Sexual history taking by doctors in primary care in North West province, South Africa: Patients at risk of sexual dysfunction overlooked

Addressing sexual health concerns in Tanzania: perceived barriers among healthcare professionals and students in the "training for health professionals" study

Little is known about the factors that may prevent healthcare professionals as key stakeholders from exploring sexual health issues in Tanzania. This study examined healthcare professionals' perspectives on the barriers to addressing sexual health concerns in practice. In June 2019, we conducted an exploratory qualitative study involving 18 focus group discussions among healthcare professionals (n = 60) and students (n = 61) in the health professions (midwifery, nursing, medicine) in Dar es Salaam, Tanzania. Study participants and design were purposively selected and stratified. We used a focus group discussion guide in Kiswahili. Data were transcribed in Kiswahili and translated into English. A thematic analysis approach was used for data analysis. Two themes were developed: (1) differences between health care professional and patient socio-demographic characteristics; (2) health care system and patients' backgrounds, such as communication barriers, lack of confidentiality and privacy within health facilities, type of clinical presentation and complaint, patient behaviours, and their clinical background. Several key barriers prevented sexual health communication between healthcare professionals and patients, affecting the quality of sexual health service delivery. Additional sexual health clinical training is warranted for health professions students and professionals to optimise sexual health care delivery in a culturally conservative country like Tanzania.

Enhancing sexual health in primary care: Guidance for practitioners

Sexual health is an integral aspect of overall health and well-being and is fundamental to the sustainable development of societies worldwide. The World Health Organization (WHO) defines sexual health as 'a state of physical, emotional, mental, and social well-being in relation to sexuality'. However, addressing sexual health has been afforded low priority in primary healthcare systems. Primary care practitioners (PCPs), who play a crucial role in providing comprehensive care to communities, receive little training on screening and managing individuals with sexual health problems. The scope of services ranges from education, prevention and screening, to management of sexual health matters. Patients with noncommunicable diseases (NCDs), such as stroke, cancer, heart disease and diabetes, are at increased risk for sexual dysfunction, possibly because of common pathogenetic mechanisms, such as inflammation. This is of considerable importance in the sub-Saharan African context where there is a rapidly increasing prevalence of NCDs, as well as a high burden of HIV. Strategies to improve the quality of sexual health services in primary care include creating a safe and non-judgemental practice environment for history-taking among gender-diverse populations, utilising effective screening tools aligned with the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria for sexual dysfunctions. In particular, the International Consultation on Sexual Medicine (ICSM -5) diagnostic and treatment algorithm can empower primary care providers to effectively address sexual dysfunctions among patients and improve the quality of care provided to communities regarding sexual and reproductive health.

Do We Care Enough About the Presence of Sexual Problems in Diabetic Patients?

Purpose

Sexual health is not only the absence of sexual dysfunction or disability, but also the presence of physical, emotional, mental, and social well-being related to sexuality. The current study aims to determine whether all adult patients who have applied for their regular health check-ups due to diabetes mellitus had ever voluntarily expressed their sexual problems to a specialist and whether they were asked about the presence of sexual dysfunction. It also aims to determine how the physicians attach importance to the issue.

Patients and Methods

All patients aged 18-65 years with type 1 and type 2 diabetes mellitus, who applied to our hospital between the years of January 2021 and 2022, were questioned by filling out a questionnaire for the presence of sexual problems in addition to screening for chronic complications of diabetes mellitus (retinopathy, nephropathy, and neuropathy) and routine history and physical examination.

Results

The association between the presence of sexual problems and whether patients were questioned about the relevant issue in their previous controls and gender and age factors, educational background, presence of comorbidities, duration of marriage, and microvascular complications of diabetes mellitus were examined. In a population of 595 patients, 53.78% of the patients stated that they had sexual problems; however, 9.91% had been questioned about this issue by the physician. It was observed that 6.3% of female and 15.3% of male patients had previously consulted a doctor voluntarily due to their sexual problems.

Conclusion

This study presents empirical findings that shed light on the inadequacies in healthcare providers' approach to addressing sexual health concerns among individuals diagnosed with diabetes, as well as the shortcomings in patients' effective communication of these concerns.

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.