Tips for Talking to Your Patients About Sex

• Nurses assist with the overall medical management of a disability and can help patients understand instructions given by the occupational therapist, the physical therapist, the physician or another clinician;
• Sexual health nurse-clinicians educate clients and their partners on changes to sexual function as a result of chronic illness or disability, and are qualified to make specific suggestions to enhance sexual functioning and fertility;
• Sexual medicine physicians or physiatrists assist with maximizing sexual physiology and reducing the medical issues that often interfere with sexual interest and activities; other physicians (e.g., urologist, gynecologist, neurologist) may also have valuable expertise;
• Physical therapists, also called physiotherapists, address clients’ physical function by helping with range of motion, pelvic muscle strength and other movement-related issues;
• Occupational therapists help clients manage and perform their daily activities and can address sexuality issues, such as how to adapt sexual devices to meet the abilities of clients (e.g., adding switches, making hands-free options);
• Recreation therapists help clients explore meaningful recreation and leisure choices; involvement in recreation activities of mutual interest is often key to meeting potential partners;
• Social workers educate and counsel partners and families on sexual and fertility concerns;
• Psychologists explore with clients, in depth, the many different emotional components of sexuality, such as self-esteem, assertiveness and positive self-talk; they also can address trauma that has affected a client’s sexuality; and
• Peer counselors, such as persons with disabilities themselves, can provide critical sources of information on what their bodies experience in different situations.⁷

7. Recognize the role grief plays in the context of a chronic illness diagnosis. Being diagnosed with a chronic illness that has no cure can, and often does, create a sense of loss. People grieve losses in different ways, but by discussing Elizabeth Kübler-Ross’ stages of grief with your patients, you’ll help educate them on the emotions they may be experiencing due to a loss or change in health.⁸

Some strategies:

• Acknowledge that a chronic illness diagnosis can cause extreme stress within a relationship, as well as worsen existing stress. For example, the healthy partner may respond to the diagnosis by pretending nothing is wrong, by trying to fix the ill partner with medical advice or unproven treatments, or by denying the disease exists. These are all attempts to regain normalcy within the relationship. Once these responses are recognized, more appropriate responses can
  be discussed;
• Encourage patients and partners to allow for feelings of loss, anger and depression so they can recover and rebuild their lives and their intimate relationships;
• Encourage patients to draw on resiliencies that already exist from a lifetime of coping; and
• Counsel patients to find appreciation for those who stood by them in their time of need and who continue to stand by them in life—not just in times of illness.

8. Follow up at each visit. Problems with intimacy may occur at any time during the disease course. You may be able to improve a situation the patient has given up on.

9. Think of other ways to engage with and relate to patients.