1. Introduction
Sexuality is a vital component of overall health, yet it is often overlooked in healthcare settings. A holistic approach to patient care necessitates addressing sexual health, requiring a team effort rather than falling solely on specialists [1]. Sexuality encompasses sexual activity, orientation, gender identity, roles, eroticism, pleasure, intimacy, and reproduction [2], representing a fundamental and lifelong human need and right [3].
Despite the acknowledged importance, many healthcare professionals (HCPs), particularly primary care providers who are often the first point of contact for patients, do not proactively discuss sexual health. Research indicates that while a majority of HCPs recognize the importance of addressing sexual issues, few initiate these conversations due to barriers like insufficient training (79%), time constraints (67%), and personal discomfort (50%) [4]. Overcoming these obstacles through improved training, clear policies, accessible patient information, and enhanced inter-professional communication is crucial.
Certain chronic conditions, such as diabetes, can significantly impact reproductive and sexual health. Primary care providers play a key role in the early detection and prevention of related problems. However, many lack comprehensive knowledge regarding the effects of various pathologies on sexual health, common sexual health issues, and medication side effects. Adequate training in reproductive and sexual health (RSH) counseling is fundamental for competent care [5].
Sex education is essential to dismantle negative stereotypes surrounding sexuality [6]. However, in medical practice, the routine investigation and treatment of sexual dysfunction remain underdeveloped. A more effective approach involves thorough discussions and exploration of underlying causes. Knowledge and attitudes towards sexuality are especially critical for those educating future healthcare providers. Medical doctors, in particular, may be hesitant to inquire about patients’ sexual lives, potentially stemming from inadequate training during medical education where sexual medicine is often marginalized. This discomfort can create a “don’t ask, don’t tell” dynamic, hindering open communication [6]. Furthermore, healthcare providers may harbor unconscious biases against LGBTQ+ individuals and lack specific knowledge about their unique needs [7, 8].
To improve patient care, higher education institutions must provide robust sexuality training for students in healthcare fields. Hospitals and clinics should also offer ongoing training for practicing professionals [9, 10]. Primary care settings are ideal for integrating such education, as family doctors and general practitioners build long-term relationships with patients and can address sexual health within the broader context of overall wellness.
Cultural factors also influence discussions about sexuality. Some cultures may present greater challenges in addressing these topics compared to others [11, 12]. A survey of British healthcare professionals found that doctors and nurses reported greater training, comfort, and willingness to discuss sexual issues compared to physiotherapists and occupational therapists. Doctors also initiated these discussions more frequently [4]. This highlights the need for tailored training across different healthcare disciplines, with primary care providers being central to initiating these conversations in diverse patient populations.
This article explores how primary care providers can enhance sex education programs by reviewing existing literature on sexuality education for healthcare professionals. By understanding the current landscape of training and its impact, we can identify strategies to better equip primary care providers to address the sexual health needs of their patients.
2. The Crucial Role of Training in Sexuality for Healthcare Professionals
Research consistently demonstrates that training is essential for effective communication about sexuality in healthcare. Studies examining various training programs reveal that even brief interventions can significantly improve healthcare professionals’ knowledge, attitudes, and comfort levels in addressing patient sexuality. However, the duration and content of these programs vary widely, ranging from short workshops to extended courses.
One early study highlighted the impact of prior sexual health training on nurses’ attitudes [13]. Interestingly, nurses who reported previous training exhibited more positive attitudes toward discussing sexual health with patients. This suggests that even basic training can begin to shift perceptions and reduce discomfort around these sensitive topics. For primary care nurses, who often play a vital role in patient education and initial assessments, such training can be particularly impactful.
A comprehensive, long-term educational intervention for oncology nurses and physicians demonstrated the sustained benefits of in-depth training [23]. This program included interactive workshops, case studies, role-playing, and ongoing staff meetings. The results showed a significant increase in the frequency with which trained professionals initiated discussions about sexual health with their patients, and these positive outcomes persisted over time. This model underscores the value of multifaceted and ongoing training initiatives for primary care teams, ensuring that discussions about sexual health become a routine part of patient interactions.
Another study evaluating a 12-week sexual health education program for nursing students further emphasizes the effectiveness of structured education [20]. This program incorporated diverse teaching methods, including lectures, group discussions, role-playing, and case analysis. The findings clearly indicated that this comprehensive education significantly improved nursing students’ knowledge, attitudes, and self-efficacy in addressing sexual health. Integrating similar robust training into medical school curricula and residency programs for primary care physicians is vital to preparing future generations of providers.
A New Zealand-based workshop, lasting two days, also demonstrated significant improvements in participants’ knowledge, skills, and comfort in addressing patient sexual health [15]. These positive outcomes were maintained at a six-month follow-up, with participants reporting increased activity in addressing patient sexual health concerns. This study, along with research from the Netherlands [16] that utilized discipline-specific training modules, underscores the effectiveness of interactive, skills-based training that incorporates role-playing and real-world case studies. For busy primary care practices, shorter, intensive workshops can provide valuable tools and strategies for addressing sexual health within the constraints of daily practice.
3. Practical Models and Approaches for Primary Care Settings
Several models and approaches can be effectively integrated into primary care settings to facilitate discussions about sexual health. The BETTER model, for example, provides a simple yet structured framework for healthcare professionals to initiate these conversations [18]. This model involves:
- Bring up: Proactively raising the topic of sexuality with patients.
- Explain: Emphasizing the importance of sexuality as a quality-of-life issue and the provider’s willingness to discuss it.
- Tell: Assuring patients that referrals to specialists are available if needed.
- Time: Discussing the topic at the patient’s preferred pace and time.
- Educate: Providing patients with information about potential sexual side effects of treatments or conditions.
- Record: Documenting assessments, treatments, and outcomes in patient records [24].
The BETTER model’s simplicity and ease of use make it particularly well-suited for primary care settings, where providers need efficient and effective tools to address a wide range of patient needs within limited appointment times. Studies have shown that even brief educational sessions on the BETTER model can empower healthcare professionals to incorporate sexual health discussions into their practice [18, 20].
Another valuable framework is the PLISSIT model (Permission, Limited Information, Specific Suggestions, and Intensive Therapy) [25]. This model offers a tiered approach to addressing sexual concerns, allowing primary care providers to offer support at different levels based on their comfort, knowledge, and the patient’s needs. Primary care providers can confidently offer “Permission” to discuss sexual health and provide “Limited Information” and “Specific Suggestions” for common concerns. More complex issues requiring “Intensive Therapy” can be appropriately referred to specialists. The PLISSIT model is particularly useful in interdisciplinary primary care teams, where different members can contribute at various levels of expertise.
Furthermore, tailoring sex education programs to specific populations within primary care is essential. For instance, programs focusing on older adults’ sexuality [22] or the sexual health needs of individuals with disabilities [14, 17] can equip primary care providers with the specialized knowledge and skills to address these often-overlooked patient groups. Addressing biases and increasing cultural competency are also critical components of effective sex education programs for primary care providers, ensuring equitable and inclusive care for all patients [7, 8, 11, 12].
4. Discussion: Overcoming Barriers and Moving Forward
Despite the clear benefits of sexuality education, significant gaps remain. Studies indicate that medical schools often dedicate limited time to human sexuality education [27]. To improve primary care practices, it is essential to address the underlying barriers that prevent providers from engaging in sexual health discussions. These barriers include personal discomfort, lack of time, and insufficient training [4].
Effective sex education programs for primary care providers should prioritize:
- Raising awareness of personal biases and discomfort: Training should encourage self-reflection and address personal barriers that may hinder open communication about sexuality [28].
- Improving knowledge and skills: Programs should provide practical knowledge about common sexual health concerns, the impact of chronic conditions and medications on sexual function, and effective communication strategies, including models like BETTER and PLISSIT.
- Promoting a team-based approach: Encouraging collaboration within primary care teams and with specialists can ensure comprehensive patient care, recognizing that not all providers need to be experts in all areas of sexual health [29].
- Emphasizing patient-centered communication: Training should focus on active listening and creating a safe and non-judgmental environment where patients feel comfortable discussing their sexual health concerns [3].
By implementing these strategies, primary care providers can become more confident and competent in addressing sexual health, leading to improved patient outcomes and a more holistic approach to healthcare. This includes moving beyond a narrow focus on contraception and STI prevention to encompass broader aspects of sexual well-being, such as sexual function, intimacy, and satisfaction across the lifespan [30].
The ultimate goal is to integrate sexuality as a routine part of primary care, recognizing its integral role in overall health and well-being [31]. This requires ongoing efforts to enhance medical training, update clinical guidelines, and foster a culture of openness and understanding within healthcare settings.
5. Conclusion
Primary care providers are uniquely positioned to improve sex education and address the sexual health needs of their patients. By investing in comprehensive and ongoing sexuality education programs, we can empower these frontline healthcare professionals to overcome personal and systemic barriers, initiate important conversations, and provide holistic, patient-centered care.
This review highlights the positive impact of various educational interventions on healthcare professionals’ knowledge, attitudes, and self-efficacy in addressing sexual health. Future research should focus on evaluating the long-term effectiveness of these programs in real-world practice settings and exploring the nuances of interdisciplinary training [18, 22]. While formal lectures can provide a foundation of knowledge, interactive teaching methods like case studies and role-playing are particularly valuable for addressing the sensitive and personal nature of sexuality.
Ultimately, improving sex education in primary care is not about finding simple solutions but about fostering a fundamental shift in perspective. It requires acknowledging the importance of sexuality as a core aspect of human experience, promoting open communication, and providing healthcare professionals with the tools and support they need to deliver truly holistic and patient-centered care [32]. By prioritizing training and providing effective communication frameworks, we can empower primary care providers to enhance the sexual health and overall well-being of their patients.
Author Contributions
Conceptualization, V.V. and S.E.; Methodology, S.E., Writing—Original Draft Preparation, V.V. and S.E.; Writing—Review & Editing, V.S. and F.P.; Supervision, F.P. All authors have read and agreed to the published version of the manuscript.
Conflicts of Interest
The authors declare no conflict of interest.
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