Sexual Health Assessment as Part of a Whole Health Model to Care: Improving Communication and Technological Barriers (Preprint)

UNSTRUCTURED Sexual health is the state of well-being regarding one’s sexuality, not just the absence of disease or dysfunction. Sexual health is highly valued by most people and associated with overall health. Assessment of sexual health, including sexual orientation and gender identity, should be integrated into the whole health approach to care. Addressing sexual health will enhance preventive care, promote healthy sexual functioning, and optimize overall health and well-being. Unfortunately, sexual health is not routinely assessed in clinical practice. One of the primary barriers is a gap in communication between patients and providers. Providers cite beliefs that patients will bring up sexual concerns themselves, or that patients might be offended by discussing sexual health. By contrast, patients often report an expectation that providers will bring up sexual health, and be comfortable with sexual health discussions in the clinic setting. Within the Veterans Health Administration (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. 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. VHA’s expertise in developing and implementing EHR-based quality improvements and health education interventions may help inform interventions beyond VHA.