Donna Trimm, DNS, RN
Associate Professor
James Madison University
Harrisonburg, VA
Barbara Couden Hernandez, PhD, LMFT, RN
Professor, Director of Physician Vitality
Loma Linda University School of Medicine
Loma Linda, CA
Marvin and Mable
Describe nursing’s responsibilities in caring for
the patient’s sexual health.
Analyze the impact of
illness/injury/aging/disability on
sexuality and sexual health.
Explore communication
techniques, interventions and
support needed for the patient’s
sexual health.
“Sexuality is a central aspect of being human
throughout life.
Sexual health is 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, as well
as the possibility of having pleasurable and safe sexual
experiences, free of coercion, discrimination and
violence. For sexual health to be attained and
maintained, the sexual rights of all persons must be
respected, protected and fulfilled” (WHO, 2006, p. 5).
Holistic care
Accrediting organizations
AACN
NLN
NANDA
Sexual dysfunction
Ineffective sexuality
patterns
Included in nursing
textbooks
Difficulty communicating sexual needs
Fear of rejection (Kralik, Koch, & Telford, 2001).
Alters relationship dynamics
Partners become caregivers
Anxiety
Loss of self-esteem
Grief & depression
Role changes (McInnes, 2003; Model, n.d.)
Negative body image (Tanyi, 2002)
Increased stress
87% of cardiac nurses (N = 157) felt responsible
for discussing sexuality with patients
67% of nurses thought patients would be upset
72% felt patients would be embarrassed
68% were afraid that patients would be anxious
40% of nurses were hesitant to discuss sexuality
because they didn’t think they would know the
answers or how to respond (Jaarsma et al., 2010)
84.8% (N = 203) said sex counseling is RN
responsibility
39.1% actually do “sometimes” counsel
42% felt comfortable counseling
46.2% felt qualified to offer counseling
71.5% said they had technical knowledge of
post-MI sexuality recommendations
(Vassiliadou et al., 2008)
Themes
Sexuality is…
Linked to attractiveness
The Obstacles Experienced…
Unable to resume the role of a satisfying sexual
partner
My rehabilitation experience…
Did not address their specific needs.
What women want: My ideal rehabilitation
Group or peer discussions
(Robinson, Forrest, Pope-Ellis, & Hargreaves, 2011)
58 Occupational therapists/ 72 Rehab Nurses
30.6% had no sexuality education
Approached 73% of patients
60% routinely offer sexuality counseling
Nurses more likely to counsel patient and
significant other together
Only 37.2% followed up original conversation
Assumed someone else was counseling
Had inadequate knowledge (Novack & Mitchell, 1988)
•Sexuality not a priority by nurses (N = 148).
•72.3% believed that giving patients permission
to talk about sexual concerns was a nursing
responsibility
•1/3 made time to discuss sex with their patients
•47.9% were uncomfortable discussing sexuality
•74.1% thought patients were not too sick to be
concerned about sexuality
•Less than half of the nurses surveyed believed
that discussing sexuality was essential to patient
health outcomes (Magnan, Reynolds, & Galvin, 2006)
“One day we convened a panel of wheelchair men
for some of our residents. These men were in their
twenties, and I was amazed to learn that if they
had their choice between getting back their
walking or their normal sexual function—they’d
choose sex—it was that important to them.
In the hospital we put all our effort toward the
walking—we were doing nothing about this other
problem” (Smith & Bullough, 1975, p. 2194).
#1—Belief patient’s do not expect nurse’s to address
(Magnan & Norris, 2008)
Sensitive/uncomfortable subject
Lack of awareness of one’s attitudes, values, &
feelings
Maintaining patient confidentiality (Health, 2011)
Inadequate relevant information
Women ‘s sexuality is considered less important (Robinson,
Forrest, Pope-Ellis, & Hargreaves, 2011).
Fear of being intrusive or offensive
Dealing with differences (Redelman, 2008)
Fear of negative reaction (Magnan & Reynolds, 2006)
Lack of privacy
Chronic progressive conditions
Chronic pain
Incontinence
Limited mobility
Mental health/dementia
(Heath, 2011)
Assessment
Establish trusting relationship
Use a set of questions
Recognize scope of practice (Longworth, 1997).
Initiate discussion
Exploration of methods
Teaching
Referral (Julien, Thom, & Kline, 2010)
1. Verbalize understanding of sexual anatomy
and function
2. Reduce anxiety and desensitize
3. Identify satisfying and acceptable alternative
sexual expression practices
4. Improve communication and relationship
skills
5. Identify resources for more in-depth sexual
health support
P=permission
Li=limited information
SS=specific suggestions
IT=intensive therapy
(Mercer, 2008; McInnes, 2003; Taylor &
Davis, 2007)
Routine questioning
“I always ask whether patients are having any
relationship or sexual problems. Your sexual
health is an important part of your life.
Generalizing
“People with chronic renal failure often
experience sexual difficulties, such as loss of
desire or problems with enjoyment. How have
you been affected?”
Normalizing
“When a woman receives a diagnosis of breast
cancer it’s normal for her to be concerned
about how treatment might affect her sex life.
What worries have you had?”
Using statistics
“Over 80% of men with peripheral vascular
disease report problems with sex, such as
difficulty gaining and keeping an erection. What
changes have you noticed?”
Other open ended questions
“What kinds of sexual challenges are you
experiencing?”
“What happens when you and your partner try
to make love?”
“How is your health affecting your
relationship?”
(McInnes, 2003, p.265).
OB-GYN and urologist specializing in sexual
health
Sexual health nurse clinician
Sex therapist
Pelvic health physical therapist
Marriage & family therapist
Psychologist
Social work sexuality specialist
Counselor
Rule out STDs
Management of hormone levels
Correction of structural impediments
Management of pain-producing anatomical and
physiological conditions
Retrograde ejaculation
Fibroids
Scarring
Prolapse
Anal fissures
Decubiti
Rehabilitation of the pelvic floor
Lymphadema therapy
Strengthening of pelvic musculature to improve
circulation and prevent venostasis
Nerve mobilization
Pelvic flexibility
Increased mobility of reproductive tissue
Spasm prevention exercises
General flexibility improvement
Talk therapy
Attitudes that prevent sexual enjoyment
Trauma recovery
Homework for patient and significant other
Cognitive behavioral therapy
Training the body to respond in new ways
Exercises for the couple to practice
Skills training
Sexual issues are a couple problem,
not an individual issue
http://www.youtube.com/watch?v=RCs-zEHnWWo (move the slider to 5:27—5:48 (the little guy talking about “a long night sit”)
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http://aasect.org/about.asp
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http://siecus.org/index.cfm?fuseaction=Page.viewPage&pageId=472
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http://www.tandf.co.uk/journals/titles/0092623X.html
EmpowHer.com
www.empowher.com
Find a Psychologist www.networktherapy.com
Find a Marriage and Family Therapist
www.therapistlocator.net
Find a Counselor www.psychologytoday.com
Find a Physical Therapist www.apta.org
Find a Specialty Therapist www.helppro.com
Sexual Health & Disability Alliance www.shade.org.uk
Sexuality Education for Youth with Disabilities
or Chronic Illness http://www.med.umich.edu/yourchild/topics/disabsex.htm
“Do you have any concerns about how your illness or
treatment might affect you as a woman/man?”
“Do you have any concerns about your sexual
functioning?” (Magnan & Norris, 2008, p. 265)
Has there been any change in your sexual functioning?
How satisfied are you with your sexual activity?
Has your medication (or condition) affected your
sexual functioning?” (Longworth, 1997, pp. 167-168)
“What physical problems or other illnesses have you
had that may have had an impact on your sexuality
before being told you had cancer?
Please describe how your sexuality has been affected
by your cancer diagnosis.
What has been the most troubling change in your
sexuality: Interest? Arousal? Ability to have an
orgasm?
Have you experience pain during intercourse?
Have you discussed your concerns about your
sexuality with your partner?
What have your doctors and nurses shared with
you about cancer and sexuality?
What would you have liked to have been told?
When, during treatment, is the best time for
sexuality discussions to occur?
(Wilmoth, Hatmaker-Flanigan, LaLoggia, & Nixon, 2011, p. 702)
Include partner
Teach about the anatomy & physiology r/t the
illness/injury/aging/disability
Join a support group
Manipulate environment
Use drugs effectively—pre-treat
Experiment
Use plenty of alternate affection