Sexual Health

Exploring barriers and solutions in sexual health services: a qualitative study from Iran.

TL;DR

This qualitative study reveals that sexual health clinics in Iran face structural, socio-cultural, professional/organizational, and service-related challenges, while identifying opportunities and solutions including resource development, evidence-based practices, and de-labeling efforts to reduce stigma.

Key Findings

Three main categories emerged from the data: Challenges, Opportunities, and Solutions in sexual health service provision in Iran.

  • Challenges were subdivided into structural, socio-cultural, professional and organizational, and service-related challenges
  • Opportunities included university capacities, alignment with national policies, autonomy, and effective leadership strategies
  • Proposed solutions included resource development, implementation of evidence-based practices, and de-labeling efforts to reduce stigma
  • Data were collected from July to October 2024 using conventional content analysis

Stigma surrounding sexual health was identified as a significant barrier to accessing sexual health clinic services in Iran.

  • De-labeling efforts were specifically proposed as a solution to reduce stigma surrounding sexual health
  • The study noted that sexual health issues are 'often stigmatized,' making it crucial to address these concerns
  • Open dialogue was identified as part of the solution to reduce stigma
  • Stigma was implicitly linked to both socio-cultural challenges and service-related barriers

A diverse group of stakeholders participated in the study, achieving data saturation across multiple participant categories.

  • Total participants included four policymakers, four specialists, 26 clients, and 120 health providers
  • Data collection methods included in-depth semi-structured interviews and Focus Group Discussions (FGDs)
  • Data saturation was achieved after engaging with this full participant group
  • The study was conducted in Sari, Iran, limiting geographic generalizability

Structural challenges were identified as a key barrier to sexual health service provision in Iran.

  • Structural challenges were listed as one of four sub-categories under the main 'Challenges' category
  • Infrastructure development was identified as part of the proposed solutions, suggesting existing infrastructure was inadequate
  • The study emphasizes the need to 'improve access to sexual health centers in Iran through infrastructure development'
  • These structural issues were identified from perspectives of policymakers, specialists, clients, and health providers

Sexual health literacy was identified as a critical factor linked to rising divorce rates and marital dissatisfaction in Iran.

  • The study cites 'rising divorce rates and marital dissatisfaction linked to sexual health literacy' as a motivating concern
  • Educational initiatives were proposed as part of the solutions framework
  • Enhancing sexual health literacy was emphasized as a key need
  • The relationship between sexual health and broader life outcomes including 'physical health, mental health, relationships, job stability, and lifestyle choices' was noted

University capacities and alignment with national policies were identified as opportunities to strengthen sexual health services.

  • Opportunities included university capacities, alignment with national policies, autonomy, and effective leadership strategies
  • These opportunities were framed as potential leverage points for improving service delivery
  • Alignment with national policies suggests existing policy frameworks could support sexual health service expansion
  • These opportunities were identified alongside the challenges as part of the three-category analytical framework

Professional and organizational challenges were identified as a distinct barrier category in sexual health service delivery.

  • Professional and organizational challenges formed one of four sub-categories under 'Challenges'
  • Health providers (n=120) were the largest participant group, suggesting provider-level perspectives were well-represented
  • These challenges were identified alongside structural, socio-cultural, and service-related challenges
  • Implementation of evidence-based practices was proposed as a solution, implying gaps in current professional practice

What This Means

This research suggests that people in Iran face significant obstacles when trying to access sexual health services, including physical and structural barriers, cultural stigma, and gaps in professional training and organizational support. The study gathered perspectives from a wide range of participants — including government policymakers, medical specialists, patients, and 120 healthcare providers — through interviews and group discussions conducted at sexual health clinics in Sari, Iran. Three broad themes emerged: the challenges people and providers face, the opportunities that exist within the current system, and practical solutions that could help. This research suggests that stigma is a particularly important barrier, with patients and providers alike affected by the social discomfort surrounding sexual health topics. At the same time, the study found reasons for optimism: existing university resources, supportive national policies, and strong leadership were identified as assets that could be built upon. Proposed solutions included investing in clinic infrastructure, improving health education, training providers in evidence-based approaches, and actively working to reduce the shame and stigma attached to seeking sexual health care. This research suggests that addressing these barriers could have wide-ranging benefits, as sexual health is connected not only to physical wellbeing but also to mental health, relationship stability, and even employment. The authors highlight that rising divorce rates and marital dissatisfaction in Iran are linked to poor sexual health literacy, underscoring the broader social importance of improving access to these services. The findings are specific to one city in Iran and may not apply universally, but they offer a framework for thinking about how cultural, structural, and educational factors interact to shape sexual healthcare access.

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Citation

Hamzehgardeshi Z, Azizi M, Ganji J, Farahani M, Gelehkolaee K. (2025). Exploring barriers and solutions in sexual health services: a qualitative study from Iran.. Reproductive health. https://doi.org/10.1186/s12978-025-02165-0