Sex and sexuality in health care: a multidisciplinary discussion

As part of our special series on The Problem With Sex, we held a multidisciplinary tweetchat, hosted by @WeNurses, to discuss some questions around sexuality in health care. @SarahChapman30 invites you to catch up with highlights of the conversation here. 

Caring for the whole person. That’s what healthcare professionals (HCPs) are taught to do, isn’t it? But what about the bits we’re not comfortable with, or which we feel ill-equipped to discuss? Teresa Chinn, @AgencyNurse , was reflecting on this ahead of our tweetchat. She also recalled a conversation with a colleague who questioned the inclusion of “expressing sexuality” in the nursing assessment of patients, stating that as the patients she cared for were elderly this didn’t really apply…! This won’t be unusual. Time to talk, as 62 of us did in our tweetchat. Here’s what we discussed.

Sexuality in healthcare

We agreed that sexuality is part of our identity; that sex and relationships are important, and health problems may create a need for both physical and psychological care in this area. But it’s challenging! As @DrSharronH put it, it’s “subjective, sensitive and often taboo!”

What stops us from talking about sex with the people we care for?

Fear of getting it wrong can stop us from asking. There is concern about causing offence and eliciting ‘bad’ reactions from patients, their relatives and our colleagues. Talking about sex can be embarrassing. We may have prejudices that get in the way of open, honest and helpful conversation, yet it’s vital that HCPs are non-judgemental. We may worry about the potential for opening a ‘Pandora’s Box’ and that we don’t know what to do about concerns that may be raised.

Many clinical settings do not afford privacy for sensitive conversations; something that was mentioned also by trainee doctors in this blog. There’s little time during clinical encounters, such as GP appointments. Then there’s fear about crossing a professional boundary. Elsewhere, as @GussieGrips noted here, it’s been found that even gynaecologists tend to agree that “sex is a private and discussing it will interfere with our provider-patient relationship”!

What might help us better approach conversations about sex and sexuality?

training nurses

Healthcare professionals feel they need better training on how to approach conversations about sex and sexuality

 A recurring theme here was the perception that HCPs need better training on how to talk about sex and sexuality, both what to ask and how to ask it, and with it the confidence to initiate and handle these conversations.

Prompts on the paperwork used for initial assessments were mentioned but, as Teresa had heard, there were mixed feelings about how useful these are and, oh dear, in practice what we do with them can fall far short of being helpful. Often they are left blank. @OlwenOlwen tweeted that she “once saw written in nurses notes under ‘Sex’ – “sleeps well”, and @DrSharronH “heard similar from nurse colleagues, sexuality as ‘patient looks after her appearance’!”

A good rapport was flagged up as essential if these conversations are to happen, but some clinical circumstances won’t lend themselves to building that rapport. We need research on how to facilitate communication about sex across all areas of care, suggests @LizHughesDD.

How might our reluctance to talk about sex have a negative impact on people we care for?

It was suggested that if we gloss over this aspect of health and wellbeing, we are failing to care for the whole person. Service users want to talk about sex, and it can be part of recovery. Patients may not access services because of HCPs reluctance to talk about sex. Sexually transmitted infections may be missed because of reluctance to ask questions on either side. Sexual health often gets overlooked with attention focused on activities of daily living, but isn’t expressing sexuality one of these?

What research are you aware of in your clinical area, about sex and sexuality?

Very little, or none, it seems. Trainee doctors were asked this question too, as part of a blog for our series on #theproblemwithsex, and you can read their answers here. The whole topic of sex and sexuality, from evidence to healthcare practice, seems often to be missing from HCP education and future learning and professional discussion. It was suggested that maybe it’s not prioritised in research. Which brings us to…

What’s holding back research & what can HCPs do to help?

Sex spelt in magnetic letters

Asking people what matters to them can bring sex onto the research agenda

Not involving patients is a potential obstacle to getting sex and relationship difficulties into research. We started this tweetchat by agreeing that our sexuality is a fundamental part of who we are and needs to be considered when we are looking at the health of the whole person. If people are asked what matters to them in relation to their health, they may well talk about sexual problems, as @sally_crowe’s blog about priority setting for chronic pelvic pain research showed.

Do also catch up on another blog in our series, by nurse Tracie Miles, whose work on vaginal dilator therapy shows brilliantly how asking people what matters to them can lead to change in research and practice. Funding and failure to prioritise sexual health were mentioned in our chat as probable obstacles to research, so it’s heartening to read that Tracie’s approach to ‘crusty old male NHS managers’ to ask for some funding for her research on vibrators and dilators was met with a yes!

@LizHughesDD highlighted the work she’s leading to design a sexual health intervention for people who use mental health services, the RESPECT Study, which is funded by the NIHR, and we’re looking forward to having an Evidently Cochrane blog from Liz about this work.

Talking can change things!

I hope everyone who took part in this tweetchat found it useful and interesting. I continue to be delighted by seeing what can happen when people engage on social media, sharing experience and expertise, research and resources. It’s wonderful to hear from respiratory physio @skmansell that her team at The Royal Free found our series #theproblemwithsex ‘enlightening’ and have committed to updating their patient information as a result. Wow! We’d love to hear about the changes you make Stephanie. Some quotes from our blogs, and links to them, have been included in the written information given at a course called ‘Sex and Cancer’ at The Maggie’s Centre in Oxford too.

We can use social media to change things. Let’s keep talking! Have you made any changes to your practice, done something for the first time or in a different way, as a result of this tweetchat or something you read in our series blogs? We’d love to hear!

Join in the conversation with @SarahChapman30 @CochraneUK @WeNurses #theproblemwithsex or post your comments here.

Sarah Chapman has nothing to disclose.

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Sarah Chapman

About Sarah Chapman

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Sarah's work as a Knowledge Broker at Cochrane UK focuses on disseminating Cochrane evidence through social media, including Evidently Cochrane blogs, blogshots and the ‘Evidence for Everyday’ series for nurses, midwives, allied health professionals and patients. A former registered general nurse, Sarah has a particular interest making evidence accessible and useful to practitioners and to others making decisions about health. Before joining Cochrane, Sarah also worked on systematic reviews for the University of Oxford and the Royal College of Nursing Institute, and obtained degrees in History from the University of Oxford and in the history of women’s health and illness in early modern England (MPhil., University of Reading).

1 Comments on this post

  1. Many problems related to sexuality occur due to lack of communication and ignorance of men, women and health professionals. Theme that should be considered by universities. Napoleon Paredes-Pérez. MD, UNIVERSIDAD DE SAN MARTÍN DE PORRES. LIMA, PERU

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