Patients' and providers' perspectives on sexual health discussion in the United States: A scoping review

Silent suffering: the impact of sexual health challenges on patient-clinician communication and adherence to adjuvant endocrine therapy among Black women with early-stage breast cancer

PURPOSE

Adjuvant endocrine therapy (AET) increases sexual health challenges for women with early-stage breast cancer. Black women are more likely than women of other racial/ethnic groups to report adverse symptoms and least likely to initiate and maintain AET. Little is known about how sexual health challenges influence patient-clinician communication and treatment adherence. This study explores facilitators of and barriers to patient-clinician communication about sexual health and how those factors might affect AET adherence among Black women with early-stage breast cancer.

METHODS

We conducted 32 semi-structured, in-depth interviews among Black women with early-stage breast cancer in the U.S. Mid-South region. Participants completed an online questionnaire prior to interviews. Data were analyzed using thematic analysis.

RESULTS

Participants' median age was 59 (range 40-78 years, SD = 9.0). Adverse sexual symptoms hindered participants' AET adherence. Facilitators of patient-clinician communication about sexual health included female clinicians and peer support. Barriers included perceptions of male oncologists' disinterest in Black women's sexual health, perceptions of male oncologists' biased beliefs about sexual activity among older Black women, cultural norms of sexual silence among Southern Black women, and medical mistrust.

CONCLUSIONS

Adverse sexual symptoms and poor patient-clinician communication about sexual health contribute to lower AET adherence among Black women with early-stage breast cancer. New interventions using peer support models and female clinicians trained to discuss sexual health could ameliorate communication barriers and improve treatment adherence.

IMPLICATIONS FOR CANCER SURVIVORS

Black women with early-stage breast cancer in the U.S. Mid-South may require additional resources to address sociocultural and psychosocial implications of cancer survivorship to enable candid discussions with oncologists.

Lessons from COVID-19 for sexually transmitted infections: Listening and learning from young adults and healthcare providers on sexual health communications dynamics and decisions in four states

OBJECTIVES

To learn how the COVID-19 pandemic response could shape public health messaging for sexually transmitted infections (STIs), researchers conducted qualitative interviews with young adults in demographic groups experiencing disparate rates of STIs and healthcare providers in California, Florida, Louisiana, and Missouri.

METHODS

Between October 2020 and October 2021, researchers interviewed 55 young adults and 49 providers about COVID-19 and STI information sources, perceived risk, and messaging. Young adults included Black/African American gay, bisexual, or other men who have sex with men (Black MSM); Latinx MSM; Black/African American transgender women; Latinx transgender women; and Black/African American cisgender women. Providers were medical doctors, doctors of osteopathy, nurse practitioners, physician assistants, and registered nurses.

RESULTS

Half of young adults identified the Centers for Disease Control and Prevention and the news as primary trusted sources of COVID-19 information; for trusted STI information, they identified providers. Conversely, providers perceived that young adults receive sexual health information from the internet, peers, and social media. Nearly all young adults assessed their likelihood of contracting COVID-19 infection and STIs as low.

CONCLUSIONS

Communication efforts surrounding the novel coronavirus can help sexual healthcare providers improve messaging by aligning multiple, trusted sources of information to reduce message variability; increasing accountability for providers' critical role in affirming sexual health discussions; and supporting patient-driven communications to address individualized STI information needs.

PRACTICE IMPLICATIONS

STI information should be presented in a simple, consistent manner from multiple credible sources-in particular, providers. Second, providers should promote patient-driven conversations that address young people's concerns and communicate with empathy in a non-judgmental fashion. Third, we can address young people's low-risk perception by emphasizing factors both within and outside of young adults' control that can facilitate an ongoing sexually healthy life.

Sexual and Reproductive Health and Rights

Sexual and reproductive health is a fundamental human right for all people, including adolescents and young adults (AYAs). Sexual and reproductive health and rights (SRHR) encompasses the right to comprehensive, medically accurate, and evidence-based sexual health information and healthcare services, as well as the ability to understand and exercise these rights. SRHR are essential to AYA's emotional, cognitive, and psychosocial development, physical and mental health, gender equality, and wider economic and social development. Access to sexual and reproductive health information and healthcare, inclusive of sexual orientation, gender identity, sexual behavior, and reproduction, is critical to achieving healthy sexual development. A strong body of research demonstrates that access to comprehensive, confidential sexual and reproductive health education and healthcare services, as well as family and community supports, improves a range of outcomes for AYAs. These favorable outcomes include delays in the age of sexual debut, reductions in sexual activity rates and the number of sexual partners, and increases in contraception and condom use. While there have been significant advancements in SRHR across the globe, AYAs continue to experience disproportionately higher rates of sexually transmitted infections, human immunodeficiency virus, unintended pregnancy, reproductive coercion, and sexual exploitation, as well as violence based on sex assigned at birth, sexual orientation, and gender identity. These disparities contribute to morbidity, mortality, and health inequities. Accordingly, the Society for Adolescent Health and Medicine adopts the following positions: (1) comprehensive sexual and reproductive health information and healthcare are fundamental human rights for all AYAs; (2) all AYAs should have universal access to comprehensive sexual and reproductive health information and healthcare; (3) all AYA-serving clinicians should have requisite knowledge and skills to provide sexual and reproductive health information and healthcare, and nonclinical AYA professionals should be an SRHR resource and provide referrals; and (4) increased investments in AYA-related sexual and reproductive health education, services, research, and advocacy, with meaningful stakeholder engagement, are needed to actualize SRHR for AYAs. Further, AYAs should have a voice in SRHR interventions and policies that affect their lives to ensure these efforts are relevant and meet their needs. Opportunities to advance the SRHR of AYAs exist at each level of the socioecological system.

Establishing Evidence for the Painful Intercourse Self-Efficacy Scale-Interstitial Cystitis

Background

Although female sexual dysfunction (FSD) and low sexual self-efficacy are common in patients with interstitial cystitis/bladder pain syndrome (IC/BPS), existing measures of these constructs do not fully capture unique challenges faced by patients with IC/BPS, such as managing sex-related symptom exacerbations, experiencing rewarding sexual activity, and maintaining intimate relationships. To address the lack of tailored measurement of FSD and sexual self-efficacy in patients with IC/BPS, we aimed to adapt the Painful Intercourse Self-Efficacy Scale-Interstitial Cystitis (PISES-IC) for this population.

Method

To form the PISES-IC, we added three items to the pain self-efficacy subscale of the PISES, each informed directly by qualitative interviews with patients with IC/BPS and literature review of patient-reported sexual experiences in IC/BPS. Utilizing baseline data of 71 female participants involved in a clinical trial for IC/BPS (NCT#04275297), we assessed the validity and reliability of the newly adapted PISES-IC.

Results

Results indicate that the PISES-IC is indeed a valid and reliable measure of sexual self-efficacy in the IC/BPS population and that the items informed by IC/BPS patient experiences (self-efficacy related to pain flares, rewarding sexual activity, and interference with romantic relationships) may be particularly related to FSD in patients with IC/BPS.

Conclusions

The PISES-IC captures aspects of sexual experiences of patients with IC/BPS that are not assessed by other existing measures. The PISES-IC can be utilized in research and clinical settings to inform patient care and to further understand sexual experiences of IC/BPS patients.

The impact of acquired communication impairments on sexuality and intimacy: A scoping review

BACKGROUND

Communication is critical to sexuality and sexual health. It is therefore reasonable to assume that acquired communication impairments would impact sexuality, but research is sparse. The research that does discuss these impacts can be difficult to find, as studies are spread across a wide variety of literature bases, and sexual topics are often combined with other concerns. Coupled with clinicians' discomfort in addressing sexual issues, this leads to a lack of clinical support for patients' sexual concerns.

AIMS

This scoping review aimed to map and summarize the existing literature on sexuality and acquired communication impairments.

METHODS & PROCEDURES

Six databases were searched: CINAHL, PubMed, MEDLINE, PsycINFO, Web of Science and Scopus. To find studies from the literature on acquired communication impairments and their aetiologies that addressed sexuality and communication, a combination of sexuality and communication impairment terms was used. A total of 97 articles met inclusion criteria.

MAIN CONTRIBUTION

Across aetiologies and literature bases, acquired communication impairments have been found to negatively affect sexuality. However, researchers rarely evaluate the nature of the communication impairment or its effects on sexuality directly. People with communication impairments are more often systematically excluded from acquired disability research on sexuality. Using the reviewed literature, we present recommendations for including sexuality-related topics in communication disorder research and including people with communication impairments in sexuality-related research. We also present recommendations for speech-language pathologists to begin incorporating sexuality-related topics in their clinical practice.

CONCLUSIONS & IMPLICATIONS

The effects of communication impairments on sexuality are insufficiently researched. The literature that does exist points to substantial impacts. This area of research deserves more concerted attention so that clinicians may have guidance and support in addressing the issue with their clients.

WHAT THIS PAPER ADDS

What is already known on the subject Though researchers have long posited reasons why acquired communication impairments would logically affect sexuality and intimacy, the literature on the topic has been difficult to find. Such research is spread across disorder areas. Sexuality effects are often hidden amid multiple quality-of-life indicators, or communication impairment impacts are described as one of many independent variables. What this paper adds to the existing knowledge This scoping review is the first of its kind to provide an overview of the research into communication impairments' effects on sexuality. It describes the effects that communication impairments can have on sexuality. What are the potential or actual clinical implications of this work? This scoping review will help clinicians to find relevant research for their clients' needs and help researchers conduct more thorough research in this area. It also provides clinical recommendations for helping clients with communication impairments access this important part of life.

Observations of Communication Practices Between Men Who Have Sex With Men With HIV and HIV Specialist Nurses During Routine Consultations Regarding Sexual Health Counseling in the Netherlands: A Qualitative Study

ABSTRACT

This study investigated how HIV specialist nurses communicate with men who have sex with men with HIV during routine consultations with a focus on sexual health counseling in the Netherlands. In this multicenter observational study, 16 video-recorded consultations from four HIV treatment centers were analyzed. Verbatim transcriptions were analyzed to assess the topics discussed, the duration of consultations, time spent on sexual health counseling, and specific issues covered. Communication skills were evaluated through a predefined framework. The findings indicated inconsistent coverage of sexual health, varied topics, and a lack of structure. Various communication skills and techniques were applied inconsistently. Given these findings, we recommend implementing communication strategies during routine consultations to improve the quality of sexual health counseling, especially for men who have sex with men with HIV. This is essential to improve the quality of sexual health counseling for persons with HIV, especially men who have sex with men.

Social and sexual networks of newly diagnosed people living with HIV: a qualitative social network analysis

BACKGROUND

A better understanding of HIV transmission dynamics is needed to further reduce the number of new HIV diagnoses in Belgium. As environmental and social context play an important role in explaining HIV acquisition despite the availability of effective HIV prevention, this study investigated how social and sexual networks may have influenced HIV prevention and risk behavior among a group of people newly diagnosed with HIV, including their perceptions of how they acquired HIV and their ability to disclose their HIV status.

METHODS

We used an ego-centric social network approach, generating sociograms of social and sexual networks through in-depth interviews with 20 participants newly diagnosed with HIV.

RESULTS

Many participants reported a considerable overlap between their social and sexual networks. Friends, family members, regular sex partners and HIV physicians were placed closest to the ego on the sociogram. Self-identified gay men did not consider their casual sex partners as emotionally close enough to be included in the sociogram, despite these partners often being participants' primary source of information about sexual health. Self-identified heterosexual and bisexual men who have sex with men (MSM) had more diverse and separated networks, and often had not considered themselves at risk for HIV. They were less aware of PrEP compared to self-identified gay MSM, partly attributed to target-group specific community-based prevention efforts. Most participants disclosed HIV only to those closest to them, and the anticipated and perceived lack of social support influenced acceptance. Feelings of internalized HIV stigma and homophobia prevented HIV disclosure, especially among heterosexuals and heterosexual and bisexual MSM.

CONCLUSION

This study revealed important differences in the networks of gay-identified MSM, heterosexuals and hetero- and bisexual identified MSM influencing sexual risk taking and prevention behavior. Future prevention initiatives should be inclusive and mainstreamed to ensure to address those who do not identify as belonging established key populations. Awareness of HIV and biomedical prevention should be raised in the general population, providing a base on which tailored prevention can be built. Involving family physicians and socially empowering people living with HIV may help to decrease anticipated and internalized HIV stigma.

The role and needs of family doctors in sexual medicine: contributions of a preliminary Portuguese qualitative study for a global action

Sexual health is fundamental for overall well-being and quality of life, making it the focus of intervention in Sexual Medicine (SM). Within the National Health Services, Primary Care Physicians (PCPs) guarantee comprehensive care in a biopsychosocial action, including in sexual health. This exploratory study aimed to investigate PCPs' perceptions about their role in SM and how to improve it. A cross-sectional online qualitative design was used, and a sample of 73 Portuguese PCPs was collected. Data was analyzed employing a summative content analysis. Three categories were established regarding how PCPs perceive their role in SM: "Protagonist", "Antagonist", and "Circumstantial". Concerning improving PCP's practice, two categories were identified: "Legitimizing Sexual Health" and "Enhancing Professional Development". In relation to SM, PCPs recognize themselves as institutional gatekeepers and comprehensive caregivers, resorting to familiar tasks to practice in a conditioned framework. To improve their role in SM, PCPs highlighted education investment, making specific suggestions for educational content, resource expedition, detailed guidelines creation, and raising provider and patient awareness beyond the biomedical scope. The results stress the need for an institutional effort to uphold PCPs' crucial role in SM to ensure adequate resource use and consistent, comprehensive sexual healthcare provision, enhancing overall patient care and placing sexual health as an essential field in primary care.

Sexual Satisfaction and Associated Factors Among Older Cancer Survivors

As little is known about sexual satisfaction among older (≥ 65 years) cancer survivors, this study examined sexual satisfaction defined as physical pleasure and emotional satisfaction in sexual relationships, including associated factors. This secondary analysis of the National Social Life, Health, and Aging Project round 3 data set included 173 partnered older cancer survivors. The data included ratings of physical pleasure, emotional satisfaction, importance of sexual activity, mental and physical health, and scores of sexual function (the presence of problems; if any, the extent of related bother) and social support and strain from partners. The sample's mean age was 74.30 years (SD = 6.36). Most were male (n = 120, 69.36%) and White (n = 139, 80.35%). Older adults reported they were "very" satisfied with sexual relationships both physically and emotionally: mean (SD) = 2.88 (1.01) and 3.18 (0.77), respectively. Seventy (40.46%) had problems with sexual function that were bothersome. Adjusted linear regression models showed physical pleasure was associated with perceived physical health (β = 0.22) and social support (β = 0.19); and emotional satisfaction was associated with social support (β = 0.39) and strain from partners (β = -0.23). Sexual function was not associated with sexual satisfaction. In conclusion, perceived health and social factors may be more influential than sexual function in older cancer survivors' sexual satisfaction, but future research is warranted to confirm these relationships. A focus on relational aspects of sexual health may provide a broader array of options to improve older cancer survivors' sexual satisfaction.

Exploring Perspectives on HIV Vulnerability Communication among Transgender and Gender Diverse Patients and Primary Care Providers

Transgender and gender diverse (TGD) individuals represent a population with a heavy burden of HIV. Multi-level stigma encountered by TGD individuals can create significant barriers to discussing topics related to HIV prevention; however, research on communication between TGD patients and primary care providers (PCPs) about HIV vulnerability and prevention remains limited. This study used in-depth qualitative interviews with 25 TGD patients and 15 PCPs conducted in 2022 to explore perspectives on HIV vulnerability communication during primary care encounters. Overall, 14 of the TGD patients were nonbinary, genderqueer, or another gender identity; all but two participants identified as a sexual minority. The majority of PCPs (n = 11) were physicians. The range of years practicing medicine was between two and 39 years. Thematic analysis was used to organize codes and establish themes. Three broad themes regarding factors that facilitate communication regarding HIV vulnerability were identified: (1) focusing on behaviors over identities, (2) conveying impartiality, and (3) acknowledging individuality among TGD patients. Findings corroborate earlier research that identified strengths in providers refraining from behavior-based assumptions tied to a patient's gender identity and sexual orientation and conveying impartial and nonjudgmental attitudes when discussing behaviors that can increase HIV vulnerability. Additionally, these findings underscore the significance of recognizing that, within the TGD community, all persons have unique circumstances, preferences, and needs. Future work should continue to explore the dynamics of HIV vulnerability and prevention discussions, especially among TGD individuals from diverse backgrounds and regions, to identify strategies for strengthening patient-provider communication and reducing vulnerability to HIV.

Sexual dysfunction among patients with type-2 diabetes mellitus attending diabetes clinics in primary healthcare centers in Bahrain-A cross-sectional study

Introduction

Sexual dysfunction (SD) is a common problem among males with type-2 diabetes mellitus (T2DM) but often goes underdiagnosed and underreported. This study aimed to measure the prevalence and risk factors of SD among males with T2DM attending diabetes clinics in Bahrain.

Methods

A cross-sectional study was conducted in ten primary health centers in Bahrain using a self-administered questionnaire. The questionnaire consisted of three parts: sociodemographic characteristics and the Sexual Assessment and Dysfunction in Diabetic Men (SAD-M) questionnaire. Descriptive and inferential analyses, including logistic regression, were performed.

Results

A total of 313 patients with an average age of 54.3 ± 10.0 years were included. More than half of the patients had dyslipidemia (n = 220, 70.3%) and hypertension (n = 178, 56.9%). Approximately half of the participants had no morning erections (n = 161, 51.4%), and about a third had less than three sexual intercourse attempts in the last six months (n = 90, 28.8%). Of the participants, 32.6% had moderate SD, 42.5% had mild SD, and 25% had no SD. Univariate analysis showed that male patients with SD were older (P < 0.001) and had a higher body mass index (P = 0.036) compared to those without SD. In addition, unemployed patients (P < 0.001), Bahraini (P < 0.001), had diabetes for 10 years or more (P < 0.001) and had prostate and spinal diseases (P = 0.004 and P = 0.010, respectively) had higher rates of SD. Logistic regression analysis showed that older patients (P = 0.007) and patients with a diabetes duration of more than 10 years were more likely to have SD than their counterparts (OR = 14.908, P < 0.001).

Conclusion

SD is a common problem among males with T2DM in Bahrain, especially among older patients and those with a prolonged history of diabetes. Therefore, primary care providers should consider screening for SD in male patients with T2DM.

"No doctor ever asked me…so I thought it wasn't a valid concern": endometriosis patients' perspectives of barriers and facilitators to sexual health communication in general practice

BACKGROUND

Sexual health communication between general practitioners (GPs) and individuals with chronic diseases is well documented as an important component of sexual well-being. However, a notable gap exists in understanding factors that contribute to sexual health communication in the endometriosis context. Endometriosis-related research has focused on the assessment of sexual functioning and its role in influencing health-related quality of life, with a limited understanding of the management of sexual well-being in primary healthcare settings.

AIM

To explore how individuals with endometriosis perceive their experiences of sexual health communication with GPs to understand the barriers and facilitators of this communication in general practice.

METHODS

This study formed part of a larger online quantitative survey measuring psychological and sexual well-being in individuals with endometriosis. In total 141 participants provided responses via open-ended unlimited free-text questions focused on their experiences of sexual health communication with GPs, including their perspectives on barriers and facilitators.

RESULTS

Four overarching themes regarding barriers to sexual health communication were identified through thematic template analysis: (1) systemic factors; (2) practitioner factors; (3) patient factors; and (4) interpersonal factors. Facilitators mirrored strategies to address these barriers. Additionally, participants offered recommendations for developing resources to improve sexual health communication.

CLINICAL IMPLICATIONS

Despite patients' interest, sexual health concerns in endometriosis are commonly overlooked in general practice due to various barriers, which individuals suggest could be addressed through comprehensive GP education and practical aids including communication tools.

STRENGTHS AND LIMITATIONS

Although the sample is large for a qualitative study, the potential selection bias-stemming from participants' high levels of sexual dysfunction and motivation to discuss sexual health with a GP-may limit the diversity of perspectives. GP perspectives were not evaluated, precluding any assessment of the accuracy of individuals' perceptions of practitioner factors.

CONCLUSIONS

Individuals with endometriosis encounter various systematic, practitioner, personal, and interpersonal factors that hinder or facilitate sexual health communication in general practice. Future research should prioritize strategies to improve sexual health communication for both GPs and patients.

Perceived barriers and facilitators to HPV vaccination: Insights from focus groups with unvaccinated mid-adults in a U.S. medically underserved area

Shared clinical decision-making (SCDM) about HPV vaccination has been recommended for U.S. mid-adults aged 27-45 since 2019. To explore barriers and facilitators to HPV vaccination in this population, we conducted 14 virtual focus groups with 86 unvaccinated mid-adults (34 men and 52 women) in California's medically underserved Inland Empire between September 2020 and January 2021. We systematically analyzed the focus group data using the rigorous and accelerated data reduction (RADaR) technique to identify key themes. Identified barriers included: lack of awareness, vaccine hesitancy, and perceived unaffordability (cited in 14 groups); lack of healthcare provider communication and insufficient time (13 groups); fear of moral judgment (12 groups); lack of motivation and information needs (10 groups); and lack of reliable transportation and foregone care during the COVID-19 pandemic (3 groups). Proposed facilitators included: tailored HPV vaccine information for mid-adults, cost mitigation, and improved vaccine accessibility (12 groups); healthcare provider-initiated conversations (6 groups); and vaccine reminders (4 groups). These findings highlight challenges to HPV vaccination among U.S. mid-adults eligible for SCDM and point to actionable strategies for improvement. Specifically, tailored educational interventions, decision-making tools for pharmacists, and integrating HPV vaccination into other healthcare encounters may enhance vaccination efforts in areas with limited primary care resources.

Understanding nurses' perceptions of sexual health and function in people requiring haemodialysis

BACKGROUND

Sexual dysfunction is common for adults receiving chronic haemodialysis; however, renal nurses seldom discuss this topic with patients.

OBJECTIVES

This study aimed to identify renal nurses' attitudes towards providing sexual healthcare and to determine their confidence in discussing sexual dysfunction with adults who are receiving haemodialysis.

DESIGN

An online cross-sectional study.

PARTICIPANTS

Renal nurses across Australia and New Zealand (n = 65) who were members of the Renal Society of Australasia provided direct care to adults receiving haemodialysis.

MEASUREMENTS

Two questionnaires measuring (1) the frequency of sexual health discussions, levels of knowledge and competence, barriers to discussing sexual dysfunction and views on accountability (Van Ek survey) and (2) communication, practical knowledge, and attitude (sexual health educator for professionals scale) were used. Demographic characteristics were also collected.

RESULTS

Most participants were females (60%) with postgraduate qualifications (61.4%). The average nephrology nursing experience was 13.10 ± 9.14 years. Most renal nurses identified as having positive attitudes (77.2%) about providing sexual healthcare and were confident in communicating with patients about sexual concerns (42.9%), although many nurses (64.35%) rarely did so. Less than one-half (48.6%) indicated feeling competent to discuss sexual dysfunction, and less than one-third (30%) had sufficient knowledge about sexual dysfunction. Barriers were lack of practical training (74.2%) and insufficient time (57.1%). Younger nurses (≤45 years old) and male nurses were significantly more confident in discussing sexual health matters.

CONCLUSIONS

Overall, renal nurses had positive attitudes towards discussing sexual health concerns with patients however they rarely did so.

Impact of sexual function domains on sexual satisfaction and quality of life: Importance across the age spectrum

BACKGROUND

Sexual satisfaction is an important component of global quality life for many adult men. Substantial gaps exist in our appreciation of how age mediates sexual satisfaction in the context of functional sexual measures. We sought to evaluate modifiable factors associated with overall sexual satisfaction and health-related quality of life (HRQoL) in a large, age-stratified community-based sample of adult men.

METHODS

A sample of adult males registered with the online research service ResearchMatch completed a 75-item online questionnaire in this cross-sectional study. Queries included demographics, general health data, and validated sexual health measures including International Index of Erectile Function-5 (IIEF-5) and Premature Ejaculation Diagnostic Tool (PEDT). Multivariable regression was performed to assess associations with self-reported sexual satisfaction (defined by "moderately satisfied" or "very satisfied" on the 5-level Likert scale) and overall HRQoL (as measured by the EQ-5D-visual analog scale (VAS) stratified by age.

RESULTS

One thousand thirty-three men completed the survey and were stratified by age cohorts. IIEF-5 and PEDT scores were higher in younger cohorts. On multivariable regression analysis, higher IIEF-5, lower PEDT, better overall health-related quality of life, and the presence of a sexual partner within the last month were associated with an increased likelihood of overall sexual satisfaction. When stratified by age cohort, higher IIEF-5 scores were consistently positively associated with sexual satisfaction (Odds Ratio (OR) 1.18, 95% CI 1.15-1.22, P < 0.001), as well as independently associated with improved overall HRQoL by EQ-5D-VAS (β = 0.71, Standard Error (SE) = 0.08, P < 0.001).

CONCLUSIONS

The erectile function was independently associated with sexual satisfaction and quality of life across all age strata and predictive of both sexual satisfaction and global HRQoL. Low overall rates of sexual satisfaction across cohorts highlight the critical importance of evaluation and treatment of sexual health, regardless of age.

Sexual Interventions in the Metaverse: Attitudes Towards Novel Therapeutic Approaches, a Qualitative Study

BACKGROUND AND OBJECTIVE

Mental health treatment for psychosexual problems is effective, but treatment rates are low. Metaverse-based therapy offers one solution to increase overall treatment rates. Understanding attitudes towards this novel approach could lead to wider adoption of metaverse-based therapy, resulting in higher treatment rates for psychosexual problems.

METHODS

Twenty-one participants across three focus groups of different ages shared their perceptions and attitudes about metaverse-based therapy broadly and for treating sexual disorders. A content analysis of the transcribed text from the focus groups using qualitative data analysis software was conducted.

RESULTS

Participants identified several perceived benefits of metaverse-based intervention, including avoiding the perceived embarrassment of going to a clinic and accessing patients (a) with diverse physical or mental functionality, (b) living in remote areas and/or (c) balancing different family/work obligations or duties. The two main concerns with metaverse-based therapy were the fear of online therapy being less personal than traditional therapy and the technological fluency needed. Clarifying their acceptance of the therapy, participants reported that they would be more likely to engage in metaverse-based therapy if they trusted their therapist. Also, although it might be effective for mild and moderate disorders, participants were more reluctant about its use for severe mental illness.

CONCLUSIONS

Results suggest that attitudes towards metaverse-based intervention are mainly positive, since it removes some barriers that hinder access to psychological treatment in general and, specifically, for problems of a sexual nature.

PATIENT AND PUBLIC CONTRIBUTION

During the design stage, a person with sexual difficulties was consulted to understand the patient's perspective. Members of the public advised the implementation of the focus groups. Three potential service users were involved in the coding of the text during the content analysis.

Care for sexual health in oncology survey: Discussions about sexual health with people with cancer in the context of the obligation to provide informed consent

PURPOSE

The purpose of this paper is to describe the impacts of cancer treatment on sexual health in a sample of people who had been treated for mixed types of cancer; to describe discussions they had with professionals about sexual health that occurred during cancer care; and to consider the extent to which these discussions were sufficient to enable participants to give informed consent for the sexual side effect of cancer treatment.

METHOD

A cross-sectional, online survey using a convenience sample of people with cancer was recruited via UK cancer charities. Eligibility criteria included having received treatment and follow-up care for any type of cancer in the UK during the previous 10 years. Univariate analysis was conducted using SPSS.

RESULTS

136 people with cancer participated in this survey. The majority of participants reported having experienced a worsening of their sexual lives, which bothered them. Whilst 33.6% of the sample (n = 125) reported having discussed sexual health during their cancer care, only 5.4% reported that a healthcare professional initiated a pre-treatment discussion about the sexual side effects of cancer treatment.

CONCLUSIONS

These results suggest that the proportion of participants who were provided with sufficient information to give informed consent for the sexual side effects of cancer treatment was very low. This indicates that healthcare professionals may require specific advice on how to include this topic during the informed consent process.

Trajectories of sexual well-being and links with grief after a recent pregnancy loss: a dyadic longitudinal study

BACKGROUND

Pregnancy loss affects 1 in 4 women and is linked with poorer overall health and relationship outcomes. Despite sexual well-being's importance to health, how sexual well-being changes across time after a pregnancy loss and what might predict such changes, like perinatal grief, have never been examined, leaving practitioners and couples without knowledge of what to expect.

AIM

We aimed to examine (1) how sexual satisfaction, sexual desire, sexual distress, and perinatal grief change from 10 to 25 weeks postloss for both couple members; and (2) if perinatal grief levels at 10 weeks postloss predict sexual well-being trajectories.

METHODS

Women and gender-diverse individuals who were pregnant when a pregnancy loss occurred (within the last 4 months) and men, women, and gender-diverse partners who were not pregnant (N = 132 couples) independently completed 4 monthly assessments of sexual well-being and perinatal grief.

OUTCOMES

Outcomes included sexual satisfaction (Global Measure of Sexual Satisfaction), sexual desire (Sexual Desire Inventory), sexual distress (Sexual Distress Scale-Short Form), perinatal grief (Perinatal Grief Scale).

RESULTS

Dyadic growth curve modeling indicated that, from 10 to 25 weeks postloss, both couple members' sexual satisfaction increased, and their sexual desire remained stable; sexual distress decreased for partners but remained stable for individuals who were pregnant; and both couple members' perinatal grief decreased. Perinatal grief levels at 10 weeks postloss did not predict sexual well-being trajectories over time.

CLINICAL IMPLICATIONS

Given sexual well-being's dynamic nature, clinicians should regularly discuss sexuality with both couple members after pregnancy loss. During such discussions, clinicians could reassure couples about their sexual relationship's recovery by sharing that, on average, sexual satisfaction, sexual desire, and sexual distress tend to improve or stay the same (rather than worsen) from 10 to 25 weeks postloss. They can also share that perinatal grief tends to decrease during this time and is unrelated to trajectories of sexual satisfaction, sexual desire, and sexual distress.

STRENGTHS AND LIMITATIONS

This is the first study, to our knowledge, to examine how sexual well-being changes across time after a pregnancy loss and perinatal grief's role in such changes. The results may not generalize broadly, as most couples were in mixed-gender/sex relationships, identified as White, and were relatively affluent.

CONCLUSION

From 10 to 25 weeks postloss, both couple members tend to experience improvements in their overall sexual well-being and declines in their perinatal grief. Early perinatal grief levels and subsequent sexual well-being trajectories are seemingly unrelated.

Gynecologic cancer survivor preferences for provider communication regarding sexual health after treatment: a qualitative study

PURPOSE

Survivorship from gynecologic cancers is becoming increasingly prevalent. There are significant sexual side effects that influence quality of life that would be reduced with proper intervention; however, existing literature highlights the lack of understanding of the sexual health needs within this population. Furthermore, multiple studies show that one contributing factor to sexual well-being in survivorship is provider-patient communication. The aim of this study is to explore experiences of sexual distress and survivor experiences of sexual health communication.

METHODS

Adult participants who had been out of active treatment for 3 months were recruited to participate in focus groups. Six focus groups (n = 32) were conducted with survivors of gynecologic cancers via Zoom. Research team members analyzed content using thematic analysis.

RESULTS

Two broad themes were identified: Experiences of provider communication and Preferences for provider communication, with subthemes nested under both. Subthemes from the Experiences theme included absent/lacking communication, negative experiences, emotional reaction to lack of communication, and feeling like sexuality was not valued. Subthemes from the Preferences theme included more conversation and open communication about sexuality, more resources/referrals, and more provider training on sexuality.

CONCLUSION

Survivor experiences of subjective sexual health are often dependent on the type and quality of information they receive from their healthcare team during treatment. Unfortunately, the majority of participants endorsed negative or absent communication related to their sexual health needs, leading to additional distress.

Factors associated with persistent sexual dysfunction and pain 12 months postpartum

OBJECTIVE

Identify factors associated with persistent sexual dysfunction and pain 12-months postpartum in an underserved population.

METHODS

Extending Maternal Care After Pregnancy (eMCAP) is a program addressing health needs/disparities of patients at risk for worse perinatal outcomes. Participants completed the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) and Urinary Distress Index (UDI-6) 12-months postpartum. The PISQ-12 was dichotomized with scores < 32.5 indicating sexual dysfunction. Urinary incontinence (UI) was defined as at-least-somewhat bothersome (vs. none or not-at-all bothersome) urgency urinary incontinence (UUI) or stress urinary incontinence (SUI). Screening for anxiety and depression was completed using Generalized Anxiety Disorder-7 (GAD-7) and Edinburgh Postnatal Depression Scale (EPDS). Bivariate and multivariable logistic regression analyses were performed for sexual dysfunction vs. normal-function, and pain vs. no-pain, using demographic, peri/postpartum, and social-determinant-of-health variables as correlating factors.

RESULTS

328 sexually active patients provided data. On bivariate analysis, sexual dysfunction (n = 31, 9.5%) vs. normal function (n = 297, 90.5%) groups showed no differences in age, BMI, parity, mode of delivery, episiotomy/laceration types, or breastfeeding. Sexual dysfunction was significantly associatedwith both UUI and SUI: 12 (39%) vs. 46 (15%) had UUI, p = 0.001, and 20 (65%) vs. 97 (33%) had SUI, P < 0.001; the dysfunction group also had higher GAD-7 and EPDS scores and greater overall stress levels. On multivariable analysis, SUI and stress remained significantly associated: OR (95% CI) 2.45 (1.02-6.03) and 1.81 (1.32-2.49), respectively. Comparing pain (n = 45, 13.7%) vs. no-pain (n = 283, 86.2%), dyspareunia patients endorsed greater stress levels.

CONCLUSION

The interplay between sexual health, incontinence, and mental health deserves further study, and all three should be routinely addressed in postpartum care.

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.

Ending HIV Transmission in Australia: Expanding PrEP to Cisgender Women: A Scoping Review

Pre-exposure prophylaxis (PrEP) availability through the Pharmaceutical Benefits Scheme provides real potential for the elimination of HIV transmission in Australia, as evidenced by a rapid decline in HIV incidence among gay and bisexual men (GBM). However, HIV elimination will not be possible without also extending PrEP to other populations, including cisgender women. We conducted a scoping review to examine the extent to which PrEP access for cisgender women has been considered in Australia. A comprehensive search across five databases, grey literature, and hand search of references was conducted. A single reviewer conducted title and abstract screening and two reviewers completed full-text screening and data extraction. Nineteen documents were included in the final review and included both peer-reviewed journal articles and guidelines and strategies. Focused discussion of cisgender women's use of PrEP was largely missing from the literature and, although their use of PrEP is supported in some relevant guidelines, little has been done to actively develop strategies to inform cisgender women about PrEP as a precursor to prescribing for HIV prevention. Healthcare providers' narrow view of PrEP as being the domain of GBM further limits cisgender women's potential access. If HIV elimination in Australia is to be a reality, we need to develop mechanisms to specifically engage with cisgender women about PrEP.

Hospitalized Adolescents' Perspectives on Sexual and Reproductive Health Discussions

OBJECTIVES

Experts recommend that providers discuss adolescent patients' sexual and reproductive health (SRH) at any health care encounter, including hospitalizations. The purpose of this qualitative study was to gain insight into hospitalized adolescents' experiences and perspectives on SRH discussions (SHDs) to better inform patient-centered care.

METHODS

Private semistructured interviews were conducted with hospitalized adolescents aged 13 to 17 years. Interviews were coded and analyzed using thematic analysis. Themes were developed through an iterative process with focus on the primary research aim.

RESULTS

Twenty participants were interviewed with a median age of 15.4 years. Adolescents expressed a range of preferences related to SHDs with providers. Themes included (1) experiences discussing SRH with providers, (2) SHDs during hospitalization, (3) communication preferences, and (4) perceptions of why providers initiate SHDs. Viewpoints about SHDs during hospitalizations varied, including that they addressed unmet needs, as well as that they seemed irrelevant to some participants. Aspects that facilitate SHDs include brevity with relevant depth, nonjudgmental provider demeanor, and reassurance of privacy. Some participants believed providers could judge the depth of discussion needed on the basis of the adolescent's age or personality.

CONCLUSIONS

This study highlights variation in adolescents' preferences around SHDs with health care providers. Providers should initiate SHDs with statements of purpose and confidentiality. Given the variation in adolescents' perspectives, tools to privately collect self-reported behaviors before an SHD may help providers frame the conversation to the adolescent's specific SRH needs and communication style preferences.

Erectile dysfunction prevalence in the United States: report from the 2021 National Survey of Sexual Wellbeing

BACKGROUND

There has been a great deal of public speculation regarding a surge in erectile dysfunction (ED) in younger men despite data consistently indicating that the ED prevalence rates increase with age.

AIM

In this study we sought to assess the prevalence and risk of experiencing ED in a nationally representative sample of men in the United States across various social groups, describe comorbidities, and examine barriers to treatment.

METHODS

Data from the 2021 National Survey of Sexual Wellbeing were analyzed by utilizing the Ipsos KnowledgePanel®, a probability-based online panel, for the purpose of obtaining US nationally representative data of adults aged 18 years and older. The analytic sample consisted of 1822 cisgender men ranging in age from 18 to 87 years, with a mean age of 47.5 years.

OUTCOMES

Study outcomes were ED as measured by the 5-item version of the International Index of Erectile Function (IIEF-5), as well as self-reported diagnosis by a medical professional, comorbidities with other health issues, medications taken for ED, and barriers to treatment.

RESULTS

The ED prevalence rate based on IIEF-5 scores was 24.2%. Prevalence increased with age: 52.2% of the 75+ age group, and 48.0% of the 65-74 age group meeting diagnostic criteria for ED. Diagnostic criteria were met for more participants in the 18-24 age group (17.9%) than the 25-34 (13.3%) or 35-44 (12.7%) age groups, but less than the 45-54 (25.3%) or 55-64 (33.9%) age groups. Only 7.7% (n = 141) of the sample reported having been diagnosed by a provider (n = 4 in 25-34, n = 6 in 35-44, n = 13 in 45-54, n = 39 in 55-64, n = 44 in 65-74, and n = 34 in ≥75-year olds), indicating a gap in access to treatment. The most common reason selected for not accessing care for ED concerns was a lack of need to see a provider in the past year.

CLINICAL IMPLICATIONS

The discrepancy between ED self-report and medical diagnosis is critical, given that ED can be an indication of underlying health risks.

STRENGTHS AND LIMITATIONS

This study is the first nationally representative update to information regarding the prevalence of ED in almost 2 decades. Standard administration of the IIEF-5 is limited to participants who have had sex in the last 6 months, so these rates do not include those men with ED who have been avoiding penetrative sex for a significant time.

CONCLUSION

The results indicate that ED prevalence and severity remain highest in older age groups and that most individuals who meet criteria for ED have not sought medical care related to this concern.

Interventions, Barriers, and Facilitators to Address the Sexual Problems of Gay, Bisexual and Other Men Who Have Sex with Men Living with HIV: A Rapid Scoping Review

Sexual problems are common among gay, bisexual, and other men who have sex with men (GBM) after diagnosis with HIV. However, these are often overlooked in care and research, where sexual risk reduction and biomedical aspects of sexual health tend to dominate. We conducted a rapid scoping review to investigate which sexual problems of GBM living with HIV are addressed by interventions, and the barriers and facilitators to their implementation. Literature from high-income countries published in English since 2010 was reviewed. Medline, Embase, PsycInfo, and Scopus databases were searched on July 4, 2022. Targeted sexual problems were categorized according to the ten dimensions of Robinson's Sexual Health Model, and barriers and facilitators, according to the five domains of the Consolidated Framework for Implementation Research (CFIR). Interventions focused solely on the dimension of Sexual Health Care/Safer Sex were excluded. Relevant information was extracted from the qualifying documents with NVivo 12 software for content analysis. Fifty-two documents were included, referring to 37 interventions which mainly took place in the United States (n = 29/37; 78%), were group-based (n = 16; 41%), and used counselling techniques (n = 23; 62%; e.g., motivational interviewing, cognitive-behavioral therapy). Their settings were mostly primary care (n = 15; 40%) or community-based (n = 16; 43%). On average, interventions addressed three sexual health dimensions (SD = 2; range: 1-10). The most targeted dimension was Sexual Health Care/Safer Sex (n = 26; 70%), which concerned sexual risk reduction. Next, Challenges (n = 23; 62%), included substance use (n = 7; 19%), sexual compulsivity (n = 6; 16%), sexual abuse (n = 6; 16%), and intimate partner violence (n = 4; 11%). Third was Talking About Sex (n = 22; 59%) which mostly concerned HIV disclosure. About a third of interventions addressed Culture/Sexual identity (n = 14; 38%), Intimacy/Relationships (n = 12; 33%), and Positive sexuality (n = 11; 30%). Finally, few targeted Body Image (n = 4; 11%), Spirituality (n = 3; 8%), Sexual Anatomy Functioning (n = 2; 5%) or Masturbation/Fantasy (n = 1; 3%). Forty-one documents (79%) mentioned implementation barriers or facilitators, particularly about the characteristics of the interventions (41% and 78%, respectively; e.g., cost, excessive duration, acceptability, feasibility) and of the individuals involved (37% and 46%; e.g., perceived stigmatization, provider expertise). The other three CFIR dimensions were less common (5%-17%). The search strategy of this review may not have captured all eligible documents, due to its limit to English-language publications. Overall, most interventions incorporated a focus on Sexual Health Care/Safer Sex, at the expenses of other prevalent sexual problems among GBM living with HIV, such as intimate partner violence (Challenges), erectile dysfunction (Sexual Anatomy Functioning), and Body Image dissatisfaction. These findings suggest they could receive more attention within clinical care and at the community level. They also highlight the importance of cost-effective and acceptable interventions conducted in non-stigmatizing environments, where patients' needs can be met by providers who are adequately trained on sexuality-related topics.

Perceptions and Experiences With Healthcare Providers Among People Navigating Reproductive and Fertility Decisions

OBJECTIVES

Primary healthcare providers have an important role in helping people manage their reproductive health and fertility by assessing pregnancy intentions to inform the provision of contraception and/or preconception care. This study explores how women navigating fertility decisions perceived and experienced interactions with their healthcare providers around their fertility.

METHODS

We conducted in-depth interviews (N = 17) and focus groups (N = 17 groups) with 65 women aged 18 to 35 years about fertility, infertility, and reproductive planning. Two researchers coded 2 transcripts using thematic and inductive methods and met to develop a structured codebook. We then applied the codebook to the remaining transcripts.

RESULTS

In all interviews and focus groups, participants discussed their interactions with healthcare providers around fertility. Three central themes emerged in the data, including a desire for more information from healthcare providers about fertility; experiences of having fertility concerns dismissed by healthcare providers (eg, ability to become pregnant when desired); and, feelings that healthcare providers lacked sensitivity in discussing fertility related issues. Notably, these themes were present, even among participants who were not trying to become pregnant or who did not wish to become pregnant.

CONCLUSION

Participants wanted information about fertility from their primary healthcare providers that they felt was lacking. Moreover, participants wanted their healthcare providers to engage with them as multifaceted individuals with current needs as well as future plans regarding fertility. While healthcare providers regularly assess pregnancy intentions, they may need to make a concerted effort to address fertility concerns among both those who want to pursue pregnancy and those who do not wish to become pregnant immediately.

Adolescent Healthcare Access: A Qualitative Study of Provider Perspectives

INTRODUCTION

Adolescent access to quality healthcare is key to prevention and early intervention for health risk behaviors. This paper provides a healthcare provider perspective on barriers and facilitators to youth accessing care.

METHODS

Five focus groups were conducted from November to December 2020 with providers from a variety of healthcare settings. Participants were asked to describe their respective adolescent patient populations, adolescent-specific health concerns, and organizational accommodations specific for youth services. Transcripts were analyzed using Inductive Thematic Analysis and themes were grouped using a social-ecological framework.

RESULTS

At an individual level, providers noted that an adolescent's knowledge and ability to navigate services varied greatly across settings. Providers identified provider trust and parent/guardian support as key interpersonal factors that support adolescents' access to services. Organizational factors included bureaucratic barriers and the clinic's reputation among youth. Community factors centered on mistrust within healthcare systems and stigmatization of seeking certain types of services. Participants also described how state-level policies influence parent/guardian consent requirements, which can limit adolescents' access to care.

CONCLUSION

Adolescent access to and utilization of healthcare in the United States is a complex problem requiring systems-level change. Healthcare organizations and providers have the opportunity and capacity to positively influence adolescents' healthcare access and experiences, however a lack of standardized, clinic-level priorities and guidelines can limit adolescent-centered care.

Gaps in sexual health content of healthcare professional curriculum: a systematic review of educational interventions

BACKGROUND

Sexual health care, including assessment and patient teaching, is part of comprehensive patient care. Health professional (medical and nursing) students' education in sexual health lacks uniformity in content and assessment skills.

OBJECTIVES

The current systematic review aimed to assess sexual health educational curriculum for health professional students regarding the educational content, duration, and evaluation of these educational interventions.

METHODS

This systematic review followed the preferred reporting guidelines for systematic reviews. A comprehensive search was conducted between May-August, 2023 across four databases (PubMed, Scopus, CINAHL, EMBASE), outlining 614 sources. Following the screening process, 36 educational intervention studies were deemed eligible for inclusion. The quality assessment of these studies was conducted using The Effective Public Health Project tool, which was found appropriate for evaluating this type of research.

RESULTS

The studies had a global representation, with most studies conducted in the US. Limited nursing educational interventions were found. Three main categories emerged from the analysis of the educational interventions: one-time interventions, workshops, and semester courses. These categories differed in terms of their duration. Upon evaluating the educational intervention programs, it was found that the majority relied on participant self-reporting, while only a few included objective evaluations.

CONCLUSIONS

This review revealed inconsistencies in educational content for healthcare professional students and may impact their clinical skills, particularly in sexual health. The variation in content, duration, and evaluation methods created challenges in assessing the interventions. The lack of standardized sexual health education highlighted a significant gap, raising concerns about students' ultimate proficiency in this area. Bridging this divide is essential by integrating comprehensive sexual health content and assessment skills into the health professional curriculum.

A qualitative assessment of barriers to healthcare and HIV prevention services among men who have sex with men in non-metropolitan areas of the south

HIV cases are increasing in the rural Southern United States, especially among men who have sex with men (MSM). To facilitate healthcare access and encourage HIV prevention for non-metropolitan MSM, it is essential to examine their barriers to care. This qualitative study conducted semi-structured interviews with 20 MSM living in non-metropolitan areas of the South. Analysis revealed that MSM experience multiple barriers accessing healthcare in non-metropolitan areas such as finding knowledgeable and affirming providers with desired characteristics and beliefs and communicating with providers about sexual health and HIV prevention. To aid in identification, many respondents expressed a desire for providers to publicly signal that they provide care for sexual and gender minority patients and are an inclusive clinical space. Overall, results suggest that MSM face unique healthcare-related challenges, beyond those typically experienced by the broader population in non-metropolitan areas, because of tailored identity-based needs. To better support MSM in non-metropolitan areas, especially in the South where increased experiences of stigma are found, providers should seek further training regarding sexual health communication and HIV prevention, indicate on websites and in offices that they support sexual and gender minority patients, and provide telehealth services to MSM living in more geographically isolated areas.

Sexual well-being needs of patients with chronic illness expressed in health care: A scoping review

AIMS

To systematically identify and summarize the needs of chronically ill people concerning their sexual well-being in peer-reviewed published literature, to enable healthcare professionals to provide support in self-management satisfying the needs.

DESIGN

A scoping review was performed according to the framework of (JBI Manual for Evidence Synthesis. JBI Global Wiki, 2020). Findings are reported in line with the PRISMA extension for scoping reviews.

REVIEW METHODS

A literature search and thematic analysis were conducted.

DATA SOURCES

Full research was carried out in 2022 in the search engine BASE and the following databases: Scopus, MEDLINE, Science Citation Index Expanded, Social Sciences Citation Index and CINAHL. Peer-reviewed articles published after 2011 were included.

RESULTS

Fifty articles could be found. Seven categories of needs could be identified. People with chronic diseases want their providers to initiate discussions about sexual concerns and treat them trustfully and respectfully. Most of the patients would like the issue of sexuality to be included in routine care. They perceive their medical specialists and psychologists as preferred providers to talk to about this issue. Nurses are seen as primary contact persons but in a smaller number of studies.

CONCLUSION

Although the scoping review included different types of chronic diseases, the needs of chronically ill patients concerning their sexual well-being are not very different. Healthcare professionals, especially nurses, who are often the first point of contact for people with chronic illnesses, should take the initiative for open discussions about sexual issues. That requires a new understanding of the role of nurses, training and further education.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Providing patient education and facilitating an open discussion about sexuality require further training in the new understanding of the role of the nurse and the concept of sexual well-being.

IMPACT

What problem did the study address? Chronic diseases have an impact on patients' sexuality. Patients want to be informed about sexual issues, but providers often do not address them. What were the main findings? Patients with a chronic condition expect providers to initiate discussions about sexual well-being, regardless of the type of chronic disease. Where and on whom will the research have an impact? The research will impact healthcare professionals', especially nurses', future educational standards and ultimately patients.

REPORTING METHOD

PRISMA extension for scoping reviews.

NO PATIENT OR PUBLIC CONTRIBUTION

Not required as it was a literary work (scoping review).

A Smartphone-Delivered Program (Anathema) to Promote the Sexual Health of Older Adults, Colorectal Cancer Survivors, and Stroke Survivors: Protocol for a Feasibility Pilot Randomized Controlled Trial

BACKGROUND

Despite the prevalence of sexual distress and dysfunction in older adults in general and stroke and colorectal cancer survivors in particular, access to specialized care is limited by organizational barriers and stigma, embarrassment, and discrimination. The internet allows reaching services that would otherwise be difficult or impossible to reach, and as smartphones are personal (intimate) technologies, they are a promising vehicle to close this gap. However, research focusing on smartphone-delivered sexual health promotion programs is scarce.

OBJECTIVE

This study aims to assess the acceptability, feasibility, and preliminary efficacy of Anathema, an 8-week, iOS/Android smartphone-delivered, individually tailored, cognitive-behavioral sexual health promotion program developed to improve relationship and sexual satisfaction, sexual functioning, sexual distress, sexual pleasure, and health-related quality of life (HRQoL) in older adults, colorectal cancer survivors, and stroke survivors compared to treatment as usual in a waiting-list control condition.

METHODS

Two-arm, parallel, open-label, waiting list, feasibility, pilot randomized controlled trials (RCTs) will be conducted involving older adults, stroke survivors, and colorectal cancer survivors. The primary outcomes are the acceptability, usability, and feasibility of Anathema. Sexual function, relationship and sexual satisfaction, sexual pleasure, sexual distress, anxiety, depression, and HRQoL are the secondary outcomes. This study has been reviewed and approved by the ethics committees of Instituto Português de Oncologia do Porto Francisco Gentil, Europacolon Portugal, Faculty of Psychology and Educational Sciences, University of Porto, and Sigmund Freud University (approval numbers: CES218R/021, CES19/023, and 2022/01-05b).

RESULTS

This project is funded by the European Commission through the Active and Assisted Living (AAL) Programme (reference: AAL-2020-7-133-CP) from April 2021 to December 2023. Recruitment for the pilot RCTs started on January 2023 in Portugal, Austria, and the Netherlands and is currently ongoing. As of May 2023, we randomized 49 participants in the trials. We expect to complete the RCTs in September 2023. The results on the acceptability, feasibility, and preliminary efficacy of Anathema are expected in the second semester of 2023. We expect Anathema to be highly accepted by the populations under study; to prove feasible to scale up to parent RCTs; and to be potentially efficacious in improving sexual functioning, relationship and sexual satisfaction, sexual distress, sexual pleasure, and HRQoL in older adults, colorectal cancer survivors, and stroke survivors compared to treatment as usual in a waiting-list control condition. The study results will be published in open-access venues according to COREQ (Consolidated Criteria for Reporting Qualitative Research) and CONSORT EHEALTH (Consolidated Standards of Reporting Trials of Electronic and Mobile Health Applications and Online Telehealth) guidelines.

CONCLUSIONS

The study results will inform the refinement and scale-up of Anathema. Anathema's wider-scale implementation can potentially promote the sexual health of largely neglected user groups such as older adults, colorectal cancer survivors, and stroke survivors.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/46734.

Successful Integration of HIV PrEP in Primary Care and Women's Health Clinical Practice: A Model for Implementation

Ending the HIV Epidemic is contingent upon the increased utilization of pre-exposure prophylaxis (PrEP). The majority of PrEP in the United States is prescribed in specialty care settings; however, to achieve national implementation goals, it is necessary to expand PrEP services in primary care and women's health clinics. To this end, a prospective cohort study was conducted of health care providers participating in one of three rounds of a virtual program aimed at increasing the number of PrEP prescribers in primary care and women's health clinics within the NYC Health and Hospitals network, the public healthcare system of New York City. Provider prescribing behavior was compared at pre-intervention (August 2018-September 2019) and post-intervention (October 2019-February 2021). Among 104 providers, the number prescribing PrEP increased from 12 (11.5%) to 51 (49%) and the number of individual patients on PrEP increased from 19 to 128. The program utilized clinical integration models centering on existing STI management workflows and was associated with increased numbers of PrEP prescribers and volume of prescriptions in primary care and women's health clinics. The dissemination of similar programs could support national scale-up of PrEP.

HIV pre-exposure prophylaxis awareness, practices, and comfort among urban and rural family medicine physicians

PURPOSE

HIV rates are increasing in rural areas, and adolescents are disproportionately affected. HIV pre-exposure prophylaxis (PrEP) is a daily pill that is effective at preventing HIV; however, PrEP uptake among adolescents is low. PrEP is dependent on primary care providers (PCPs) prescribing it, but research has overwhelmingly sampled urban PCPs. This study compared the PrEP awareness, practices, and comfort between rural and urban family medicine physicians.

METHODS

A total of 256 family medicine physicians in the United States were recruited from a Qualtrics panel to complete an online cross-sectional survey between July 15 and August 9, 2022. Participants completed items assessing their demographic characteristics and PrEP awareness, practices, and comfort. A chi-square test of independence and multiple logistic regression were used to determine rural/urban differences.

FINDINGS

Rural family medicine physicians were less comfortable than urban family medicine physicians in providing sexual risk reduction counseling to adolescents, telling an adolescent patient their HIV test result was HIV positive, and implementing all of the PrEP clinical activities for adolescents.

CONCLUSIONS

Education, skill-building, and collaborative partnership interventions could improve the comfort levels of rural family medicine physicians in implementing the PrEP guidelines for their adolescent patients. Future research is needed to understand the factors that explain the differences in PrEP-related attitudes and practices between urban and rural family medicine physicians. Results from such studies could inform provider-based interventions that ultimately increase PrEP use and decrease HIV rates among rural adolescents.

The Use of Nursing Theory to Support Sexual and Reproductive Health Care Education in Nursing Curricula

BACKGROUND

Inclusive sexual and reproductive health care (SRH) content is limited in nursing curricula, resulting in nurses who lack education to provide complex SRH services to marginalized patients, especially sexual and gender minorities (SGM).

METHOD

The 10 Caritas Processes, the framework of Watson's Theory of Caring, were evaluated for being integral components of SRH. This theory is used to advocate for SGM-inclusive SRH content in nursing curricula.

RESULTS

The interpretation of Caritas Processes 2, 4, and 7 provide theoretical support for SGM-inclusive SRH content. Specific strategies to modify and improve nursing curricula are described.

CONCLUSION

There is a need to incorporate inclusive SRH education into nursing curricula to normalize evidence-based SRH for diverse, marginalized patient populations. By emphasizing the caring intentions necessary for nursing professionals, Watson's Theory of Caring is an appropriate framework to guide the development of SGM-relevant SRH content in nursing education. [J Nurs Educ. 2023;62(2):69-74.].

Burden of vaccine-preventable diseases among at-risk adult populations in the US

Life-course immunization holds significant benefit for population health by reducing the burden of vaccine-preventable diseases (VPD) through vaccinating individuals at different stages and circumstances in life. The study aimed to determine the epidemiologic, clinical, economic, and societal burden of VPDs among at-risk adult subpopulations in the United States. A systematic literature review was conducted for articles published between January 2010 and June 2020, which identified 72 publications. There was heterogeneity in available epidemiology data, with the prevalence of VPDs ranging from 1.1% to 68.7%. Where the disease burden was described, outcomes were typically worse among high-risk subpopulations than in the general population. Several VPDs, including herpes zoster, meningococcal, and pneumococcal infections were associated with increased costs. This review suggests that subpopulations may not frequently interact with the healthcare system, or their risk factors may not be recognized by healthcare providers, and therefore individuals may not be appropriately targeted for vaccination.

Development of a usability checklist for public health dashboards to identify violations of usability principles

OBJECTIVE

To develop a usability checklist for public health dashboards.

MATERIALS AND METHODS

This study systematically evaluated all publicly available dashboards for sexually transmitted infections on state health department websites in the United States (N = 13). A set of 11 principles derived from the information visualization literature were used to identify usability problems that violate critical usability principles: spatial organization, information coding, consistency, removal of extraneous ink, recognition rather than recall, minimal action, dataset reduction, flexibility to user experience, understandability of contents, scientific integrity, and readability. Three user groups were considered for public health dashboards: public health practitioners, academic researchers, and the general public. Six reviewers with usability knowledge and diverse domain expertise examined the dashboards using a rubric based on the 11 principles. Data analysis included quantitative analysis of experts' usability scores and qualitative synthesis of their textual comments.

RESULTS

The dashboards had varying levels of complexity, and the usability scores were dependent on the dashboards' complexity. Overall, understandability of contents, flexibility, and scientific integrity were the areas with the most major usability problems. The usability problems informed a checklist to improve performance in the 11 areas.

DISCUSSION

The varying complexity of the dashboards suggests a diversity of target audiences. However, the identified usability problems suggest that dashboards' effectiveness for different groups of users was limited.

CONCLUSIONS

The usability of public health data dashboards can be improved to accommodate different user groups. This checklist can guide the development of future public health dashboards to engage diverse audiences.

Sexual health and intimacy after cancer treatment in women of color: A systematic review

OBJECTIVE

Cancer diagnosis and treatment can significantly affect women's sexual health and intimacy, leading to diminished quality of life in survivorship. The perspectives and experiences of women of color (WOC) with cancer are critical to inform comprehensive, inclusive sexual wellbeing care in survivorship. The purpose of this systematic review is to summarize contemporary literature describing sexual wellbeing experiences of WOC treated for cancer.

METHODS

A comprehensive search of CINAHL, PubMed, Embase and PsycInfo and Scopus identified studies that addressed sex and intimacy of U.S. WOC treated for cancer published in the last 15 years. The authors identified emergent themes from the literature through thematic content analysis.

RESULTS

Eighteen studies (10 qualitative, 8 quantitative) met the inclusion criteria, all with breast or gynecologic cancer samples. Studies include African American (13), Asian American (3), and Latina (10) women, as well as Non-Hispanic Whites and 'other' race/ethnicity women. Overarching themes identified were: 1) impacts of treatment on sexual health and body image, 2) process of accepting and overcoming, 3) value of an engaged and supportive partner, and 4) current clinical practice and barriers to sexual health care.

CONCLUSIONS

WOC experience changes in sex and intimacy after cancer treatment, and experiences of sexual function, sexual communication, and sexual healthcare are often shaped by sociocultural experiences. An understanding of WOC's sexual health and intimacy after cancer treatment can inform inclusive, culturally responsive sexual health interventions.

The relationship between the sexual care attitudes, beliefs and self-efficacy of nursing students and gender roles: A cross-sectional study

PURPOSE

The aim of the research is to determine the relationship between the gender role approaches and the sexual care attitudes, beliefs, and self-efficacy of nursing students.

DESIGN AND METHODS

This cross-sectional study included 109 nursing students.

FINDINGS

A negative correlation was found between the Gender Roles Attitude Scale and the Sexual Attitudes and Beliefs Scale (p < 0.001). A positive correlation was found between the Gender Roles Attitude Scale and the self-efficacy in clinical performance scale total score and its assessment, diagnosis, planning, and implementation subscales (p < 0.05).

PRACTICE IMPLICATIONS

This study is considered to be useful to specify the education and awareness strategies that will contribute to better preparation of the nursing students for sexual health services.

A Survey of Latin American Rehabilitation Professionals on Addressing Sexuality-Related Concerns After Spinal Cord Injury

To examine rehabilitation professionals' training and education, attitudes, beliefs or misconceptions, and assessment of issues related to sexuality in individuals with Spinal Cord Injury (SCI) and their romantic partners. 318 healthcare professionals from Latin America (LA) who worked with individuals with SCI completed an online survey. 99.0% affirmed that sexuality is an issue that should be addressed during the rehabilitation of people with SCI. 86.0% reported being asked questions about sexuality after SCI by their patients and/or their partners, but only 33.2% of the professionals affirmed that it was very likely for them to initiate a conversation about the topic. Only 35.4% reported discussing sexuality issues with patients and their partners as a regular practice; further, 61.5% of the sample reported not being prepared at a scientific, therapeutic, and/or educational level to be able to advise people with SCI in the area of sexuality. 95.9% indicated they would be interested in attending courses, seminars, or conferences tailored to the topic of sexuality after SCI. Participants agreed nearly unanimously (96.8%) that it would be easier to discuss sexuality with people with SCI and their partners if they had more training on this topic, which they believed should have been received during their undergraduate (63.5%) and advanced (34.9%) studies. Findings provide insight into the way sexuality is addressed and attended to in the field of rehabilitation in LA and inform initiatives to improve the provision of care in the realm of sexuality for individuals after SCI.

"Let's Be a Person to Person and Have a Genuine Conversation": Comparing Perspectives on PrEP and Sexual Health Communication Between Black Sexual Minority Men and Healthcare Providers

Patient-provider communication is a key factor affecting HIV pre-exposure prophylaxis (PrEP) awareness and access among Black sexual minority men (SMM). Optimizing patient-provider communication requires a deeper understanding of communication dynamics. In this study, we investigated the perspectives of both HIV-negative/status-unknown Black SMM and practicing community healthcare providers regarding patient-provider communication about PrEP and sexual health. We conducted eleven semi-structured qualitative focus groups (six with Black SMM; five with providers) in the Northeastern USA and thematically analyzed transcripts. A total of 36 Black SMM and 27 providers participated in the focus groups. Our analysis revealed points of alignment and divergence in the two groups' perspectives related to patient-provider communication. Points of alignment included: (1) the importance ascribed to maximizing patients' comfort and (2) belief in patients' right to non-discriminatory healthcare. Points of divergence included: (1) Black SMM's preference for sexual privacy versus providers' preference that patients share sexual information, (2) Black SMM's perception that providers have an ethical responsibility to initiate conversations about PrEP with patients versus providers' perception of such conversations as being optional, and (3) Black SMM's preference for personalized sexual health conversations versus providers' preference for standardized conversations. Findings underscore a need for providers to offer more patient-centered sexual healthcare to Black SMM, which should entail routinely presenting all prevention options available-including PrEP-and inviting open dialogue about sex, while also respecting patients' preferences for privacy about their sexuality. This approach could increase PrEP access and improve equity in the US healthcare system.

How Do Family Physicians Perceive Their Role in Providing Pre-exposure Prophylaxis for HIV Prevention?-An Online Qualitative Study in Flanders, Belgium

Introduction:

In Belgium, the provision of pre-exposure prophylaxis (PrEP) for HIV prevention is centralized in specialized HIV clinics. Engaging family physicians in PrEP care could help scale-up its delivery and reach underserved populations. The objective of this study was to gain insight into family physicians' self-perceived roles in providing PrEP.

Methods

We conducted 16 online group discussions with a total of 105 Flemish family physicians, between November 2020 and February 2021. A brief online questionnaire assessed their socio-demographics and experience with sexual health. We analyzed verbatim transcribed data using a grounded theory approach.

Results

Despite limited awareness and experience, participants reported a high willingness to be more actively involved in PrEP care. Four potential roles for the family physician in PrEP care were identified: acting as low-threshold entry point for advice; opportunistic case finding of PrEP candidates; initiating appropriate care for PrEP-eligible clients; and ensuring high-quality follow-up care for PrEP users. Participants framed each of these roles within their current activities and responsibilities as primary care providers. Yet, participants differed in their views on the concrete operationalization of these roles, and in the extent of their involvement in PrEP. Particular challenges were a lack of experience with antiretrovirals, perceived limited exposure to clients at high HIV risk, and a lack of expertise and resources to conduct time-intensive risk assessments and counseling related to PrEP.

Conclusion

Belgian family physicians demonstrated a keen willingness to be involved in PrEP care, but had differing views on the practical implementation into their practices. Providing tailored training on sexual health and PrEP, and investing in collaboration between primary and secondary care, could optimize the integration of PrEP in the primary care practice.

'Most women really actually do just appreciate being asked': clinicians' views on integrating sexual wellbeing into contraceptive care

A growing body of literature suggests that contraceptives' impact on sexual experiences influences willingness to initiate and continue with a method. Little is known, however, about how clinicians engage with clients on this topic during contraceptive consultations. Fifteen clinicians in South Eastern Australia participated in semi-structured interviews between April and June 2019. Interviews were analysed using inductive, semantic thematic analysis. Participants varied in their evaluation and management of contraceptives' sexual side effects and the legitimacy given to women's bodily experience versus their own understanding of the evidence in the medical literature. We identified two distinct groups of clinicians: those who prioritised sexual wellbeing as a primary issue in contraceptive consultations and those who perceived sexual wellbeing as a secondary concern. The difference in practices was influenced by whether participants considered sexual wellbeing to be part of holistic care provision and their views on the clinician's role in raising the topic. Strategies to equip clinicians to integrate sexual wellbeing into contraceptive consultations include interactive clinical training and incorporating information about sexual side effects into contraceptive guidelines and client resources. Benefits gained from normalising sexual wellbeing could extend beyond contraceptive care to help clinicians address clients' sexual wellbeing in other contexts.

It is not just about sex: viewpoints of men with inflammatory arthritis on the overall impact of the disease on their sexual health

Objectives

Sexual health is defined as a state of physical, emotional, mental and social well-being in relation to sexuality. The impact of inflammatory arthritis (IA) on male sexual health has been mainly studied focusing on erectile function, one of the physical components of sexual health. Our objective was to describe the viewpoints among men with IA in the Netherlands on the overall impact of IA on their sexual health.

Methods

Q-methodology, a mixed methods approach to systematically study subjectivity was used. Adult men diagnosed with IA ranked 34 opinion statements about potential impacts of IA on their sexual health and were interviewed. By-person factor analysis was used to identify common patterns in the rankings, which were interpreted as viewpoints. Data from the interviews were used to verify and adjust the interpretations.

Results

30 men (22–77 years) with IA were included. The analysis revealed three viewpoints. Men with the viewpoint ‘Arthritis negatively affects my sexual health’ experience a dramatic impact on all components of sexual health. In viewpoint ‘I am keeping up appearances’, IA negatively impacts sexual health but a distinguishing coping mechanism could mask a more serious negative impact. Men with the viewpoint ‘I am satisfied with my sexual health’' experience no significant impact of IA on their sexual health.

Conclusions

We identified three viewpoints on the impact of IA on male sexual health, two revealed a negative influence that goes beyond the physical act of sex. IA can severely affect the emotional, mental and social components of sexual health.

Sexual and reproductive health service utilisation of adolescents and young people from migrant and refugee backgrounds in high-income settings: a qualitative evidence synthesis (QES)

Young people with migrant or refugee backgrounds from low- and middle-income countries settle in high-income countries and tend to underutilise sexual and reproductive health (SRH) services. This review aimed to explore perceptions and experiences of SRH services and the factors that shape their use among migrant youth. It focuses on qualitative studies that examine SRH service use among young migrants living in high-income countries. Seven peer-review databases and web-based grey literature were searched using pre-determined search criteria. The review includes 16 articles that met the inclusion criteria. The qualitative evidence synthesis (QES) method was used to synthesise findings. Thematic analysis resulted in five main themes and 11 sub-themes. Findings suggest that despite diversity of countries of origin and host countries, there were considerable similarities in their perceptions of and experiences with SRH services. Some young migrants reported experiences of discrimination by service providers. Cost of care was a deterrent to SRH service use in countries without universal healthcare coverage. Lack of information about SRH services, concerns about confidentiality, community stigma around sexually transmitted infections and premarital sex were key barriers to SRH service use. Health systems should integrate flexible service delivery options to address access barriers of SRH service use in young migrants. Engagement with parents and communities can help to destigmatise sexual health problems, including STIs. Host countries need to equip young migrants with the knowledge required to make informed SRH decisions and access relevant SRH services and resources.

Sexual myths and attitudes regarding sexuality of nursing students: A mixed method study

PURPOSE

To determine the nursing students' sexual myths and attitudes regarding sexuality, and to explore their views towards sexual care in practice.

DESIGN AND METHODS

A mixed-method sequential explanatory design was used. Data were collected using Questionnaire Form, Sexual Myths Scale (SMS), Sexual Attitude and Beliefs Scale (SABS), and Focus-Group Interview Form.

FINDINGS

The average scores on the SMS and the SABS were 58.66 ± 18.74 and 37.50 ± 6.97, respectively, indicating students' sexual myths and their attitudes regarding sexuality were moderate. A positive, significant correlation was found between SMS and SABS scores (p < 0.001). In the interviews, the views on the barriers and facilitators in sexual care and the negative effect of sexual myths on sexual care were revealed.

PRACTICE IMPLICATIONS

Courses regarding sexuality should include into nursing curriculum from the first years of undergraduate education.