Despite all of this information, many healthcare providers lack the training and self-confidence needed to address their patients’ sexual concerns. A study of orthopedic hip surgeons revealed that 80% reported that they rarely or never discuss sexual activity with their patients.3 Communication is essential to alleviate these issues. The next case study indicates this point.
Case #2: George
George is a 65-year-old retired factory worker who resembles the Marlboro Man. A 40-plus-pack-year smoker, he has both RA and OA and a history of prostate cancer. During a routine visit, I told George about my upcoming lecture for patients about intimacy and arthritis. He nodded in acknowledgment but did not press for more information. I tried again, more directly this time. “Many patients with arthritis have sexual concerns. Are you having any?” He responded without looking at me, “Since my prostate surgery, nothing much worked anymore, so, I just stopped touching my wife.”
Confused, I clarified: “Since your prostate surgery you stopped touching your wife altogether?” “Yep,” he said, “she has been kind of sad about it.”
“You no longer hug or kiss her?” I inquired.
“Why should I? If I hug her or kiss her she will just get excited and then I won’t be able to satisfy her anymore,” George replied.
I looked George in the eye and assured him that was not the case. “Most women like the hugging and kissing better. Everyone needs some type of physical contact to stay healthy,” I said. “That may be all the intimacy Betty needs to be satisfied. Have you talked to her about this?”
I left him with that idea. On his follow-up visits, I continued to keep the lines of communication open. George reported that his relationship has improved with his wife and he is back to showing her affection.
Educating patients on intimacy should include the following:
- The definition of sexuality;
- Physical anatomy;
- Sexual physiology; and
- The fact that sexuality does not necessarily equate to intercourse.
Patients often need reassurance about what should be considered normal when it comes to sexual concerns. In a society where most couples work full- or part-time, children are engaged in multiple activities, and the time that couples spend alone and focused on one another is dwindling, sexual encounters have to be planned. Those who have a chronic illness or disability require even more planning. In the book, The Ultimate Guide to Sex and Disability, the authors discuss the complexities of relationships when one partner is wheelchair bound. The authors describe a patient’s options including having a caregiver prepare them for a sexual encounter versus having their partner get them undressed and positioned. These are real concerns that deserve discussion.
