Sexual health assessment is vital to whole health models of care
Authors: Uzdavines Alex , Helmer Drew , Spelman Juliette , Mattocks Kristin , Johnson Amanda , Chardos John F , Lynch Kristine E , Kauth Michael R 
Published: December 2021

Introduction:Sexual health is the state of well-being regarding one’s sexuality. Sexual health is highly valued by most people and associated with overall health. Overall health and well-being are more than the absence of disease or dysfunction. Healthcare systems adopting wholehealth models of care need to incorporate holistic assessment of sexual health. This includes assessing patients’ sexual orientation and gender identity (SOGI). If health systems, including but not limited to the Veterans Health Administration (VHA), incorporate sexual health into whole health models of care they could enhance preventive care, promote healthy sexual functioning, and optimize overall health and well-being.Benefits of Assessing Sexual Health:Assessing sexual health can give providers important information about a patient’s general health, well-being, and health goals. Sexual concerns or dysfunction may also signal undiagnosed health conditions. Additionally, collecting SOGI information as part of a sexual health assessment would allow providers to address problems that drive disparities for LGBTQ+ populations.Barriers to Assessing Sexual Health:Unfortunately, healthcare providers do not routinely assess sexual health in clinical practice. One barrier to assessing sexual health is a gap in communication between patients and providers. Providers cite beliefs that 1) patients will bring up sexual concerns themselves or 2) that patients might be offended by discussing sexual health. By contrast, patients often report 1) an expectation that providers will bring up sexual health and 2) being comfortable with discussing sexual health with their providers.Within the VHA, the lack of a sexual health template within the electronic health record (EHR) adds an additional technological barrier. The VHA’s transition toward whole health and updates to its EHR will provide unique opportunities to integrate sexual health assessment into routine care. We highlight future system modifications to address this within the VHA. These examples may be helpful for other healthcare systems interested in moving to a whole health model of care.Overcoming Barriers to Sexual Health Assessment:Given the multifaceted barriers to sexual health assessment, it will be vital for healthcare systems integrating a whole health approach to develop both practical and educational interventions to address the communication gap. These interventions will need to target both providers and patients in healthcare systems that transition to a whole health model of care, not just the VHA.Conclusions:Both the communication gap between providers and patients and the lack of support within some EHR systems for sexual health assessment are barriers to assessing sexual health in primary care clinics. Routine sexual health assessment would benefit patient well-being and present an opportunity to address health disparities for lesbian, gay, bisexual, transgender, queer and similar minority (LGBTQ+) populations. Healthcare systems (i.e., both the VHA and other systems) can overcome these barriers by implementing educational interventions and updating their EHRs and back-end data structures. VHA’s expertise in developing and implementing health education interventions and EHR-based quality improvements may help inform interventions beyond VHA.