Identifying sexual health concerns, risk-taking and violence using the newly developed SEXIT Adult tool in a Swedish public outpatient sample

Abstract Background Sexual health concerns, risk-taking behaviors, and experiences of violence are common among outpatients but are rarely addressed during healthcare consultations. Patients seldom raise these issues themselves, and healthcare professionals (HCPs) often lack the knowledge and confidence to initiate discussions. The SEXual health Identification Tool (SEXIT) was developed to facilitate identification of sexual health concerns, risk-taking behaviors, and experiences of violence. This is the first study to evaluate the use of the SEXIT Adult questionnaire (18+) in a diverse Swedish outpatient population. The study examined the questionnaire’s ability to identify individuals’ needs of further discussion and explored whether responses indicating need for follow-up differed by age, gender identity, sexual orientation, or clinics sexual health specialization. Methods Consecutive data collection was conducted using the paper-based SEXIT Adult questionnaire at 10 publicly funded outpatient clinics in Sweden during a three-month period in 2023–2024. The sample comprised 438 patients. Data were collected by 61 HCPs, including physicians, midwives, nurses, psychologists, and social workers. Analyses included descriptive statistics and parametric tests. Differences in the mean number of responses indicating need for follow-up were examined using one-way ANOVA (age, gender identity) and independent t-tests (sexual orientation, clinic specialization). Results More than 90% of participants provided at least two responses indicating follow-up. Nearly half (49.1%) reported ongoing sexual problems, and 58.0% reported experiences of sexual violence. Furthermore, 4.4% reported having crossed another person’s sexual boundaries. Patients attending clinics specializing in sexual health reported significantly more responses indicating need for follow-up than those attending non-specialized clinics. Individuals aged 30–54 years reported more such responses than both younger and older age groups. Sexually diverse participants reported more concerns than heterosexual participants. Conclusions SEXIT Adult identified a substantial and likely unmet need for discussions about sexual health, risk-taking behaviors, and experiences of violence in outpatient care. The findings highlight the importance of routinely addressing these issues in clinical encounters and underscore the need for knowledgeable, inclusive, and tailored care, particularly for gender and sexually diverse populations.