How to communicate with a patient about sexuality

1
How to communicate with a patient about sexuality

• Elsa Almås
• Specialist in clinical psychology
• Specialist in clinical sexology NACS

2
Two approaches

• Objective approach
• Diagnostic tools
• Laboratory and clinical findings
• Medical and surgical treatment
• Knowledge about scientific findings on sexuality
  and cancer

• Subjective approach
• Listen to the clients story
• Learn what sexuality means for the client
• Listen to the clients fears
• Explore the clients rescourses

3
If you choose the objective approach

• What is it helpful for?
• Understanding organic disorders that can affect
  sexuality.
• Offering medical or surgical treatment when
  needed.
• Use surgical methods that do not affect sexual
  function in a negative way.
• Explaining how illness or treatment can affect
  sexuality.

4
What should you be aware of?

• Knowledge about anatomical and physiological
  aspects of sexual function.
• Knowledge about how medical and surgical
  treatment can affect sexual function.
• Knowledge about why it is important to address
  sexual issues whith cancer patients.
• Knowledge about how your own attitudes and
  knowledge affect whether you address these issues
  - or not.

5
If you choose the subjective approach

• What is it helpful for?
• To talk about sexuality is to talk about life!
• It opens up for the clients own worries and
  thoughts.
• It can provide relevant knowledge for the client
  to deal with sexual problems.
• Appropriate treatment for sexual problems can be
  offered.

6
What should you then be aware of?

• Your own attitudes towards sexuality?
• Are you sex positive or sex negative?
• Do you have your own unsolved sexual issues?
• Do you feel free to talk about sexual matters?
• Do you have knowledge enough to act in a
  professional way when sexual issues are brought
  up?

7
Young or old?
8
Versatility
9

• The sexological counsellor must be able to behave
  professional and neutral towards the clients
  sexological problems.

10
What is a professional attitude?

• Make space for the clients story
• Listen and explore the story with the client
• Now that the problem can be understood and solved
  in different ways
• Versatility
• Systemic approach
• Flexibility
• Respect your own professionality - and be aware
  what is your competence - and what is not!

11
ATTITUDE CHANGE

• IS A PROCESS CHARACTERISED BY THE FOLLOWING
  STAGES
• DESENSITIVISATION, WHICH IS A PROCESS WHERE YOU
  GET USED TO FEAR PROVOKING SITUATIONS. YOU LEARN
  TO BE MORE COMFORTABLE WITH DIFFERENT SEXAL
  ISSUES, EXPRESSIONS AND VARIATIONS.

12

• SENSITIVISATION REFERS TO AN INCREASED AWARENESS
  OF OWN ATTITUDES AND FEELINGS TOWARDS SEXUAL
  ISSUES. HOW DO I THINK AND WHAT DO I FEEL?
• INCORPORATION IS A PROSESS WHERE YOU INTEGRATE
  NEW INFORMATION WHITH ALREADY EXISTING KNOWLEDGE.

13

• IN CERTAIN CASES THIS INTERGATION WILL BRING
  ABOUT A CHANGE IN YOUR ATTITUDES AND VALUE NORMS.
  THIS HAPPENS IF THEY ARE BASED ON MISINFORMATION
  OR PREJUDICES.

14
The PLISSIT model
15
What is the clients needs?

• In a new situation, as frightening as having a
  cancer diagnosis, the client will often only
  accept or be able to receive very concrete
  information.
• Information should be repeated.
• It should be possible for the client to raise
  questions when they appear.
• All oncological wards should have a specialist in
  sexological counselling.

16
The client needs

• Adequate treatment - whitout unnecessary harm
  done to systems that are vital for future sexual
  function.
• Doctors can also be coloured by the idea that
  cancer treatment is to save life, not to preserve
  life.

17
The client needs

• Knowledge about how sexual function can be
  affected by the illness or the treatment.
• Assurance that no unnecessary harm will be done.
• Treatment that can reduce necessary harm done by
  illness or treatment.
• Counselling alone and together with partner.

18

• Information about technical aids, when necessary.
• Counselling in how to use technical aids.
• Further counselling when necessary.

19
Timing

• When should sexuality be brought up as an issue?
• Sooner than you think!
• A P should be present as the patients enters
  the doctors office, or the hospital, for
  instance by a leaflet giving information about
  sexuality and cancer.
• The patient should know that he or she can ask
  for counselling when needed.

20
The meaning of sexuality

• For some patients sexuality is a positive and
  vital life force, as important as life itself.
• For other patients, sexuality is a painful issue,
  that is avoided as much as possible.
• For some patients sexuality is a continuous
  struggle, a never ending issue of conflict.
• For other patients sexuality is a calm river,
  that can be entered when wanted.