Taking a Sexual History: Best Practices.

Recognizing the holistic definitions of sexual health, health-care providers must approach sexual health history taking with sensitivity, inclusivity, and a trauma-informed perspective. Many versions of what a sexual history should look like exist but certain principles are commonly found. Education of health-care providers on sexual history taking can involve reviewing the components of the sexual history but should also include the importance of using nonstigmatizing language, having a patient-centered approach, and practicing trauma-informed and culturally sensitive care.

Report From the National Academies of Sciences, Engineering and Medicine-STI: Adopting a Sexual Health Paradigm-A Synopsis for Sexually Transmitted Infection Practitioners, Clinicians, and Researchers.

ABSTRACT: Despite decades of medical, diagnostic, and public health advances related to diagnosis and management of sexually transmitted infections (STIs), rates of reportable STIs continue to grow. A 2021 National Academies of Sciences, Engineering, and Medicine report on the current state of STI management and prevention in the United States, entitled Sexually Transmitted Infections: Adopting a Sexual Health Paradigm, offers recommendations on future public health programs, policy, and research. This new report builds upon the 1997 Institute of Medicine report, The Hidden Epidemic: Confronting Sexually Transmitted Diseases, and provides 11 recommendations organized under 4 action areas: (1) adopt a sexual health paradigm, (2) broaden ownership and accountability for responding to STIs, (3) bolster existing systems and programs for responding to STIs, and (4) embrace innovation and policy change to improve sexual health. We present our interpretive synopsis of this report, highlighting elements of particular interest to STI and sexual health practitioners, including clinicians, researchers, disease intervention specialists, community outreach workers, and public health staff. The report asserts that it is possible to create a healthier and more equitable future where fewer adolescents and adults are infected, fewer babies are born with STIs, and people entering their sexual debut and continuing throughout the life span are taught the language and skills to conceptualize and enact their own vision for what it means to be sexually healthy.

Meeting the Patient Care, Education, and Research Missions: Academic Medical Centers Must Comprehensively Address Sexual and Gender Minority Health.

While sociopolitical advances have improved the rights of sexual and gender minorities (i.e., lesbian, gay, bisexual, transgender, queer [LGBTQ+] persons), they continue to face a health system that discriminates against them and does not provide competent, comprehensive care. Despite calls for advancing research, there remains limited sexual and gender minority health research funding, mentorship, and institutional support. Academic medical centers are best suited to systematically tackle disparities and improve care for all sexual and gender minority people through their tripartite missions of patient care, education, and research. In this article, the authors outline discrimination experienced by LGBTQ+ persons and highlight the unique disparities they experience across access and outcomes. The authors posit that by systematically improving clinical care of, incorporating education and training about, and research with LGBTQ+ people into their core missions, academic medical centers can dramatically change the health care landscape. Academic medical centers can eliminate health disparities, expand necessary research endeavors about sexual and gender minorities, and prepare the health care workforce to address the unique needs of these overlooked populations.

Sexual health-related training of Canadian midwives and its association with practice outcome.

BACKGROUND: Although promoting sexual health should be an integral part of midwifery practice, little is known about midwives' preparation to address their clients' sexual health concerns. AIMS: To assess the formal and self-directed training on sexual health topics relevant to midwifery practice of Canadian midwives as well as the association between training and various practice outcomes. METHODS: Forty midwives registered in the Province of Ontario, Canada completed an online survey assessing their formal and self-directed sexual health training, knowledge, comfort, and practice related to 10 sexual health issues. FINDINGS: In terms of formal training, three of the 10 topics were coved in-depth and seven were covered in general terms only or not at all. Participants had received an average of 26.0 hours of formal training related to sexual health. Almost all (90%) participants had engaged in self-directed learning on at least one topic. Participants had asked at least one client about only 5 of the 10 topics and been asked by at least one client about 4.5 of them. Participants who reported more extensive formal training had been asked about more sexual health topics by their clients. More self-directed learning was associated with more positive attitudes toward midwives' role in addressing sexual health concerns, feeling more knowledgeable, and being asked about and asking about more sexual health topics. CONCLUSION: The midwives in this sample had limited training in some important sexual health issues relevant to midwifery practice. Likely as a result, they often did not address these issues in practice.

Estrategias de educación en Salud Sexual a personas con estomas de eliminación con el enfoque de la Teoría de Cuidados de Kristen Swanson. "Scoping Review" / Sexual Health education strategies for people with removal stomata with the Kristen Swanson Theory of Care approach. "Scoping Review"

Objetivo: Proponer estrategias de educación en salud sexual a personas con estomas de eliminación con el enfoque de la teoría de Cuidados de Kristen Swanson. Método: El presente estudio, se realizó con la metodología "Scoping Review", en 2 etapas: la etapa 1 se dividió en 5 fases para la obtención y análisis de los resultados obtenidos en la revisión; en la etapa 2 se planteó la elaboración de la propuesta de cuidado a través de 3 fases con los momentos del cuidado propuesto por Kristen Swanson. Resultados: Se seleccionaron 21 artículos, entre los año 2010 al 2020. Se realiza la caracterización de los artículos, se evidenció que los estudios cuantitativos aportaron el 57% de los hallazgos y el 43% corresponde a estudios cualitativos. Luego de la saturación de los contenidos de la información se obtuvieron 3 categorías: Estrategias de Educación en Salud Sexual, Mi Estoma Opción de Vida y Cuidado de Enfermeria para el Bienestar. Estas fueron usadas para la construcción de la propuesta de cuidado planteado en 6 fases durante el preoperatorio y posoperatorio. Conclusiones: Generar una propuesta de cuidado, basado en el modelo de Kristen Swanson adaptado a las necesidades de salud sexual a las personas con estomas de eliminación, se considera esencial para un abordaje y evaluación integral en el preoperatorio y posoperatorio, que permitió plantear 6 fases de la intervención educativa propuesta, como indicador empírico facilitará a enfermería brindar un cuidado holístico en este tipo de pacientes

Objective: To propose strategies of education in sexual health to people with stomata of modification with the focus of the theory of Care of Kristen Swanson. Method: The present study will be carried out with the "Scoping Review" methodology, which is divided into 2 stages: in stage 1 it is divided into 5 phases to obtain the results; in stage 2 the preparation of the care proposal through 3 phases contemplating the moments of care. Results: 21 articles were selected, between the years 2010 to 2020. The characterization of the articles was carried out, it was evidenced that quantitative studies contributed 57% of the findings and 43% correspond to qualitative studies. After saturating the information contents, 3 categories were obtained: sexual health education strategies, my stoma life option and nursing care for well-being. These were used for the construction of the care proposal proposed in 6 phases during the preoperative and postoperative periods. Conclusions: Generating a care proposal, based on Kristen Swanson's model adapted to the sexual health needs of people with removal stomata, is considered essential for a comprehensive approach and evaluation in the preoperative and postoperative period, which allowed to propose 6 phases of the proposed educational intervention, as an empirical indicator, will facilitate nursing to provide holistic care in this type of patient

A qualitative study of sexual and reproductive health communication with adolescent and young adult oncology patients.

BACKGROUND: Adolescent and young adult patients with cancer (AYAs) identify sexual and reproductive health (SRH) as an important but often neglected aspect of their comprehensive cancer care. The purpose of this study was to explore AYA perceptions and experiences of SRH communication with oncology clinicians. METHODS: Twenty-three AYA patients and survivors ages 15-25 years from a large academic oncology center participated in semistructured qualitative interviews investigating their experiences discussing SRH issues, including specific topics discussed, conversation barriers and facilitators, suggestions for clinicians on how to improve conversations, and education and resource needs. Interviews were audio recorded, transcribed, and coded using a thematic analysis approach. RESULTS: Interviews with AYAs revealed two primary themes-a need for oncology clinicians to discuss SRH and critical gaps in current SRH communication practices. AYAs reported a need for improved SRH communication for the purposes of general education, addressing specific SRH issues experienced, and understanding the long-term impact of cancer and treatment on SRH. The current communication gaps are exacerbated by patient discomfort initiating conversations and the presence of family members. AYAs shared six key recommendations for clinicians on how to improve SRH communication. CONCLUSIONS: AYAs identify a role for oncology clinicians in discussing SRH as a primary aspect of comprehensive health care during cancer treatment and in survivorship; however, multiple gaps and barriers interfere with such discussions. Future efforts must focus on clinician education and training in SRH as well as education and intervention opportunities for AYAs to optimize the care provided.

Evaluation of an assessment instrument for a sexual health curriculum for nurses and midwifery students in Tanzania: The sexual health education for professionals scale (SHEPS).

We assessed the structure and content of a new scale, the SHEPS, to assess change in sexual health confidence, knowledge and attitudes in nursing and midwifery students following an intervention (a 2-day standardized workshop on sexual health). Students were 78 Tanzanian nursing and midwifery students attending a University of Health Sciences, who were assessed immediately before and after the workshop on matched pre- and post-workshop questionnaires. Data confirmed significant changed pre- and post-test on knowledge and confidence on topics taught in the workshop, with the effect also extending to some topics not or minimally covered, suggesting that there was a general increase in confidence and a perception of increased knowledge following the workshop. There was power to detect differences even with a moderate sized matched sample. Correlations between knowledge and confidence on the same content items were between 0.52 and 0.63, suggesting that respondents could clearly distinguish between knowledge and confidence. There were no significant differences pre- and post-test on several controversial cultural and religious attitudes including on abortion and non-vaginal penetrative sex. Alpha coefficients were 0.93 for pre-test and 0.90 for post-test. This field test demonstrates the preliminary appropriateness of the SHEPS as a tool for evaluating sexual health interventions in health care workers.

"And Then Break the Cliché": Understanding and Addressing HIV Vulnerability Through Development of an HIV Prevention Telenovela with Men Who Have Sex with Men and Transwomen in Lima, Peru.

HIV and other sexually transmitted infections (STIs) continue to affect men who have sex with men (MSM) and transgender women (TW) in Peru at disproportionately high rates. The ineffectiveness of traditional prevention strategies may be due to the disconnect between health promotion messages and community-level understandings of sexual cultures. We conducted 15 workshops with MSM and TW to develop a community-based sexual health intervention. Intervention development consisted of focus groups and scenic improvisation to identify sexual scripts for an HIV prevention telenovela, or Spanish soap opera. Workshops were stratified by self-reported socioeconomic status, sexual orientation, and gender identity: (1) low-income MSM (n = 9); (2) middle/high-income MSM (n = 6); and (3) TW (n = 8). Employing a conceptual model based on sexual scripts and critical consciousness theories, this paper reports on three themes identified during the telenovela-development process as participants sought to "rescript" social and sexual stereotypes associated with HIV-related vulnerability: (1) management of MSM and TW social identities at the intersection of socioeconomic status, sexuality, and gender performance; (2) social constructions of gender and/or sexual role and perceived and actual HIV/STI risk(s) within sexual partnership interactions; and (3) idealized and actual sexual scripts in the negotiation of safer sex practices between MSM/TW and their partners. These findings are key to reframing existing prevention strategies that fail to effectively engage poorly defined "high-risk populations." Leveraging community-based expertise, the results provide an alternative to the static transfer of information through expert-patient interactions in didactic sessions commonly used in HIV prevention interventions among MSM and TW.

Preparing the sexual health workforce to deliver integrated services: is education the answer? A qualitative study exploring the impact of sexual health education on developing integrated policy and practice.

Aim This study aimed to explore the ability of sexual health nurses working in the South West of England, to implement new learning within existing sexual health service delivery models. Drawing on Lipsky's account of street-level bureaucracy to conceptualise policy implementation, the impact of workforce learning on the development of integrated services across this region of the United Kingdom was assessed. BACKGROUND: In order to achieve the United Nations' goal of universal access to sexual health, it is essential for reproductive and sexual health, including HIV provision, to integrate into a single service. This integration requires a commitment to collaboration by service commissioners and an alignment of principles and values across sexual health and contraceptive services. UK health policy has embraced this holistic agenda but moves towards integrating historically separate clinical services, has presented significant workforce development challenges and influenced policy success. METHODS: Employing a qualitative approach, the study included data from semi-structured telephone interviews and focus groups, and longitudinal data from pre- and post-intervention surveys, collected between September 2013 and September 2015. Data were collected from 88 nurses undertaking a workforce development programme and six of their service managers. Data were analysed using thematic analysis to identify consistent themes. Findings Nurses confirmed the role of new learning in enabling them to negotiate the political landscape but expressed frustration at their lack of agency in the integration agenda, exposing a clear dichotomy between the intentions of policy and the reality of practice. Nevertheless, using high levels of professional judgement and discretion practitioners managed the incongruence between policy and practice in order to deliver integrated services in the interests of patients. Workforce education, while essential for the transition to the delivery of integrated services, was insufficient to fulfil the sexual health agenda without a strengthening of public health.