Rabathaly Patrice A, Chattu Vijay Kumar
Department of Social and Environmental Health Research, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine (LSHTM), London, United Kingdom.
Public Health and Primary Care Unit, Department of Paraclinical Sciences, Faculty of Medical Sciences, The University of the West Indies, St. Augustine, Trinidad and Tobago.
J Family Med Prim Care. 2019 Feb;8(2):626-633. doi: 10.4103/jfmpc.jfmpc_325_18.
A good quality sex life and interest in sex are positively associated with health in middle-aged and later life. For effective diagnosis of sexual health problems, an appropriate discussion about sexual health issues including a sexual history is advised. The sexual health care delivery and management during consultations by primary care physicians is relatively unexplored, especially for older patients. This paper aims to explore primary health care physicians' (PCPs) attitudes to sexual health care and management of middle-aged and older patients in Trinidad and Tobago.
In-depth, semi-structured interviews were conducted with 35 PCPs in Trinidad and Tobago. Topics examined included physician-patient relations, sexual health care management challenges, communication and sexual history taking practices, and training needs of PCPs. The framework analysis method was adopted for analysis.
Most doctors stated that they were not comfortable with conducting a sexual history with their older patients, and they rarely discussed or initiated talking about sexual health with them. Barriers included time constraints, inappropriate environmental conditions for privacy, inadequate professional referral services, insufficient medical training in sexual function in middle and old age, reluctant patient behavior, conflicting personal beliefs on sexuality, and socio-cultural factors.
PCPs may be reluctant to raise sexual health-related issues with their older patients, and these older patients may not initiate this discussion because of discomfort and embarrassment. Consequently, physicians' inability to effectively communicate with these patients could result in missed opportunities for interventions and patients' concerns may remain unheard and their sexual problems untreated.
良好的性生活质量和性兴趣与中老年健康呈正相关。为有效诊断性健康问题，建议就包括性病史在内的性健康问题进行适当讨论。初级保健医生在会诊期间提供性健康护理和管理的情况相对缺乏研究，尤其是针对老年患者。本文旨在探讨特立尼达和多巴哥的初级保健医生（PCP）对中老年患者性健康护理和管理的态度。
对特立尼达和多巴哥的35名初级保健医生进行了深入的半结构式访谈。考察的主题包括医患关系、性健康护理管理挑战、沟通和性病史采集实践以及初级保健医生的培训需求。采用框架分析法进行分析。
大多数医生表示，他们对与老年患者进行性病史询问感到不自在，并且很少与他们讨论或主动提及性健康问题。障碍包括时间限制、缺乏隐私的合适环境条件、专业转诊服务不足、中老年性功能方面的医学培训不足、患者行为抵触、在性方面相互冲突的个人信念以及社会文化因素。
初级保健医生可能不愿意与老年患者提出与性健康相关的问题，而这些老年患者可能由于不适和尴尬而不主动发起这种讨论。因此，医生无法与这些患者有效沟通可能导致干预机会的错失，患者的担忧可能未被倾听，他们的性问题也得不到治疗。
