Integrating structured sexual healthcare into a public gynaecological service: a single-centre retrospective implementation study

Sexual health is a fundamental component of overall health, yet it remains insufficiently addressed within public healthcare systems, where access to structured sexual healthcare is limited. Women with gynaecological conditions represent a population with a high burden of sexual health concerns, highlighting a significant unmet need. This study aimed to describe the real-world implementation of a structured sexual healthcare pathway within a public gynaecological service. We conducted a retrospective, uncontrolled, real-world implementation study in a tertiary public hospital in Barcelona, Spain. Women aged ≥ 18 years with gynaecological conditions and suspected sexual dysfunction were referred to a specialised sexual health consultation between January 2016 and December 2023. The intervention consisted of a structured, stepwise sexual healthcare approach delivered by gynaecologists trained in clinical sexology. Outcomes included continuity within the planned follow-up pathway, treatment delivery, sexual activity, and overall sexual well-being. Clinical outcomes were assessed from documented clinical assessments at the last recorded consultation; no validated patient-reported outcome measures were used. A total of 184 women were included (mean age 41.6 years, SD 13.1). The proportion of sexually active women increased from 58.7% (108/184; 95% CI 51.2–65.9) at baseline to 84.8% (156/184; 95% CI 78.8–89.6) at the last documented assessment, with 48 of 76 women (63.2%; 95% CI 51.3–73.9) who were sexually inactive at baseline resuming sexual activity (exact McNemar test, p < 0.001). Overall, 101 participants (54.9%; 95% CI 47.4–62.2) experienced improvement in sexual health, defined as resolution of symptoms or adaptation to a satisfactory sexual life despite persistent symptoms, while 33 (17.9%; 95% CI 12.7–24.3) reported a neutral or non-prioritised sexual life. Continuity within the planned follow-up pathway was observed in 118/184 participants (64.1%; 95% CI 56.7–71.1). A structured, multimodal sexual healthcare pathway delivered by gynaecologists with postgraduate training in clinical sexology was associated with documented improvements in sexual well-being and resumption of sexual activity among women with complex gynaecological conditions. The findings support the integration of specialised sexual healthcare within tertiary gynaecological services, while the retrospective uncontrolled design limits causal inference and conclusions regarding scalability or resource efficiency.