Addressing Sexual Problems in German Primary Care: A Qualitative Study

Abstract

Although general practitioners (GPs) are often the first contact for patients’ sexual issues, little is known about how German GPs approach, diagnose, and treat sexual problems and disorders. Therefore, the present qualitative study explores approaches and management of sexual health issues used by GPs. The sample included 16 GPs from Kiel and surroundings and Sachsen-Anhalt. The in-depth, semi-structured interviews were coded according to the qualitative content analysis by Mayring using MAXQDA. The results revealed 5 main themes, 2 of which are explored in more detail in relation to the study objective (2 and 4): (1) sexual issues that arise in general practice, (2) addressing sexuality, (3) influencing factors in doctor-patient communication about sexuality, (4) diagnosing and treating sexual dysfunctions, and (5) changes in the approach to sexuality over time. Most GPs did not routinely ask their patients about sexual problems. Common barriers included lack of time, suspected embarrassment on both sides, and fear of offending patients. Almost all GPs tended to diagnose sexual problems individually adapted to patients’ issues, not following a standardized approach. Medication was offered as the main treatment for sexual problems. For complex disorders, most GPs lack sexual medicine knowledge, and they requested a better range of training courses in sexual medicine.

Women’s sexual health improvement: sexual quality of life and pelvic floor muscle assessment in asymptomatic women

“…Health professionals revealed obstacles to discussing sexual wellbeing during regular visits with their patients ( 9–11 ):…”

“…Patients do not want to embarrass the health professional by asking intimate questions and are not convinced that the doctor has enough knowledge about sexual problems. Additionally, patients and their partners have other sources to derive information on sexual education, such as the Internet, their surroundings (family and peer group), and healthcare professionals who may not be an authority on sexual health ( 9 , 10 ).…”

Young Australians’ receptiveness to discussing sexual health with a general practitioner

“…For example, a recent study involving interviews with Victorian GPs found that raising sexual health in unrelated consultations with young male patients was not necessarily routine or straightforward for all GPs (Collyer et al 2018). Other research conducted overseas has also identified that addressing sexual health proactively in primary care is challenging for many providers, due to issues, such as time constraints, complexity and sensitivity of issues, and a lack of training (Gott et al 2004;Zannoni et al 2021). Despite these challenges, primary care remains a crucial setting for the provision of sexual health care to young people, and sexual and reproductive health care is a key component of general practice.…”

The Diagnostic Interview for Sexual Dysfunctions in Women for DSM‐5 and ICD‐11: Development and initial validation using a vignette‐based approach

“…Different authors have demanded to reduce this problem by using well‐validated, standardized instruments (e.g., McCabe et al., 2016 ; Simons & Carey, 2001 ). In clinical care, many practitioners (e.g., psychotherapists and physicians) feel insecure and ill‐equipped to diagnose and treat sexual dysfunctions (Levkovich et al., 2021 ; Zannoni et al., 2021 ). A valid, reliable, and easily applicable structured diagnostic instrument for sexual dysfunctions would help to reduce uncertainties in clinical care and enhance diagnostic validity in clinical research.…”