Sex and sexuality may not be easy topics to broach, but nurses should be more aware of these important areas of care and more prepared to discuss potential issues with patients, says Lynn Buckley
”Shhh. Let’s talk dirty” and “A playboy guide to good sex”. These are a couple of titles of talks I’ve been asked to give about sexuality and gynaecology. They highlight the ‘seediness’ that can be associated with sex and sexuality. I noted down both titles and use them to challenge the views we have as health professionals in this often overlooked area of care.
When I started my nurse training in the 1980s, the nursing process was in its infancy, and Roper, Logan and Tierney’s Activities of Daily Living Model had just been introduced. When patients were assessed, the two components of sexuality and death were often ignored with a ‘no problem’ or ‘N/A’ written next to it, or maybe ‘married’ would be recorded; obviously there were sometimes exceptions but this was the norm.
Have things changed in the past 30 years? Not really. I think some of us now find it easier to discuss death with patients, yet sexuality remains a taboo. I have even caught myself not asking women about sexuality within a holistic needs assessment by making a judgement call as they were either elderly or recently widowed. You may think yes, that’s a good judgement call, but sexuality is so much more than just sex. Is it less important to an 85-year-old than a 45-year-old to have the opportunity to explore any issues they have?
Freud once said: “Sex is something we do. Sexuality is something we are.” Sexuality plays an integral role in everyone’s quality of life. It is a complex and multifaceted phenomenon that includes self-concept (gender identity, roles, expectations, and body image), sexual relationships and sexual function.
Our sexuality is forever changing and adapting throughout our lives. It is experienced by each and every one of us in one way or another. Illness and disease can affect how our patients view and experience their sexuality – for some the experience may be positive, but for many it is negative.
I’m not suggesting that we all start undertaking in-depth assessments of our patients’ sexuality and sex lives, but I do think we should be more aware of this important area of care and be prepared to discuss issues or signpost patients to the help that they might need. It is a fundamental right of patients to have the opportunity to receive, if they wish to, information and support for their changing sexual health needs as a result of ill health. This is an element of care that in my opinion remains sadly lacking.
Sexuality-related needs may be simple, such as passing a patient their lipstick to put on, giving a shave, maintaining dignity, avoiding stereotyping, using gender-neutral terms, or acknowledging same-sex partners. The list is endless and probably something you already do without knowing.
Going back to one of my patients who was in her mid-80s, I was asked to have a quiet word with her as she had asked about sex. All she wanted to know was when it was okay to resume sexual intercourse following surgery – basic information that should have been given on discharge from hospital.
A final thought. We all exist, one way or another, because of the act of sex. If who we are is governed by the conscious and/or subconscious choices we make about our sexuality, then why is it so difficult to approach or recognise the needs of others in this fundamental and essential part of care?
Lynn Buckley is clinical nurse specialist – gynaeoncology, Hull and East Yorkshire Hospitals NHS Trust.
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