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Sexual health care is an area of practice that can be both rewarding and challenging. There is general acceptance that adequately addressing health concerns and risk in relation to sexuality is essential to the provision of holistic care; however, integrating this domain into practice can represent challenges (Hayter et al. 2012). Furthermore, human sexuality is multidimensional incorporating biological, social, emotional, psychological, cultural and spiritual dimensions, so that in addition to having an understanding of the physiological, there is also a need to understand the many other facets that influence human sexuality and sexual behaviour.

These other dimensions can and do raise many clinical, practical and ethical concerns, and this is evident in a recent series of commentaries appearing in the journal (East et al. 2010, 2011a,b, Hayter 2010). These clinical, practical and ethical concerns open up debates such as the appropriateness of services for marginalised groups, how sexually transmitted infections (STI) can affect/stigmatise people and also the medico-legal elements of HIV/STI transmission. Clearly, there is still much work to do in caring for people with sexual health problems – particularly around mental and social well-being.

We have gathered a snapshot of papers published in the journal over the past five years (see Table 1). While not exhaustive, this table gives a sense of the breadth and scope of papers in the area. The papers do move the debates on substantially, but there are very few papers that look, for example, at the effectiveness of interventions to address sexuality and sexual health.

Table 1. Focus, approach, sample and country of papers
Focus of paperApproachSampleCountry
Constructing masculinitiesQualitativeMen aged 85 years or olderSweden
Becoming parentsQualitativeLesbian couplesAustralia
Recovering from cancer-related breast surgeryQualitativeWomen under 50 yearsAustralia
Gendered attitudes to sexual relationshipsQualitativeYoung people aged 14–16 yearsEngland
Well-being after open-heart surgeryQualitativeHealth professionalsSweden
Nursing students’ knowledge, attitudes and readiness to work with sexual health concernsSurveyNursing studentsHong Kong
Relationships between sexual self-concept, sexual risk cognition and sexual communication in adolescentsSurveyAdolescent school studentsTaiwan
Experiences of intersexualityQualitativeAdults with intersex conditionNew Zealand
Identifying challenges in interviewing regarding sexuality in chronic illnessDiscursiveLiteratureInternational
Patients’ experiences of changes with intimate relationships following treatment for head and neck cancer.QualitativePatients treated for head and neck cancerEngland
Nurses’ views about psychiatric medication and sexual side effectsQualitativeMental health nursesAustralia
Nurses’ attitudes to sexualitySurveyNurses caring for adolescentsTurkey
Women's problems after total or partial mastectomySurveyWomen post-breast surgeryPoland
Impact of stroke on spousal relationshipsQualitativeAdults poststrokeIreland
Sexual activity in older peopleSurveyAdults over 65 yearsTaiwan
Improve adolescents’ understanding about puberty and related health risksInterventionSchool children 12–14 yearsChina
Nurses’ experiences of caring for males (series of three papers)QualitativeFemale nursesChina
Young women's experiences of STI (series of two papers)QualitativeWomen 21–39 yearsAustralia
Expressing sexuality in residential careReviewLiterature reviewInternational
Issues for nurses in caring for malesReviewLiterature reviewInternational

Scanning these papers as a single discourse, it is evident that much work is qualitative in nature – this is not a problem in itself – qualitative approaches are required to uncover the rich and complex issues inherent in the study of human sexuality. Furthermore, some aspects remain largely hidden and so qualitative research is an essential step in gaining the necessary insights. However, it is time we also started to see more quantitative work in this area. For example, we have a sound knowledge base about how patients with numerous health problems feel about sexuality – but not as much that develops and tests the effectiveness of interventions. Similarly, work on gender factors in sexual health identifies various issues such as disempowerment, vulnerability and invisibility, but a quantitative element that asks ‘what works’ in addressing these issues is still lacking.

Another issue is the relative lack of gay/lesbian/transgender themes in papers published in the Journal of Clinical Nursing. There is a body of literature that refers to sexual health services as ‘hetero-normative’ (Owen et al. 2010, 2011) and represents some health and social care personnel as being uncomfortable around people who exemplify diversity in their sexuality. This literature highlights the need for research into the health needs of sexually diverse communities and identification of appropriate and helpful nursing responses.

There are remarkably few papers on STI, especially so given the potential that nurses have to contribute to improved awareness, education and outcomes. This is especially important as infection rates of some STI continue unimpeded, particularly in certain age groups. In addition to young people, the number of people entering into new relationships in late middle age/early old age is being characterised by an increase in STI in this age group. Studies on HIV are also noticeable by their absence. HIV-focussed knowledge and research has moved on apace with new therapies raising substantial nursing issues as well as behavioural aspects – such as the criminalisation agenda – creating new medico-legal and ethical dilemmas for nurses. A reappraisal of the issues of confidentiality and public health with nurses working with people with HIV is long overdue for example, particularly because there is some evidence that the number of people with HIV infection is showing a moderate increase in a number of western countries such as America and the UK.

What are the main implications for practice, education and further research? For many clinicians and student nurses, sexual health and sexuality is filed away as a specialist area of health care that does not impinge upon their own client group. However, the current fashion for the provision of ‘holistic’ care may mean that they ignore it at their peril. Understanding human relationships in all of their forms should be a key part of nurse education and the translation of that understanding into effective and sensitive clinical care is a rich and under researched area.

Clearly, sexuality is an area of clear interest to nurses with a range of research and scholarly activities dedicated to better understanding sexual health needs and concerns pertaining to sexuality across the lifespan. However, there is still a need for more research and advancement of nursing knowledge into this essential area of practice. We hope this review provides a stimulating perspective on ‘where we are’ now and also helps to move the research agenda in this key area of nursing practice forward.

References

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  2. References
  • East L, Jackson D, Peters K & O'Brien L (2010) Disrupted sense of self: young women and sexually transmitted infections. Journal of Clinical Nursing 19, 19952003.
  • East L, Jackson D, Peters K & O'Brien L (2011a) Response to Hayter M (2010) Commentary on East L, Jackson D, Peters K & O'Brien L (2010) Disrupted sense of self: young women and sexually transmitted infection. Journal of Clinical Nursing 19, 2952-2953. Journal of Clinical Nursing 20, 23782379.
  • East L, Peters K, O'Brien L & Jackson D (2011b) Healthcare experiences of women who have been diagnosed with a sexually transmitted infection. Journal of Clinical Nursing 20, 22592265.
  • Hayter M (2010) Commentary on East L, Jackson D, Peters K & O'Brien L (2010) Disrupted sense of self: young women and sexually transmitted infections. Journal of Clinical Nursing 19, 1995–2003. Journal of Clinical Nursing 19, 29522953.
  • Hayter M, Jackson D, Carter B & Nyamathi A (2012) The three developmental phases of addressing sexuality in nursing care: where do we go from here? Contemporary Nurse 42, 187189.
  • Owen J, Carroll C, Cooke J, Formby E & Hayter M (2010) School-linked sexual health services for young people (SSHYP): a survey and systematic review concerning current models, effectiveness, cost-effectiveness and research opportunities. Health Technology Assessment 14.
  • Owen J, Cooke J, Formby E, Hayter M & Stapleton H (2011) Selling it as a holistic health provision and not just about condoms…” Sexual health services in school settings: current models and their relationship with sex and relationships education policy and provision. Sex Education: Sexuality, Society and Learning 10, 423435.