Original Research - Special Collection: Sexual Health

Sexual history taking by doctors in primary care in North West province, South Africa: Patients at risk of sexual dysfunction overlooked

Deidre Pretorius, Ian D. Couper, Motlatso G. Mlambo
African Journal of Primary Health Care & Family Medicine | Vol 14, No 1 | a3238 | DOI: https://doi.org/10.4102/phcfm.v14i1.3238 | © 2022 Deidré Pretorius, Ian D. Couper, Motlatso G. Mlambo | This work is licensed under CC Attribution 4.0
Submitted: 04 September 2021 | Published: 23 May 2022

About the author(s)

Deidre Pretorius, Division of Family Medicine, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
Ian D. Couper, Division of Family Medicine, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa; and, Ukwanda Centre for Rural Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
Motlatso G. Mlambo, Division of Family Medicine, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa; and, Department of Institutional Research and Business Intelligence, University of South Africa, Pretoria, South Africa


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Abstract

Background: Sexual history taking seldom occurs during a chronic care consultation and this research focussed on consultation interaction factors contributing to failure of screening for sexual dysfunction.

Aim: This study aimed to quantify the most important barriers a patient and doctor experienced in discussing sexual challenges during the consultation and to assess the nature of communication and holistic practice of doctors in these consultations.

Setting: The study was done in 10 primary care clinics in North West province which is a mix of rural and urban areas.

Methods: One-hundred and fifty-five consultation recordings were qualitatively analysed in this grounded theory research. Doctors and patients completed self-administered questionnaires. A structured workplace-based assessment tool was used to assess the communication skills and holistic practice doctors. Template analysis and descriptive statistics were used for analysis. The quantitative component of the study was to strengthen the study by triangulating the data.

Results: Twenty-one doctors participated in video-recorded routine consultations with 151 adult patients living with hypertension and diabetes, who were at risk of sexual dysfunction. No history taking for sexual dysfunction occurred. Consultations were characterised by poor communication skills and the lack of holistic practice. Patients identified rude doctors, shyness and lack of privacy as barriers to sexual history taking, whilst doctors thought that they had more important things to do with their limited consultation time.

Conclusion: Consultations were doctor-centred and sexual dysfunction in patients was entirely overlooked, which could have a negative effect on biopsychosocial well-being and potentially led to poor patient care.


Keywords

sexual history taking; routine consultation; holistic practice; communication; patient-doctor engagement; diabetes; hypertension; sexual dysfunction

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