Sexual Boundaries with Patients and Colleagues

Why is sexual assault relevant to healthcare professionals?

Because they often work hands-on with vulnerable people and must maintain safe, professional boundaries.

Define “boundaries” according to Harper & Steadman (2003).

Boundaries establish therapeutic relationships, recognize separateness, foster safety, and define contexts of power, authority, trust, and dependence.

What influences boundaries?

Social, cultural, political, philosophical, clinical, ethical, legal, and personal factors.

What are sexual boundaries?

Limits that prevent healthcare professionals from displaying sexualised behaviour toward patients or carers.

Why must sexual boundaries be maintained?

Because the healthcare relationship is based on trust; breaching it causes harm, is unprofessional, and may be criminal.

Define “sexualised behaviour.”

Acts, words, or behaviour designed or intended to arouse or gratify sexual impulses or desires.

What happens if a healthcare professional breaches sexual boundaries?

It damages public trust, the profession’s reputation, and may constitute a criminal offence.

Why are sexual boundaries important for hands-on professionals?

Because physical contact increases the potential for misinterpretation or misconduct.

What common “defences” are used by professionals accused of breaches?

“The patient started it,” “The patient wanted it,” “I was mentally unwell,” “I fell for the patient.”

What does GCC require about professional boundaries?

They must be clearly defined and maintained to avoid harm or confusion.

GCC Code – D1

Do not abuse your position of trust or cross sexual boundaries.

GCC Code – D2

Always be professional and treat all patients with respect and dignity.

GCC Code – D3

Explain why clothing removal is needed, offer privacy and a gown.

GCC Code – D4

Consider using a chaperone for intimate procedures, children, or vulnerable adults.

Is it ever appropriate to date a former patient?

Usually no. The previous power imbalance may still influence the relationship.

What makes former patients more vulnerable?

Chronic conditions, pain, mental health issues, and dependency on care.

Why is it risky to date a former patient?

You’ve held privileged knowledge and power; it can lead to harm or confusion.

What should you do if you’re attracted to a patient?

Seek help from a colleague, stay professional, and transfer care if objectivity is lost.

What should you do if a patient is attracted to you?

Consult a colleague, discuss professionally (with a witness), document, and consider transferring care.

Are sexual boundaries one-directional?

No, they are contextual and multi-directional — both patient and professional perceptions matter.

What factors create power imbalance in care?

Patient vulnerability, practitioner control of contact and frequency, and knowledge imbalance.

How do boundary breaches usually begin?

With small, gradual steps — “boundary creep.”

Examples of boundary creep?

• Sharing personal details

• Social invitations

• Out-of-hours appointments alone

• Non-clinical conversations

Key positive behaviours to maintain sexual boundaries?

• Explain clothing removal.

• Offer gowns and privacy.

• Document exposure/consent.

• Never be alone with minors or vulnerable adults.

• Prevent carers from leaving the room.

Example of good documentation?

“Offered gown, patient declined and consented to shoulder treatment in bra.”
“Patient consented to gluteal region treatment, draped with towel.”