Utvecklad dialog om sexuell hälsa med fokus på unga kvinnor - en möjlighet vid det gynekologiska besöket

Abstract

Background: Many women who have sexual problems or who have been subjected to sexual abuse do not seek help and health professionals often avoid raising such issues. The gynaecological encounter could be an opportunity for creating a dialogue aimed at improving women’s sexual health. Article 1: Aim: To describe women’s experiences concerning the personnel´s behaviour in the situation of gynecologic examination. Design: Descriptive. Method: Open interviews with 30 strategically chosen women aged 18-82. Critical incident technique analysis. Result: The main areas were trust and confirmation. The personnel enabled trust in the examination situation and they confirmed the woman as an individual. Trust concerned participation, confidence and support. Confirmation involved respect and engagement. The opposite behaviour contributed to lack of trust and confirmation. Conclusion: Positive behaviour enabled trust and confirmed the women as individuals, while negative behaviour was decisive in an unfavourable way. Article 2: Aim: To describe young women’s sexual health and their views on a dialogue about aspects of sexuality in connection with a gynecologic examination. Design: Descriptive Method: Cross sectional study. Women aged 23, 26 and 29, who had been called for gynaecological screening (n=488, response rate 75 %). Descriptive statistics, multiple logistic regression and bivariate analysis. Result: Of the women 95 % had a positive attitude towards sexuality, although 22 % were dissatisfied with their sex life. Questions about sexuality were considered appropriate by 92 % and about sexual abuse by 72 %. Demographic variables, aspects of life, sexuality and sexual abuse were irrelevant for whether women considered it appropriate to be asked such questions. Conclusion: The result can encourage health professionals to initiate a dialogue about sexual issues with young women. Article 3: Aim: To describe young women’s perceptions of being asked questions by midwives or doctors pertaining to sexuality and sexual abuse in connection with visits for gynaecological examination. Design: Descriptive. Method: All 23, 26 and 29 year old women who had been called for gynaecological screening over a five-month period were invited to participate. Data comprised responses to open-ended questions in a questionnaire analysed by qualitative content analysis. Result: Midwives and doctors can be trusted and questions can open up a dialogue as well as clarify the woman’s situation. Furthermore, the context of a gynaecological examination is relevant and the women regarded sexuality as an essential part of life, thus such questions enable professionals to strengthen women. Those who felt that it would not feel natural to be asked such questions considered that the context is wrong and such questions encroach on the personal sphere. Conclusion: There are good reasons for midwives and doctors to raise questions about sexuality and sexual abuse when meeting young women. Article 4: Aim: To describe the experiences of midwives and physicians with a focus on possibilities regarding a dialogue with young women on sexuality and sexual abuse. Design: Descriptive. Method: A purposive sample of 26 midwives, gynaecologists and general practitioners aged 30-65, were interviewed. Data were analysed using qualitative content analysis. Result: The informants described their capacity to create a respectful encounter when meeting young women during a gynaecological visit and the potential to strengthen women and improve their sexual health. Support from the organisation and personal skills were found to promote dialogue while lacking organisational support and lacking communication skills as well as having difficult emotions complicated the situation. Conclusion: Dialogue offers possibilities for improving women’s sexual health. Implications: The gynaecological encounter could be improved through reflection on the personnel´s behaviour. Education and supervision for health professionals are important for enhancing the quality of dialogue about sexual matters. This in turn could enable health professionals to raise these questions, thus improving women’s sexual health.