Clinicians Find Pelvic Health Clinic Helpful for Patient Sexual Health

Doctors and nurses involved in the care of people with multiple sclerosis (MS) at a center in Scotland “highly” value the existence of a Pelvic Health Clinic for referrals — where patients identified as having concerns related to sexual health can be referred for consultation for guidance and care with a sexual specialist — a small study found.

“Knowing that there was a service available empowered clinicians to ask patients about sexual health needs,” the researchers wrote, adding, “Specific referral criteria may help further develop the service and improve patient care.”

While the team acknowledged that “this is a small scale, qualitative case study,” they noted that “staff welcome training and support in this area or the option to signpost onwards; either mechanism lends itself to enhancing MS patient needs.”

According to the researchers, “implications for the extension of such interservice collaborations out with the realm of PwMS [people with MS] might also be considered.”

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The study, “Let’s talk about sex(ual) wellbeing! Staff perceptions of implementing a novel service for people with Multiple Sclerosis,” was published in Multiple Sclerosis Journal – Experimental, Translational and Clinical.

Most people with MS tend to experience difficulties related to sexual health, but these problems are often hard to bring up, and they tend to get overlooked by MS clinicians.

Recognizing this problem, a group of clinicians in Tayside, Scotland, created a “Pelvic Health Clinic” for MS patients in 2018. It basically was a collaboration between several MS specialists and a sexual health clinician, who provides advice and counseling on a monthly basis to people with MS experiencing sexual problems. The clinician also gives advice to people using contraception, and in menopause.

In a previous report, the group had asked a few patients about their experiences with the Pelvic Health Clinic. These were largely positive — and more detailed analyses of patient attitudes are ongoing.

“It was difficult to disclose my insecurities about lack of intimacy, but I am so glad that I did as [the sexual health clinician] made a potentially difficult discussion, much easier than I feared,” one patient said. “She has helped me to understand devoting time and effort to protect one’s relationship, even in the face of coping with the demands of MS is essential to intimacy.”

“I got on really well with the specialist doctor,” said another patient. “She made me feel really comfortable and suggested a medication. I’m not embarrassed to say that erectile dysfunction caused a significant impact on quality of life. I felt able to express my difficulties. Otherwise, I would most likely have gone to my GP [general practitioner], eventually, at some point. If I’m truthful I kept putting off a visit to the GP!”

Now, the MS care team members were interviewed about their experiences with having the clinic available for referrals, and how it impacted their practice. All five of the program’s clinicians — two doctors, one male and one female, and three nurses, all women — participated in the interviews.

The clinicians acknowledged that talking about sexual health can be difficult or uncomfortable, with one nurse describing these conversations as “an area we have perhaps neglected in the past.”

“Not comfortable … so I don’t tend to go there,” one doctor said of such discussions. The other physician called it “quite a difficult area.”

In particular, several clinicians expressed discomfort broaching topics of sexual health with a patient who was not the same gender. Others said that they often did not feel like there was time to get into these discussions.

While the team stressed a need for further clinician education and training, having the Pelvic Health Clinic available appeared to help in dealing with patients’ sexual and intimacy issues, since clinicians had a ready tool that they could offer.

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This is especially important, the researchers noted, given that the average age of onset for MS patients in the U.K. is 42 years. Accordingly, many patients are being diagnosed or starting on disease-modifying therapies [DMTs] during their reproductive years.

“It was acknowledged that patients on DMT for MS may require contraceptive advice, or on the contrary, may be planning a pregnancy creating an imperative that contraception and DMT management is discussed,” the investigators wrote.

Even though a nurse or neurologist might not have the time or expertise to offer detailed guidance on a patient’s sexual health, they can easily give a referral to a specialist capable of providing those exact services.

“I anticipate that it [the clinic] provides a protected space for patients to disclose any problems that they may have in terms of sexual health and pelvic floor health,” said one nurse.

Overall, the study found that the “MS service staff highly valued the new MS ‘pelvic health clinic,’” the team wrote.

“Our results indicate that interdisciplinary collaborations (e.g. neurology and sexual/reproductive health services) can create a safe space in which MS patients concerns … can be remediated,” the team concluded. “The availability of the ‘pelvic health clinic’ allows staff to support enquiries about sexual wellbeing, including contraceptive methods, menopausal matters, sexual dysfunction and healthy relationships, as part of the MS clinical review.”