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'Why don’t we talk to patients about sex?'

Sian Rodger
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I work in a spinal injury unit and we recently asked our patients for their opinions about the education we provide to them.

Patients told us that they wanted to know more about sexual function following their injury, which is not surprising as the research shows that sexual function is related to quality of life.

It made me reflect on why we don’t talk to patients about sex.

Is it because talking about sex can be embarrassing for us and we feel it might embarrass our patients? Is it because we lack knowledge? Do we make assumptions that patients do not want to talk about sex or may be too old or too sick to be interested?

Many long-term conditions, other than spinal cord injury, can have an effect on sexual function – for example, diabetes, cardiovascular disease and multiple sclerosis – so we all need to know how to address it. It is not up to health professionals to decide whether a patient needs or wants information about sex. It is the patient’s decision.

Being able to initiate conversations on what might be an uncomfortable subject can be difficult but it is important that front-line nursing staff have this skill and that we do not shy away when patients raise uncomfortable or embarrassing subjects.

We should be open to conversations about sexual function and be able to signpost the patient to the right health professional who can address our patients’ concerns and answer their questions.

I feel able and confident enough to approach the subject with my patients and have asked patients of different ages, and with different diagnoses, if they want information on sexual function following spinal cord injury.

”A patient may chooses you to start a conversation because they trust and value your knowledge and opinion”

We recently had a young patient, who was dependent on a ventilator and I broached the subject with him. He voiced concerns that he would never be able to form a relationship following his injury. This opened up a conversation about intimacy, which he found helpful. 

I also raised the subject with an older person who lived alone. Although I thought she would probably decline any further information, I felt that I should not make assumptions. When asked, she rolled her eyes to heaven, and with a little chuckle, she told me that she had managed without a man for the last 20 years so she did not need information. I did go on to tell her that should things change in the future, she could discuss it with a clinical nurse specialist as an outpatient.

I encourage you not to shy away from conversations about sex. If you feel awkward then the patients will feel it too and they may go home with unanswered questions and a lack of knowledge.

It is worth remembering that a patient may chooses you to start a conversation because they trust and value your knowledge and opinion.

In response to our review of patient education, we have set up small same-sex discussion groups for outpatients every week. The new service has been well-received, but we are continuing to evaluate it and tailor it to patient need.

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