- Department of Child and Adolescent Psychiatry, University Medical Center of the Johannes Gutenberg University, Mainz, Germany ,Institute of Integrative Medicine, Witten/Herdecke University, Herdecke, Germany
| | - Alida van der Steeg
- Department of Pediatric Surgery, Emma Children’s Hospital, AMC and VU University Medical Center, Amsterdam, The Netherlands
| | - Iris A. L. M. van Rooij
- Department of Surgery-Pediatric Surgery, Amalia Children’s Hospital-Radboudumc Nijmegen, Nijmegen, The Netherlands ,Department for Health Evidence, Radboud Institute for Health Sciences, Radboudumc Nijmegen, Nijmegen, The Netherlands
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Tirgari B, Rafati F, Mehdipour Rabori R. Effect of Sexual Rehabilitation Program on Anxiety, Stress, Depression and Sexual Function among Men with Coronary Artery Disease. JOURNAL OF SEX & MARITAL THERAPY 2019; 45:632-642. [PMID: 30912471 DOI: 10.1080/0092623x.2019.1599091] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Background: Patients with coronary artery disease suffer from diminished sexual activity leading to anxiety, stress, and depression. Sexual rehabilitation is the key to the care and treatment process of such patients. Purpose: The present study aimed to examine the effect of sexual rehabilitation program on anxiety, stress, depression and sexual function in men with coronary artery disease. Methods: This was a clinical trial study conducted on 80 male patients suffering from coronary artery disease referred to CCU (Coronary Care Unit) wards in Kerman, Iran. Sample was randomly assigned into two intervention and control groups. The intervention consisted of the sexual rehabilitation program which included two components of education and exercise. Using IIEF (International Index of Erectile Function) and DASS21 (Depression, Anxiety, Stress Scale) anxiety, stress, depression and sexual function have been examined before and one-month after intervention in the two groups. The collected data were analyzed with SPSS version 19 (IBM, Armonk, New York), using descriptive and inferential statistics (such as Pearson correlation coefficient, independent t test, and analysis of variance). Results: Result showed that the intervention group had significantly lower mean scores in anxiety, stress, depression and sexual function compared to the control group (p < 0.0001). Conclusion: According to the results, sexual rehabilitation reduced anxiety, stress, and depression and improved sexual function among men with coronary artery disease. Therefore, it is recommended sexual rehabilitation be an integral part of cardiac rehabilitation.
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Affiliation(s)
- Batool Tirgari
- Nursing Research Center, School of Nursing And Midwifery, Kerman University of Medical Sciences , Kerman , Iran
| | - Fatemeh Rafati
- Nursing Research Center, School of Nursing and Midwifery, Kerman University of Medical Sciences , Kerman , Iran
| | - Roghayeh Mehdipour Rabori
- Nursing Research Center, School of Nursing and Midwifery, Kerman University of Medical Sciences , Kerman , Iran
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Rabathaly PA, Chattu VK. An exploratory study to assess primary care physicians' attitudes toward talking about sexual health with older patients in Trinidad and Tobago. J Family Med Prim Care 2019; 8:626-633. [PMID: 30984685 PMCID: PMC6436267 DOI: 10.4103/jfmpc.jfmpc_325_18] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: A good quality sex life and interest in sex are positively associated with health in middle-aged and later life. For effective diagnosis of sexual health problems, an appropriate discussion about sexual health issues including a sexual history is advised. The sexual health care delivery and management during consultations by primary care physicians is relatively unexplored, especially for older patients. This paper aims to explore primary health care physicians’ (PCPs) attitudes to sexual health care and management of middle-aged and older patients in Trinidad and Tobago. Methods: In-depth, semi-structured interviews were conducted with 35 PCPs in Trinidad and Tobago. Topics examined included physician-patient relations, sexual health care management challenges, communication and sexual history taking practices, and training needs of PCPs. The framework analysis method was adopted for analysis. Results: Most doctors stated that they were not comfortable with conducting a sexual history with their older patients, and they rarely discussed or initiated talking about sexual health with them. Barriers included time constraints, inappropriate environmental conditions for privacy, inadequate professional referral services, insufficient medical training in sexual function in middle and old age, reluctant patient behavior, conflicting personal beliefs on sexuality, and socio-cultural factors. Conclusion: PCPs may be reluctant to raise sexual health-related issues with their older patients, and these older patients may not initiate this discussion because of discomfort and embarrassment. Consequently, physicians’ inability to effectively communicate with these patients could result in missed opportunities for interventions and patients’ concerns may remain unheard and their sexual problems untreated.
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Affiliation(s)
- Patrice A Rabathaly
- Department of Social and Environmental Health Research, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine (LSHTM), London, United Kingdom
| | - Vijay Kumar Chattu
- Public Health and Primary Care Unit, Department of Paraclinical Sciences, Faculty of Medical Sciences, The University of the West Indies, St. Augustine, Trinidad and Tobago
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Kristufkova A, Pinto Da Costa M, Mintziori G, Vásquez JL, Aabakke AJM, Fode M. Sexual Health During Postgraduate Training-European Survey Across Medical Specialties. Sex Med 2018; 6:255-262. [PMID: 29706561 PMCID: PMC6085219 DOI: 10.1016/j.esxm.2018.04.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 03/12/2018] [Accepted: 04/03/2018] [Indexed: 11/06/2022] Open
Abstract
Background Sexual health problems are common. Therefore, training in sexual health is relevant for the clinical practice of trainees and early-career specialists in several specialties who deal with patients with sexual health problems. However, little is known about how sexual health training is provided across countries and specialties. Aim To assess (i) sexual health training during postgraduate training programs in psychiatry, obstetrics and gynecology, urology, and endocrinology across Europe; (ii) the confidence of trainees and early-career specialists in dealing with patients with sexual health problems; and (iii) their need for further training in sexual health during postgraduate training programs. Methods The study was based on a collaboration among European societies of trainees in these 4 specialties. An online survey was developed and conducted from January 2015 through June 2016. Main Outcome Measures Self-reported questionnaire. Results We collected 366 completed surveys from 40 countries. Sexual health training was considered an important or very important part of specialty training by 78.7% of participants. Overall, 62.3% of participants had not received any training in sexual health. Especially in obstetrics and gynecology, the large majority did not have training in sexual health (82.8%), followed by psychiatry (59.8%), urology (58.4%), and endocrinology (56.1%). There were statistically significant differences among specialties in the confidence of participants in managing patients with sexual health problems. In general, trainees and early-career specialists who had received sexual health training felt more confident in dealing with patients with gender dysphoria (P = .011), need for sexual therapy (P = .0004), paraphilic disorders (P = .0003), and sexual dysfunction (P = .0017). Conclusions Trainees and early-career specialists found sexual health training important for their future medical practice; however, less than half received it during their postgraduate training. Participants felt more confident in managing patients with sexual health problems when sexual health training was included in the postgraduate training program. Kristufkova A, Pinto Da Costa M, Mintziori G, et al. Sexual Health During Postgraduate Training—European Survey Across Medical Specialties. Sex Med 2018;6:255–262.
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Affiliation(s)
- Alexandra Kristufkova
- 1st Department of Obstetrics and Gynecology, Faculty of Medicine, Comenius University, Bratislava, Slovakia.
| | - Mariana Pinto Da Costa
- Hospital de Magalhães Lemos, Porto, Portugal; Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto, Porto, Portugal; Unit for Social and Community Psychiatry (WHO Collaborating Centre for Mental Health Services Development), Queen Mary University of London, London, UK
| | - Gesthimani Mintziori
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki Medical School, Thessaloniki, Greece; Department of Endocrinology, Ippokratio General Hospital of Thessaloniki, Thessaloniki, Greece
| | - Juan Luis Vásquez
- Department of Urology, University Hospital of Zealand, Roskilde, Denmark
| | - Anna J M Aabakke
- Department of Obstetrics and Gynecology, Herlev University Hospital, Herlev, Denmark
| | - Mikkel Fode
- Department of Urology, University Hospital of Zealand, Roskilde, Denmark
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