Integrating sexuality into holistic palliative care: a narrative review

Palliative care applies a holistic, person-centered approach to pain and symptom management for health-related suffering up to the end of life. But, it often excludes sexuality, despite its continued importance to patients and their intimate partners. This review identifies gaps and suggests future directions for research and practice. Sexuality is important for patients receiving palliative care, even toward end of life. Patients are willing to discuss sexuality but would prefer healthcare professionals to introduce the subject. Healthcare provider attitudes, discomfort, and insufficient training affect their ability to effectively discuss sexuality, which may also uniquely result in discriminatory care for sexual and gender diverse people. Research gaps include self-sexuality, kink, consensual non-monogamy, sex work, and strengths-based approaches. From the existing literature, we propose an intersectional sex-positive approach to palliative care that is person-centered and strengths-based. This requires a cultural shift in palliative care practice, where addressing sexuality is seen as important and routine, patients’ sexuality is facilitated, and palliative care teams integrate sex therapists and sexual and gender diverse community resources into their practice.