Sexuality and sexual health in nursing care
- Fundamental
Illness, surgery, medicines and age can affect sexuality; the nurse opens the topic respectfully, gives clear information and refers when needed.
What it is
WHO describes sexual health as physical, emotional, mental and social well-being in relation to sexuality, not only the absence of disease, with a respectful approach and freedom from coercion, discrimination and violence. It matters at every age and for every orientation and identity. Chronic illness, cancer, surgery, an ostomy, pain, fatigue, medicines and mood can all change sexual life, yet patients rarely raise it and professionals often avoid it for lack of time, training or comfort. The PLISSIT model (Annon, 1976) gives a simple structure: Permission to talk, Limited Information, Specific Suggestions and Intensive Therapy by a specialist. Nurses usually work at the first levels and refer the rest. The approach is clinical, private, nonjudgmental and focused on assessment and education.
Key points
- Privacy and confidentiality.
- Neutral, inclusive language («partner» rather than assuming).
- Permission from the patient before asking.
- Knowing the limits of one's role and the referral pathway.
Components
- Permission: tell the patient that sexual concerns are common and can be talked about.
- Limited Information: give general facts relevant to the patient's condition or treatment.
- Specific Suggestions: after learning the patient's situation, offer practical suggestions within one's competence (for example, timing, positions, managing fatigue or pain).
- Intensive Therapy: refer to a specialist when the problem goes beyond the first levels.
What it is for
- Detects problems that affect quality of life and adherence (for example, stopping a treatment because of sexual side effects).
- Prevents risks: sexually transmitted infections, unplanned pregnancy, violence.
- Supports body image and the couple's relationship after illness or surgery.
In nursing practice
- Open the topic as part of the routine assessment: «Many people with this condition notice changes in their sexual life. Is that something you would like to talk about?»
- Explain how the illness, surgery or treatment may affect sexuality and what can be done; involve the partner if the patient wishes.
- Watch for signs of sexual violence or coercion and follow the institutional pathway.
- Refer to the treating doctor or a specialist when there is pain, dysfunction or distress that does not improve with basic information.
Common mistakes
- Never asking, assuming the patient will raise it.
- Assuming that older adults, people with disabilities or people without a partner have no sexual needs.
- Using judgemental or heteronormative language.
- Giving specific advice beyond one's competence instead of referring.
Test yourself
Think of the answer, then tap the question to see it.
What does PLISSIT stand for?
Permission, Limited Information, Specific Suggestions and Intensive Therapy: four levels of intervention, from opening the topic to referral to a specialist.
Which PLISSIT levels are usually within nursing practice?
The first levels: giving permission to talk, limited information and, within one's competence, specific suggestions. Intensive therapy is a referral.
Why do patients and professionals often avoid the topic of sexuality?
Because of discomfort, lack of time, lack of training or resources, and communication barriers. Opening the topic routinely and respectfully helps.
Connections
Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order.
Sources: PLISSIT model: sexual counseling for breast cancer survivors (Revista Brasileira de Enfermagem (SciELO), 2019); Sexual health (health topic) (World Health Organization (WHO), 2024); Nursing Fundamentals, 19.3: Care of the older adult, applying the nursing process (Open RN, Wisconsin Technical College System (CC BY 4.0), LibreTexts, 2021).
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Representative model, for educational purposes only.