Dr ROB IRWIN, Chair of the Association of Psychosexual Nursing, examines an essential skill for any practitioner who aims to promote sexual health.

Understanding the importance of psychosexual awareness

Although the prevalence of sexual problems in the community is difficult to gauge accurately, the "self reported problems related to sexual function" of participants in the Natsal 2000 survey suggest that short-term sexual problems are relatively common with over a third of men and half of women experiencing at least one sexual problem of at least one month's duration in the previous year.

Persistent sexual problems were less frequently reported, with 6.2 per cent of men and 15.6 per cent of women indicating sexual difficulties that had lasted more than six months in the previous year (Mercer et al., 2003: p.427).

However, among participants who did report sexual problems over 30 per cent of men and 60 per cent of women indicated that they avoided sex because of their problems. Given this, it could be argued that psychosexual awareness is an essential skill for any health care practitioner concerned with the promotion of sexual health.

More than simply dysfunction

Sexual problems are often equated with sexual dysfunction, yet the concept of dysfunction does not adequately capture the full spectrum of anxieties, distress and dissatisfaction experienced in relation to sex (Bancroft et al., 2003; Richters et al., 2003). As Bancroft (2009: p.55) notes: "the sexual experience is par excellence psychosomatic."

Problems related to sexual interest and function are often multi-factorial in origin and the possibility of underlying physical pathology must always be excluded. However, emotional distress may be both a cause and consequence of sexual symptoms.

As a cause of sexual symptoms, such distress may not relate directly to sex, but instead may occur as a result of loss, a reaction to a life event or some sense of personal inadequacy (Wells, 2000). Recognition of emotional distress and timely intervention may prevent such sexual symptoms becoming intractable sexual problems.

Sexual health clinics in particular tend to be seen by service users as places to which "the emotional baggage of sex gone wrong" can be brought and, if circumstances are conducive, unpacked (Crowley, 1997: p.6). No matter how impeccably carried out, the intimate nature of the examination and treatment provided at such clinics may potentially disturb "a patient's sense of their own private space" (Nicholson, 1998: p.144). In doing so, anxieties and distress associated with recent or past sexual experiences may be revealed.

For some patients, the diagnosis of a sexually transmitted infection may also have psychosexual sequelae (Green, 2002).

Discussing sexual problems is seldom easy

The presentation of sexual anxieties and difficulties is often covert - sometimes partially revealed in a patient's reaction to intimate examination, the questions asked (or not asked), or the disturbance a patient causes to the practitioner's own feelings and sense of professional self. Even when such problems are disclosed, it can be difficult to stay with patients' emotional pain and distress - to provide them with the space they require to begin to unpack and make sense of their feelings (Penman, 1998).

While some patients will need referral to specialist psychosexual services, all many require of practitioners is just that their sexual anxieties and distress are heard and acknowledged.

Psychosexual awareness is a skill that, once developed, needs to be constantly honed. One way in which some practitioners chose to do this is through regular attendance at Balint-style psychosexual seminars organised by the Association of Psychosexual Nursing (Clifford, 1998; Wells, 2000).

Psychosexual seminars provide an opportunity for guided reflection on recent clinical encounters and they also facilitate experiential learning. Seminar training does not aim to turn practitioners into "experts" in sexual problems, but to support and enhance the psychosexual care they provide in the course of their everyday practice.

Ultimately what many patients are seeking are practitioners with the courage, sensitivity and skills to listen.

Psychosexual Awareness module (30 credits at level 3)

This module is offered by the Association of Psychosexual Nursing and validated by the University of Greenwich. It can be undertaken in various parts of the country, facilitated by course leaders from the Association. For details, see www.gre.ac.uk/schools/health or contact the Association directly at www.psychosexualnursing.org.uk Alternatively write to the Association at: PO Box 2762, London W1A 5HQ.

References

  • Bancroft J (2009) Human sexuality and its problems (third edition), Edinburgh: Churchill Livingstone Elsevier.
  • Bancroft J, Loftus J and Long JS (2003) Distress about sex: a national survey of women in heterosexual relationships, Archives of Sex Behaviour, 32(3), pp.193-208.
  • Clifford D (1998) "Psychosexual nursing seminars" in Barnes, E; Griffiths, P; Ord, J and Wells, D (editors) Face to face with distress: the professional use of self in psychosocial care, Oxford: Butterworth Heineman.
  • Crowley, T (September, 1997) Psychosexual medicine in a genitourinary medicine clinic, Institute of Psychosexual Medicine Journal, 16, pp.5-9.
  • Green J (2002) "Psychological factors in sexually transmitted diseases" in Miller, D and Green, J (editors) The psychology of sexual health, Oxford: Blackwell.
  • Mercer CH, Fenton KA, Johnson AM, Wellings K, Macdowall W, McManus S, Nachahal K and Erens B (2003) Sexual function problems and help seeking behaviour in Britain: national probability sample survey, British Medical Journal, 327, pp.426-427.
  • Nicolson P (1998) "Talking about sexuality and sexual problems" in Bayne, R; Nicolson, P and Horton, I (editors) Counselling and communication skills for medical and health practitioners, Leicester: BPS Books.
  • Penman J (1998) Action research in the care of patients with sexual anxieties, Nursing Standard, 13 (13-5),
    pp.47-50.
  • Richters J, Grulich AE, deVisser RO, Smith AMA and Rissel CE (2003) Sexual difficulties in a representative sample of adults, Australian and New Zealand Journal of Public Health, 27, pp.164-170.
  • Wells D (editor) (2000) Caring for sexuality in health and illness, Edinburgh: Churchill Livingstone.