Who wants to talk about sex?

Su Yin Yap says every healthcare professional should be ready to discuss sexual health issues.

Healthcare professionals face many barriers when talking about sex – but the main one is embarrassment: one’s own embarrassment and fear of embarrassing the patient. It can also be unclear who should talk to patients about sex.  As a clinical psychologist and psycho-sexologist working in pain management and sexual health, I see first-hand how the lack of dialogue about sexual wellbeing in the healthcare system can cause problems for patients.  
Research conducted in the UK shows that one person in six reports having a health condition that affects their sex life, but only a minority seek help. Many suffer in silence, feeling embarrassed and alone with their problem.  As this continues, it can have a long-term impact on partner relationships, self-esteem and overall wellbeing.
Talking about sexual functioning at a broad level need not solely be the preserve of pelvic pain teams or pelvic health physiotherapists. After a heart attack, for example, patients may wonder when it will be safe to resume sexual activity, while patients with chronic obstructive pulmonary disease may be afraid that sexual activity will worsen their breathlessness and that they won’t be able to breathe. Patients with musculoskeletal problems may worry about damaging parts of their body during sexual activity. However, despite these concerns being directly related to their health condition, patients may not know who to talk to about their concerns, or may be too embarrassed to broach the topic.
Physiotherapists and psychologists are in an ideal position to champion placing sex on the agenda. The first step is to raise awareness of these issues and to consider sexual wellbeing in relation to the patient in front of you. Simple steps such displaying appropriate resources in waiting areas can help to create an environment in which patients feel comfortable about raising any concerns. 
Arthritis Research UK has a fantastic patient booklet on Sex and Arthritis. Extra training can be invaluable in building up skills, knowledge and confidence in the area. I recently ran a brief training session in London for members of the Physiotherapists in Pain professional network, which generated some very interesting discussions. 
It can be useful to keep the PLISSIT model in mind when talking about sex with patients.

This stepped model stands for: 

  • permission:creating a space where patients feel that they can bring up appropriate concerns regarding sexual functioning 
  • limited information: directing patients to other organisations or resources that may be able to help
  • specific suggestions: physios may make suggestions that are relevant to the patient’s concerns based on their own professional knowledge base, such as which positions are best for patients with lower back pain
  • intensive treatment: it is important to know the limits of your professional knowledge and your remit. At this point, onward referral to a specialist service may be required. 
After all, research shows that sexual wellbeing is an important component of our overall wellbeing and the quality of life we experience.  Keeping sex on the agenda allows us to offer a more holistic model of patient care.
  • Dr Su Yin Yap is a clinical psychologist and psycho-sexologist at the pain management service, Royal Free London NHS Trust. Email mindsurgerylondon@gmail.com
Dr Su Yin Yap is a clinical psychologist and psycho-sexologist at the pain management service, Royal Free London NHS Trust.

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