The commercialisation and democratisation of the health and wellness industry empowers and educates a growing audience in the possibilities and impact of aesthetic and regenerative medicine. However, it has also blurred the lines between professional and non-professional practice, creating a marketplace fraught with risks and uncertainties amidst long overdue regulatory barriers. In this dynamic environment, aesthetic nurses are uniquely positioned to lean into a specialism that not only sets them apart, but also leverages their core competencies: compassion, courage, communication, and commitment (NMC, 2018). Intimate wellness offers a powerful opportunity for nurses to diversify their skillsets and expand their service offerings. By focusing on this deeply personal aspect of patient care, nurses can engage both new and existing clients in meaningful ways, fostering trust and loyalty whilst addressing critical aspects of women's health. Intimate wellness serves a purpose not only as an expansion of an aesthetic offering, but as a natural extension of the holistic care that nurses are already primed to provide.
With the integration of intimate wellness in existing practice, aesthetic nurses can enhance patient outcomes within their clinical remit, offering counsel and knowledge alongside the provision of evidence-based treatments aiming to improve quality of life from both a physiological and psychological perspective. This specialisation allows nurses to stand out in a saturated landscape, reinforcing their role as trusted healthcare professionals dedicated to the well-being of patients. In a rapidly changing industry, embracing this specialism not only strengthens practice but also reaffirms the essential values that define the nursing profession.
Intimate wellness: redefining sexual health
Intimate wellness is by no means a new concept, encompassing genitourinary, sexual and psychosexual health from a holistic perspective. The World Health Organization (WHO) defines guideposts for clinicians and research in sexual health, defined as ‘…a state of physical, emotional, mental and social well-being in relation to sexuality; it is not merely the absence of disease, dysfunction or infirmity. Sexual health requires a positive and respectful approach to sexuality and sexual relationships’ (WHO, 2006a).
Reflecting the broader societal shift to a more integrated understanding of health and wellbeing, intimate wellness surpasses the reductive diagnostic criteria for specialist referrals in gynaecology, genitourinary or sexual health. It recognises the interconnected nature of the physical, emotional and the psychological impact of intimate concerns on quality of life and the mental health of individuals, couples, and families. Although intimate wellness has no defining sexuality or gender, this preliminary work will specifically refer to intimate health within the remit of a (biologically) female perspective. It should be emphasised that intimate wellness is of critical importance in male, female, trans and non-gender conforming individuals and populations.
A review of existing literature examined research surrounding intimate wellness, aiming to identify key themes and determine an appropriate definition for intimate wellness. Mitchell et al (2021) outlined the ‘conflation’ of sexual health and sexual wellbeing, arguing that the public health approach to sexuality remains rooted in a risk-focused biological or medical standpoint. Failing to identify the differentiation of health vs. wellbeing and recognising the interconnectivity serves to exacerbate the existing ambiguity surrounding intimate wellness concerns and widens the barriers for patients seeking care. A thematic analysis of literature drew four key themes - depicted in Figure 1.0, allowing for an inclusive definition of intimate wellness which serves as a reference point for future development and research.
Barriers to intimate wellness
Intimate wellness is an essential component of overall health, yet it remains a challenging area to address due to a multitude of barriers faced by both patients and providers (Kinsberg et al, 2019). Despite the growing interest in this field significant obstacles prevent many individuals from seeking the care they need. Exploring these barriers, drawing on both quantitative survey results and qualitative insights highlights the challenges and allows for the proposal of solutions and guidance for practitioners.
Despite increasing openness and inclusivity around sexual health, greater awareness of key issues in intimate wellness and changes in governmental and public policy supporting areas such as menopause, women's health and sexual wellbeing, social stigma around female sexuality remains. As a result, women may avoid or experience shame when discussing sexual health with health care providers (HCP's) (Kinsberg et al, 2019). Lack of awareness and misconceptions around sexual or intimate health conditions for both patients and HCP's lends to conditions being undiagnosed or misdiagnosed. There exists a significant lack of training, resources and time which impedes appropriate clinical assessment and discussions about intimate health conditions and the impact of associated sequelae (FemTechnology, 2022).
» By focusing on this deeply personal aspect of patient care, nurses can engage both new and existing clients in meaningful ways, fostering trust and loyalty whilst addressing critical aspects of women's health «
Irrespective of governmental strategies and a rise in public policy for women's health, women in the United Kingdom continue to battle with misinformation and mismanagement of concerns across all avenues of care delivery. According to the 2021 Department of Health and Social Care call for evidence for the UK Government's 2024 Women's Health Strategy, women felt that they were not listened to throughout all stages of their care pathway, including being dismissed or not taken seriously by HCP's, having to self-advocate over months and years to secure a diagnosis (DHSC, 2024). A review of the current NICE guidelines demonstrates the varying pathways and ambiguous management for intimate health issues. Women's health is overtly marginalised and siloed, leading to missed diagnoses and mismanagement of conditions.. The complex commissioning models split across local and national organisations such as fertility, sexual health, menopause, gynaecology, maternity and more, fails to recognise the interconnectivity of these sectors and stipulates strict diagnostic criteria for referrals or access to care. Meeting this narrow criteria for referral to specialist services allows for patients presenting with significant pathology to access the appropriate care pathway, and it is strongly acknowledged that defined clinical specialisms are imperative for positive outcomes. However, this leaves a vast cohort of individuals with non-acute, subclinical, or chronic concerns experiencing significant detriments to physiological and psychological health. Evidence suggests that for common presentations such as genitourinary symptoms of menopause, fertility and sexual health, the input of HCPs in primary and tertiary care settings varies widely and access is not equitable nor integrated (NICE, 2022; DHSC, 2024).
Patient insights: intimate wellness and existing knowledge
Preliminary primary research was undertaken to assess the scope of intimate wellness concerns within a cohort of aesthetic patients. A cross-sectional survey was conducted over a 12-month period, 150 female patients between the ages 25-66 were invited to participate during routine aesthetic consultations or follow-up appointments, participants submitted responses anonymously. The survey consisted of a structured questionnaire, involving both quantitative and qualitative components, with the goal of assessing intimate health concerns.
The survey spanned the 4 core domains identified in the literature review
- Vaginal and vulval health: including appearance, atrophy, dryness and discomfort
- Sexual health: including sexual satisfaction, libido, dyspareunia and sexually transmitted infections
- Psychosexual wellbeing: including mental health, intimacy and relationships and body image
- Hormonal health: PCOS, imbalances, perimenopause and postmenopause.
Likert-type format was incorporated to measure satisfaction and concern levels, with responses ranging from ‘very satisfied’ to ‘very dissatisfied’, and ‘no concern’ to ‘extreme concern’. Additional questions assessed participants' knowledge of which HCPs to consult for intimate health concerns, and their comfort level in discussing these issues with different professionals. The quantitative data were analysed using descriptive statistics to determine the prevalence of various intimate health concerns. Cross-tabulation was employed to explore relationships between the type of concern and the preferred healthcare professional. Qualitative responses were analysed thematically to provide context to the quantitative findings.
Results indicated that 82% (N=123) of participants reported one or more intimate health concerns. The most prevalent concerns were related to menopause symptoms at 48% (N=72), sexual satisfaction, 42% (N=63) and recurrent infections, 38% (N=56). Despite these concerns, 67% (N=101) of respondents were unsure which healthcare professional to consult, with 64% (N=96) expressing discomfort discussing these issues with their general practitioner (GP) or an unknown professional. Notably, 78% (N=117) reported they would be comfortable discussing their concerns and seeking advice from their aesthetic clinician.
The findings of this preliminary research suggest that intimate health concerns are indeed prevalent among a wide age-range of women who are existing aesthetic patients, yet there is significant uncertainty about where to seek help. The high level of discomfort in discussing these issues with an unknown HCP, and the lack of knowledge about when and how to seek support from specialist referrals such as gynaecology or urology, highlights a major pitfall in the knowledge and understanding of intimate health concerns. Given that the majority of participants stated that they would feel comfortable discussing intimate health concerns with their aesthetic practitioner due to a strong rapport and trusting relationship, there is a clear opportunity for aesthetic nurses to expand their role by incorporating intimate wellness services and providing a trusted, knowledgeable resource for patients.
Whilst offering important initial insights, the findings of this work are exploratory rather than conclusive due to the limited scope and methodological constraints. The preliminary study confirms intimate health concerns within a small cohort of aesthetic patients and iterates the need for subsequent rigorous research allowing for much wider generalisability and validity of findings with the goal of constructing actionable insights and a framework for integrating intimate wellness into aesthetic practice.
Exploring clinical perspectives: practitioner insights in intimate health
A preliminary qualitative research study was conducted with the aim of exploring perceptions and experiences of medical aesthetic practitioners within the context of intimate wellness. Two focus groups were conducted (N=20) within a cohort of NMC-registered nurses and midwives, GMC-registered doctors, GDC-registered dentists, and GPC-registered pharmacists. Selection criteria required that participants spend at least 75% of their clinical practice in the aesthetic field. All participants were performing at least one treatment that could be adapted for intimate wellness such as energy-based devices, platelet rich plasma (PRP) or injectables, but none were offering intimate wellness as a service in their practice. Two focus groups were conducted, each comprising 10 participants. The 90 minute discussions were held in a neutral setting conducive to open dialogue. Focus groups were facilitated by an experienced moderator, who guided the discussions using a semi-structured interview format. This guide included questions about the participants' experiences, challenges, and perceived barriers in addressing intimate health concerns. The sessions were audio-recorded and transcribed verbatim for analysis. The data was analysed via thematic analysis, appropriate for identifying and interpreting patterns within qualitative data (Maguire and Delahunt, 2017). In order to ratify and enhance accuracy of analysis, Atlas.ti AI software was employed to assist in coding the transcripts and extrapolating key themes.
This research highlights several key challenges that medical aesthetic practitioners face with the implementation of intimate wellness into their practice, including lack of knowledge, confidence, and access to training. Despite these barriers, there was a significant interest amongst practitioners for expanding service offering to include more holistic wellbeing treatments. To effectively incorporate intimate wellness into aesthetic practice, there is a need for comprehensive training programs, clear clinical guidelines and a supportive practice environment that encourages open dialogue about these sensitive issues. By addressing these challenges, aesthetic practitioners can play a crucial role in improving the overall health and wellbeing of their patients.
While the findings offer valuable insights, it also highlights the need for more extensive research. Future studies should involve larger, more diverse samples, employ a combination of qualitative and quantitative methods and explore the identified themes in greater depth. By addressing these limitations, future research can provide more robust guidance for practitioners looking to expand their service offerings to include intimate wellness. By doing so, aesthetic nurses can not only enhance patient outcomes by addressing an important aspect of overall health but also strengthen their relationships with patients, increase patient satisfaction, and potentially attract a broader client base. This integration of intimate wellness into aesthetic practice underscores the evolving role of aesthetic nurses as trusted, holistic healthcare providers who are uniquely positioned to address both the physical and psychosocial needs of their patients.
Aesthetic nurses: paving the way for intimate wellness
The findings of the literature review and preliminary patient and practitioner research ratifies the initial hypothesis that aesthetic nurses are in a strong position to champion this growing field of healthcare. Aesthetic nurses are uniquely situated to raise sensitive topics with patients and address intimate wellness concerns due to the distinctive rapport and long-term patient engagement. The evolving holistic nature of the aesthetic nurse's remit emphasises the pertinence of expanding service offering to intimate health. The profound nature of aesthetic nursing practice, combined with the trusted, long-term relationships that nurses build with their patients, places them at the forefront of this essential aspect in patient care. Further research seeks recommendations and a framework for the implementation of intimate wellness into aesthetic practice, aimings to establish clear guidelines for education, treatment, referral pathways and the maintenance of positive long-term patient outcomes.
How can aesthetic nurses champion intimate wellness in clinical practice?
Building trust and rapport
- One of the key strengths of aesthetic nurses is their ability to build a strong rapport with patients over time. Aesthetic practices often involve regular visits and follow-ups, which means that nurses are not only familiar with their patients' medical histories but also have a deep understanding of their psychosocial contexts.
- This ongoing relationship creates a safe, trusting environment where patients feel comfortable discussing sensitive issues, including those related to intimate wellness. The trust that aesthetic nurses cultivate with their patients is crucial in overcoming the stigma and discomfort that often surround conversations about intimate health.
Leveraging existing skills and tools
- Aesthetic nurses are already equipped with a wide range of skills and tools that can be effectively extended to intimate wellness.
- The expertise in minimally invasive procedures, skin care, and the use of advanced technologies like lasers and radiofrequency devices can be directly applied to treatments aimed at improving intimate health.
- For instance, techniques used for skin rejuvenation can be adapted for vaginal rejuvenation, offering patients non-surgical options to enhance both function and appearance.
- Moreover, aesthetic nurses' comprehensive understanding of the body's anatomy and physiology allows them to approach intimate wellness with the same precision and care that they apply to facial and body aesthetics. This versatility not only broadens the scope of services they can offer but also ensures that these services are delivered with a high standard of care.
Creating a safe space for intimate discussions
- Incorporating intimate wellness into an aesthetic practice requires creating a safe space where patients feel empowered to discuss their concerns without fear of judgment.
- Aesthetic nurses are well-suited to facilitate conversations due to the empathetic approach and commitment to patient-centred care.
- By normalising discussions about intimate health and educating patients on the available treatments, nurses can demystify these issues and encourage patients to take an active role in their own wellness
- Nurses can initiate these conversations during routine consultations by asking open-ended questions about overall health and well-being, subtly introducing the topic of intimate wellness in a way that feels natural and non-intrusive.
- Providing patients with informational materials or incorporating questions about intimate health into intake forms can also help to break the ice and signal to patients that these topics are welcome in the clinical setting.
Expanding service offerings to enhance patient outcomes
- By integrating intimate wellness into their practice, aesthetic nurses can offer a more holistic approach to patient care, addressing concerns that go beyond traditional aesthetic goals.
- This expansion not only enhances patient outcomes by improving quality of life and boosting self-esteem but also positions the practice as a leader in comprehensive wellness care. As the demand for intimate wellness services continues to grow, aesthetic nurses who embrace this niche will be well-positioned to meet the needs of a diverse patient population.
- Additionally, offering intimate wellness services can strengthen the business by attracting new clients and retaining existing ones.
- Patients who trust their aesthetic nurse with their intimate health are likely to become more loyal and engaged, leading to higher satisfaction and long-term relationships. This trust is particularly important in an industry where word-of-mouth and patient referrals are key drivers of business growth.
Summary
- Aesthetic nurses are uniquely qualified to integrate intimate wellness into their clinical practice, leveraging their existing skills, tools, and relationships with patients to address a critical area of health that is often overlooked. By creating a safe space for intimate health discussions and confidently incorporating these services into their offerings, aesthetic nurses can enhance patient care, improve outcomes, and solidify their role as leaders in the holistic wellness movement.
- As the landscape of aesthetic medicine continues to evolve, those who embrace this opportunity will not only expand their practice but also contribute to a broader understanding and acceptance of intimate wellness as vital component of overall health.