Background: Sexual health concerns are prevalent yet frequently neglected during menopause. This qualitative study explored the perceptions and experiences of midwives, obstetrics and gynecology (OB/GYN) residents, and general practitioners (GPs) regarding discussions of sexual health with postmenopausal women, using the Theory of Planned Behavior (TPB) as a guiding framework.
Materials and Methods: We conducted a directed content analysis integrating Theory of Planned Behavior constructs with conventional content analysis, following Graneheim and Lundman. Using purposive maximum-variation and snowball sampling, we recruited 32 participants from multiple settings in Mashhad, Iran. In-depth, semi-structured interviews were conducted and analyzed until thematic saturation.
Results: Fourteen midwives, 13 general practitioners, and 5 obstetrics and gynecology residents participated. Analysis yielded 1,156 initial codes, refined to 226 final codes, 54 subcategories, 18 categories, and five Theory of Planned Behavior–aligned themes: attitudes, subjective norms, perceived behavioral control, intention, and behavior. Attitudes reflected tension between protecting professional dignity and the potential benefits of discussing sexual health, including family stability, biopsychosocial well-being, and improved sexual health literacy. Subjective norms emphasized cultural and religious sensitivity, respectful care, and adherence to professional codes. Perceived behavioral control was hindered by inadequate knowledge and communication skills, weak policies, low prioritization of sexual health services, and cultural taboos. Intentions relied on assessing women’s readiness and creating supportive environments; behaviors included patient priming, counseling, and therapeutic services.
Conclusion: Healthcare providers face tension between the benefits of sexual health discussions and perceived risks to professional standing. Their intentions and practices are constrained by social expectations, inadequate knowledge and skills, and structural barriers. Interventions should strengthen communication skills, address sociocultural taboos, and improve healthcare-delivery protocols.