Addressing sexual health after cancer: whose job is it anyway? Provider practices and communication barriers.

PURPOSE: Despite established clinical guidelines recommending sexual health screening in oncology care, significant gaps in provider-patient communication persist. This study examined the experiences of gynecologic oncology providers regarding sexual health communication to guide the design of a targeted training intervention. METHODS: Semi-structured interviews were conducted with 21 gynecologic oncology healthcare providers, including gynecologic oncologists, nurse practitioners, and physician assistants, practicing across three large healthcare systems in a single Midwestern U.S. state. Interviews were conducted via Zoom, audio recorded, professionally transcribed, and analyzed using inductive thematic analysis. RESULTS: Two overarching themes were identified: contextual variability of sexual health communication and factors influencing sexual health communication. Providers described variability in the initiation, timing, and content of sexual health discussions, with advanced practice providers reporting greater comfort initiating these conversations than physicians. Key barriers included perceived time constraints, provider and patient discomfort, age-related assumptions, cultural and linguistic challenges, and uncertainty about professional scope of practice. Notably, providers demonstrated awareness of these barriers yet reported difficulty translating that awareness into consistent practice. CONCLUSION: Gynecologic oncology providers recognize the importance of sexual health communication but face substantial structural, interpersonal, and cultural barriers that limit consistent implementation. Findings support the need for accessible, skills-based training and system-level strategies that embed sexual health communication as a routine component of gynecologic cancer survivorship care.