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Aims: To ask UK women with diabetes whether they have discussed sexual health with healthcare professionals (HCPs) during diabetes care, and to explore communication barriers. Methods: An online questionnaire was developed, based on a published HCP communication survey, piloted by six women with diabetes. A total of 163 participants, recruited via social media and HCP network, completed Part 1 by selecting Likert or narrative response options, providing descriptive data. We report proportions with 95% confidence intervals (Wilson); percentages are calculated using the number responding to each item. Item-level missingness is retained as a non-analysed category, and the n is reported per question. No inferential comparisons were planned a priori. After Part 1 completion, participants could choose to finish, or to continue to Part 2 questions regarding vulval anatomy, function, and vocabulary (77 completed 2A: 80 completed 2B). Part 2 data was analysed thematically. Results: During diabetes care, a minority of participants, 44/163 (27%), said they had ever discussed sexual health, or had been advised how to access sexual health support, 28/163 (17%). If an HCP discussed sexual health, many women said they expected to feel surprised, 114/163 (70%), or pleased, 88/163 (54%). Some participants said they expected HCPs would find the topic inappropriate, 56/163 (36%), or annoying, 44/163 (27%). Some participants expressed HCP gender preference (75/163 [46%] female and 4/163 [3%] male) for such discussion. Part 2 findings revealed unmet sexual health literacy needs with potential to impact on communication with HCPs. Conclusions: Women reported infrequent communication about sexual health and diabetes during diabetes care. Findings highlight potential communication barriers for some participants including the following: unmet educational needs regarding diabetes and sexual health, lack of confidence about available support, fear of a negative HCP response, and preference for the gender of the HCP. Whereas in previous research, HCPs feared upsetting women by discussing sexual health, many participants said they expected to respond positively.

Aims To explore UK healthcare professionals' practice and attitudes towards asking women with diabetes about sexual health problems, including symptoms of female sexual dysfunction (FSD). Methods An online questionnaire to address the study aims was developed, piloted by ten healthcare professionals (HCPs) and completed by 111 eligible HCPs, recruited via professional networks and social media. Free text data were analysed and reported thematically. Two questions were analysed to test the hypothesis of differences between men's and women's responses. Results The majority of respondents did not ask women with diabetes about sexual problems. Multiple barriers to inquiry were reported, including inadequate training, time constraints, competing priorities, the perceived likelihood that questions will cause surprise or distress (especially for certain groups of women), the belief that sexual problems are to be expected as women age, and the belief that FSD is complex or untreatable, with unclear management pathways. Exploratory findings indicated significant differences in men and women's responses (men disagreed more strongly with prioritisation, and fewer reported routine inquiry about sexual problems in their usual practice). Conclusions HCPs reported not asking women with diabetes about sexual problems during routine care. They described multiple factors reinforcing the silence about sexual health, including inadequate education and perceived social risk for individual HCPs who deviate from the patterns of topics usually discussed in diabetes consultations.