Background: Sexual health concerns are prevalent yet frequently neglected during menopause. This qualitative study explored and explained the perceptions and experiences of midwives, obstetrics and gynecology (OB/GYN) residents, and general practitioners (GPs) regarding discussing sexual health with postmenopausal women, framed within the Theory of Planned Behavior (TPB).

Methods: We conducted a directed content analysis, integrating TPB constructs into conventional content analysis per Graneheim and Lundman. Using purposive sampling with maximum variation, supplemented by snowball sampling, 32 participants were recruited from multiple settings in Mashhad, Iran. Data were collected through in-depth, semi-structured individual interviews and analyzed until thematic saturation.

Results: Thirty-two interviews with 14 midwives, 13 GPs, and 5 OB/GYN residents yielded 1,156 initial codes, refined to 226 final codes, 54 subcategories, 18 categories, and five TPB-aligned themes: attitude, subjective norms, perceived behavioral control, intention, and behavior. Attitudes reflected tension between perceived risks to professional dignity and benefits such as family stability, biopsychosocial health, and improved sexual health literacy. Subjective norms emphasized cultural and religious sensitivity, respect-oriented care, and adherence to professional codes. Perceived behavioral control was constrained by limited knowledge and skills, weak policies, low prioritization of sexual health services, and cultural taboos. Intentions depended on assessing client readiness and creating a supportive environment; behaviors included patient priming and delivering counseling and therapeutic services.

Conclusion: Healthcare providers experience conflict between perceived benefits of discussing sexual health and potential risks to professional standing. Clinicians’ intention and behavior are substantially constrained by social pressures, skill deficits, and structural barriers. Interventions should move beyond information sharing to empower providers to navigate socio-cultural taboos, enhance clinical communication training, and reform healthcare delivery protocols.