‘Not tonight, dear, I have a headache’ doesn’t serve us well when we have a chronic or serious illness.
BY DANIEL GAITAN | firstname.lastname@example.org
Sex isn’t just for the sexy.
The seriously ill and aged may still enjoy a healthy sex life despite their physical limitations and scars.
“When a person is diagnosed with a serious illness, we know that their priorities may suddenly change,” said Shirley Otis-Green, clinical director of consulting services for Coalition for Compassionate Care of California. “They may find that their energy lags, that their anxieties increase and certainly, they may find themselves facing a numerous set of symptoms.”
However, sexual expression remains a significant factor to patients’ quality of life.
“Sensual expression is an important element within most intimate relationships,” Otis-Green said during a presentation on sex to palliative care physicians, geriatricians and nurses this week.
She encouraged providers to help address the “elephant in the room.” People working with seriously ill adults or people near the end of life should feel comfortable fielding – or asking – questions related to sex and desire.
“Quality of life matters, and it matters when a person is well and it certainly matters when a person is ill,” she said. “Being able to address things that have mattered to a person, whether that includes sexual expression or sexual identity, is really important for us.”
Because sex is still a taboo topic for many Americans, patients may be reluctant to ask about it during doctor appointments – especially if their time is limited.
“We know many patients hesitate to being up sexual concerns because they feel embarrassed or they have a lack of time with medical personnel,” Otis-Green said, adding that providers often fail to bring the topic up because they lack the training or the tools to do so with confidence.
To help remedy the problem, Otis-Green suggests palliative care physicians work to “minimize” their patients’ regret by directly addressing concerns about sex.
“Patients, partners and professionals can all be waiting for the other person to introduce this issue,” she said. “But we know that it’s important for us to minimize regret – that’s a big part of what we do in palliative care. Remind ourselves that acts of ‘omission’ are more often a source of regret than ‘commission.’ It’s important for us to encourage people to ‘follow their bliss’ and live their passion.”
Intimacy remains a vital component of palliative medicine, which helps treat symptoms and side-effects of disease and aggressive treatments.
When palliative care physicians begin a psychosocial assessment of a patient, it is helpful for them to learn their patient’s sexual history. Sexual orientation, religious beliefs, possible negative sexual experiences and availability of partners should all be considered.
“Don’t be afraid to address the issues that are of importance to those we serve,” she said. “We have an obligation to address whatever the concerns are that may be affecting a person’s quality of life.”
What Can We Do?
Amputations, reconstructions, cancers, AIDS, medications and hormonal changes can all affect a person’s sexual functioning, Otis-Green said. Psychological problems stemming from disease may include poor self-image, anger, guilt or depression.
Because each case is different, Otis-Green suggests doctors encourage exploration and experimentation of new positions, techniques, interventions.
“Support the desire for intimacy at whatever level a couple chooses,” she said. “Perhaps they are not in a position where they’re going to engage in sexual intercourse in the way they have in the past. But that doesn’t mean that they are no longer sensual.”
It may also be necessary to refer patients to a so-called “sexpert,” someone able to provide coaching and behavioral interventions such as sensate focus exercises or scheduled sexual activities.
– Image courtesy WikiMedia Commons