Original article
Reproductive and sexual health in males with cystic fibrosis: a case for health professional education and training

https://doi.org/10.1016/S1054-139X(00)00172-5Get rights and content

Abstract

Purpose: To survey the attitudes and clinical practice of health professionals to identify current practice and possible barriers to discussion of sexual and reproductive health issues in adolescent males with cystic fibrosis (CF).

Methods: An interview schedule was developed to seek information about attitudes to reproductive and sexual health in males with CF and to elicit details of reported professional practice of health care providers from four CF centers in Massachusetts.

Results: Of 32 health professionals interviewed, 66% informed parents about male infertility soon after diagnosis in infancy; 22% of those not informing parents at this time waited until later childhood or adolescence; and 12% reported they did not discuss these issues with parents during childhood or adolescence. All respondents reported they discuss infertility with male adolescents. The mean age thought most appropriate to discuss infertility was 13.8 (±2.2) years, although most do so at 15.2 (±2.8) years (p < .05). Fifty percent report routinely discussing that sexual performance is not affected by CF; 38% discuss the importance of condom use; 50% discuss normal sexual performance; 13% offer semen analysis to adolescents; and 3% inform males about small-volume ejaculates. Reproductive options are discussed with adolescents by 19% of clinicians. The themes of embarrassment, insufficient time, the difficulty of finding the “right” time, and insufficient training were identified as barriers to these discussions.

Conclusions: Greater training for health professionals in the reproductive and sexual health issues of CF is a step to more complete, timely, and comfortable discussion of this area of health care.

Section snippets

Subjects

Health care providers (respiratory physicians, respiratory fellows, and nurse-practitioners) who regularly provide specialist CF care at the four CF centers in the state of Massachusetts (Children’s Hospital, New England Medical Center, and Massachusetts General Hospital in Boston and University of Massachusetts Medical Center in Worcester) were identified and invited to participate in this study. Thirty-two practitioners, consisting of 19 respiratory physicians (59%), ten respiratory fellows

Results

Twenty-seven of the 32 health care providers (84%) believe that the CF center, not the primary care provider, has the main responsibility of informing males about reproductive and sexual health issues as they relate to CF.

Twenty-one health care providers reported informing parents of newly diagnosed male infants with CF of likely infertility soon after diagnosis. Ten reported they did not again talk to parents about reproductive and sexual health unless specifically asked. Seven reported first

Discussion

This study suggests that, among these health care providers, there is consensus with the recent recommendations when it comes to the importance of discussing infertility with adolescent males with CF. However, a more variable practice was reported when it comes to discussion of the other recommended topics (6) ranging from 50% who routinely reassure men about normal sexual performance to only 3% of health care providers who report they discuss small-volume ejaculate with adolescents with CF.

The

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      As many view their subspecialist as a primary care provider [20], men may rely on the CF team for SRH counseling and referrals. Unfortunately, CF providers may lack training and comfort in SRH [4,21]. In a survey of men with CF, one-third preferred to hear about fertility issues from their CF team, one-third from parents, and the remainder from a combination of parents, providers, and educational materials [16].

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    1

    Dr. Sawyer is currently Associate Professor, Department of Paediatrics, University of Melbourne, Australia.

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