Brighton and Sussex Medical School, and University Hospitals Sussex NHS Foundation Trust, Brighton, UK.
Department of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, UK.
Womens Health (Lond). 2024 Jan-Dec;20:17455057241277723. doi: 10.1177/17455057241277723.
Midlife, beginning at 40 years and extending to 65 years, a range that encompasses the late reproductive to late menopausal stages, is a unique time in women's lives, when hormonal and physical changes are often accompanied by psychological and social evolution. Access to sexual health and sexual well-being (SHSW) services, which include the prevention and management of sexually transmitted infections, contraception and the support of sexual function, pleasure and safety, is important for the health of midlife women, their relationships and community cohesion. The objective was to use the socio-ecological model to synthesise the barriers and enablers to SHSW services for midlife women in high-income countries. A systematic review of the enablers and barriers to women (including trans-gender and non-binary people) aged 40-65 years accessing SHSW services in high-income countries was undertaken. Four databases (PubMed, PsycINFO, Web of Science and Google Scholar) were searched for peer-reviewed publications. Findings were thematically extracted and reported in a narrative synthesis. Eighty-one studies were included; a minority specifically set out to study SHSW care for midlife women. The key barriers that emerged were the intersecting disadvantage of under-served groups, poor knowledge, about SHSW, and SHSW services, among women and their healthcare professionals (HCPs), and the over-arching effect of stigma, social connections and psychological factors on access to care. Enablers included intergenerational learning, interdisciplinary and one-stop women-only services, integration of SHSW into other services, peer support programmes, representation of minoritised midlife women working in SHSW, local and free facilities and financial incentives to access services for under-served groups. Efforts are needed to enhance education about SHSW and related services among midlife women and their healthcare providers. This increased education should be leveraged to improve research, public health messaging, interventions, policy development and access to comprehensive services, especially for midlife women from underserved groups.
中年期始于 40 岁，延伸至 65 岁，涵盖了女性生殖后期到绝经期后期的阶段，是女性生命中的一个独特时期，此时荷尔蒙和身体变化通常伴随着心理和社会的发展。获得性健康和性福祉 (SHSW) 服务对于中年女性的健康、她们的人际关系和社区凝聚力非常重要，这些服务包括预防和管理性传播感染、避孕以及支持性功能、性愉悦和安全性。本研究旨在使用社会生态学模型综合高收入国家中年女性获得 SHSW 服务的障碍和促进因素。对高收入国家 40-65 岁女性获得 SHSW 服务的促进因素和障碍进行了系统评价。在四个数据库（PubMed、PsycINFO、Web of Science 和 Google Scholar）中搜索了同行评议的出版物。研究结果以叙述性综合的方式进行了主题提取和报告。共纳入 81 项研究，其中少数专门研究了中年女性的 SHSW 护理。出现的主要障碍是服务不足群体的交叉劣势、女性及其医疗保健专业人员 (HCP) 对 SHSW 和 SHSW 服务的知识匮乏，以及耻辱感、社会联系和心理因素对获得护理的总体影响。促进因素包括代际学习、跨学科和一站式仅限女性的服务、将 SHSW 纳入其他服务、同伴支持计划、代表少数中年女性从事 SHSW 工作、当地和免费设施以及为服务不足群体提供经济激励以获得服务。需要努力提高中年女性及其医疗保健提供者对 SHSW 和相关服务的认识。这种增加的教育应被利用来改善研究、公共卫生信息传递、干预措施、政策制定和获得全面服务的机会，特别是为服务不足的中年女性群体。
