# Healthcare providers’ perceptions of sexual health concerns among female patients with cervical and breast cancer and survivors in Rwanda: a qualitative interview study

## TL;DR

This study explores how healthcare providers in Rwanda perceive and address sexual health concerns for women with breast and cervical cancer, highlighting cultural and systemic barriers.

## Contribution

The study provides novel insights into healthcare providers’ perceptions of sexual health in cancer care within a low-resource setting like Rwanda.

## Key findings

- Healthcare providers face social and cultural barriers in discussing sexual health with cancer patients.
- Systemic issues like staff shortages and unclear responsibilities hinder comprehensive sexual healthcare delivery.
- Sexual and gender-based violence is a significant barrier to sexual health during cancer treatment.

## Abstract

In Rwanda, breast and cervical cancer are the most common cancers among women of reproductive age, posing significant public health challenges. These cancers do not only account for the highest mortality and morbidity, but also impact women’s sexual health and well-being—often overlooked in cancer care settings. Little is known about healthcare providers’ capacity to counsel patients on sexual health in contexts with limited psychosocial cancer services.

A qualitative cross-sectional study was conducted to explore healthcare providers’ perceptions, attitudes and knowledge concerning sexual health among female patients with cervical and breast cancer and survivors in two regions of Rwanda. Between January and March 2023, semistructured in-depth interviews were conducted with 15 healthcare providers (medical doctors, nurses, midwives) experienced in treating patients with breast or cervical cancer at four facilities. Interviews were recorded, transcribed verbatim and analysed using content analysis to identify emerging themes related to providers’ perspectives on sexual health counselling.

Two main themes emerged, with the first theme ‘Perceived barriers to sexual healthcare for female cancer patients’ highlighting social and cultural taboos related to sexuality, sexual health knowledge and awareness among both providers and patients, and socio-economic barriers. The second theme, ‘Systemic challenges in delivering comprehensive sexual healthcare’, illustrated health systems barriers such as staff shortage and unclear responsibilities, gendered barriers during counselling and ambiguous sexual health information provided. Sexual and gender-based violence as a barrier to sexual health emerged as a cross-cutting theme, with providers noting different forms of violence faced by patients during cancer therapy.

Findings underscore the pressing need to prioritise women’s sexual health and well-being within cancer care settings in a lower-middle income country context such as Rwanda. Health systems efforts are necessary to enhance the sexual health counselling proficiency of current oncology providers, as well as to train new generations of providers.