Challenges in Sexual Health Communication
Despite the medical provider's awareness of the importance of discussing sexual function, and the patient's interest in receiving further information about sexual health issues, assessment and counseling about sex is not commonly a part of routine medical care across the world. There are numerous barriers to this important conversation on both sides of the examination table, and often neither the patient nor the PCP feels comfortable initiating conversations about sexual health.
From a patient's perspective, he or she may experience challenges due to the patient/provider relationship, and a lack of accurate knowledge about sexual function and cancer. Moreover, patients report that if his or her provider does not bring up a medical issue, then it must not be of significant concern. Therefore patients are cautious about bringing up sexual dysfunction concerns because they are uncertain about its validity if their provider does not initiate and they may be worried about feeling disrespected in such an interaction. During the particularly stressful period of time soon after a cancer diagnosis, patients are often overwhelmed with information and treatment planning and simply do not have the capacity to consider the sexual health implications of their cancer treatment. In addition, cancer patients may possess inaccurate beliefs about sexuality that reduce the likelihood that they will raise such issues with medical providers. For example, they may worry that cancer is contagious and can be spread through sexual acts, that sexual activity may impact their cancer recovery, or that side effects from cancer treatment make sexual activity impossible.
For the PCP, the literature points to types of barriers that bar effective communication about sexual health: patient characteristics, provider characteristics, and systems-based challenges. First, there are a number of patient characteristics that can discourage a medical provider from discussing sexual health; for example, age, gender, race/ethnicity, sexual orientation and partner status can all impact the provider's initiative. In addition, the patient's health prognosis, particularly in a palliative care setting, is likely to play a role in impacting whether the medical professional believes that the patient is interested in having a conversation about sexual health. Second, provider characteristics including their training background, knowledge about sexual health issues, and attitudes towards sex can negatively impact the likelihood of a conversation about the topic. Some medical providers recognize that they lack the experience and/or knowledge about sexual health issues that would allow them to feel confident with discussing it with their patients. Furthermore, medical providers report that it is frequently unclear as to which member of the multi-disciplinary medical team is responsible for initiating the conversation. Given that sex is often considered a taboo subject in many cultures not to be discussed openly, medical providers admit that they are sometimes embarrassed to openly speak about sexual issues, and consequently, avoid such intimate conversations. Finally, the medical system itself can make conversations about sexual health issues challenging. Physicians often have overloaded patient schedules and do not have sufficient time to thoroughly explore sexual functioning with each and every patient. Even when patients and providers discuss sexual dysfunction, there may be systemic difficulties surrounding the lack of resources available for the patient, and whether their health insurance would provide coverage for these issues. Given that cancer survivors may have complicated medical histories and a variety of other late effects of treatment, barriers such as time constraints and lack of experience and/or knowledge may be even more problematic for the PCP.