Intimacy, Sex and Relationship Challenges Laid Bare Across the Lifespan

Applied Principles and Practice for Health Professionals

Judy Benns, Sue Burridge, Jean Penman

• Publisher: Routledge
• Year: 2021
• ISBN:
  9781000398373
• Edition: 1
• Topic: Medicine
• Subtopic: Nursing

This accessible book uses case studies to explore issues around intimacy, sexual function and sexual development over the lifespan, introducing applied principles and practices when working with sexuality-related issues.

Introducing an easy-to-use 'Reflect and Respond' model as a framework for interactions, this book discusses a broad selection of topics and life stages, including hidden loss, gender identity, disability, early years experiences and older age. Exposing anonymized real-life experiences of intimacy, sexual function, and sexual development from birth to end of life, this book develops the reader's insight into sexual wellbeing and confidence in communicating about it. The experiential learning and research-based content in readable style will educate and inspire readers with an interest in sexual wellbeing and how this impacts on physical and mental health.

Demonstrating how being open to talk about sex and intimacy can change lives, this guide is suitable for a wide range of health and social care professionals, including nurses, doctors, occupational therapists, social workers, psychologists and counsellors.

1 Experiences in early years

First relationships and early sexual development

The mother-and-baby relationship represents the first relationship in the lifespan, beginning in utero or through the anticipation of arrival. Subsequently, the holding and eye-to-eye contact during the feeding process with the primary carer(s) facilitates falling in love with the infant through the release of the hormone oxytocin. Anxiety over feeding may temporarily affect bonding within the first intimate relationship. As the mother or primary carer breast or bottle feeds their child, this represents a good enough source of comfort, nourishment and physical acceptance to build the bond over time. Sexual development begins from birth with the baby’s exploration of their own body and what may feel good and comforting. Toddlers’ interest in their own and others’ bodies can be an embarrassment but it is important for the parents, carers and HPs to find out which behaviours are age appropriate for sexual development. Professional guidelines are available online, such as the Brook ‘Traffic Light Tool’ (Brook, n.d.)

‘Falling in love’ with a father figure is just as important in the sexual development of a child. As the father connects emotionally with the infant, the child in turn learns the value of a different kind of relationship.

Affirmation provides a foundation from which the child can grow, giving security, a different type of play and discipline, and eventually the confidence to make friendships outside the family.

We acknowledge that parenting today takes many different forms that provide equal opportunity for the early development of intimate relationships.

During childhood there will also be many other relationships that will subtly or overtly influence sexual development, such as those with other adults, siblings, friends and teachers.

Influences on sexual development

In healthcare settings it is important to be aware of healthy sexual development and when safeguarding processes need to be initiated.

There are powerful influences in society that impact on children as they grow up, which convey conflicting messages about the value of gender, body image and relationships, communicated through social media. Messages concerning sexual behaviour may conflict with the beliefs and attitudes of parents, families, schools, cultural and religious communities, leading to confusion and self-doubt in young people. Confusion and distress can be magnified among those who are questioning their gender identity and sexuality. National directives and sexual health messages, which tend to focus on rising sexually transmitted infections and teenage pregnancy rates, give the impression that all young people are sexually active. The combination of all these factors can become a source of internal compulsion and external coercion to become sexually active. Girls and boys talk about the immense pressure from their peers to have their first sexual experience. In contrast to the media’s idealisation of sexual freedom, the young person with a number of sexual experiences is often labelled in derogatory terms by their peers, which can have negative consequences on their ongoing sexual development.

Celine: Am I normal?

A bright young girl, Celine, aged 16, went to see her GP for help with her low mood as this was affecting her school work. The GP listened carefully and asked her if there was anything she was worried about. She spoke about her fear that she wasn’t normal; she didn’t feel anything during occasional sex with an older boyfriend. The GP asked her to say a little more about what was really bothering her. Celine described how she hated her peer group criticising and judging others’ sexual behaviours or, equally, ridiculing their choice not to have sex. Celine’s understanding through listening to friends was that she should enjoy sex ‘whatever’ the circumstances. Because of this, Celine was concerned to find out if her lack of feeling during sex was normal. The GP discovered that Celine didn’t really like her boyfriend. They came to agree that as Celine developed a trusting and respectful relationship in the future, sex was more likely to become a pleasure for her.

REFLECT

A lack of experience of rewarding relationships can lead to unrealistic expectations developed through the use of social media and peer pressure. As with Celine, this may lead to the belief that something is seriously wrong, causing considerable anxiety.

RESPOND

It may help to take an interest in the young person’s perspective on the sexual difficulty before offering any reassurance or treatment.

Disruption to sexual development

Challenging life events during childhood, such as acrimonious divorce or the early death of a parent, may appear to be overcome at the time. However, as we hear from people about their sexual difficulties, an exploration of the cause often leads us back to significant experiences and relationships in early years. Subsequently, these experiences are found to impact on adult sexual relationships, presenting blocks to emotional and sexual intimacy and function. We have found that if changes in adult sexual experience are not due to a medical cause or medication, they are likely to have been triggered by a recent life event and later found linked to an early life experience.

Experiences of loss are very personal and can manifest in different ways.

The following two cases illustrate the unpredictable effects of loss in early life and the unexpected long-term effects on sexual intimacy.

Amanda’s disconnection

A 36-year-old businesswoman, Amanda, was referred to a psychosexual therapy clinic complaining of complete loss of sexual desire within two successive same-sex relationships. Having initially enjoyed sex with each partner, there was no obvious explanation for her lack of feelings. Amanda was also adamant that she did not want children. The therapist reflected with Amanda on her early years to explore any predisposing or precipitating factors. Showing little emotion, Amanda described how her unemotional parents had separated when she was eight years old and how confusing and disruptive this had been for her. She was given no opportunity to talk about her difficult feelings. Amanda and the therapist discovered that she had learned to block out her feelings as way of coping as a child. Her partner would do everything she could to arouse her but she remained emotionally and physically disconnected. Despite a good deal of resistance, in time Amanda acknowledged her anger with her parents and her own fear of separation in long-term relationships. Once her anger and fear were recognised, this seemed to allow Amanda to talk to her partner and reconnect emotionally. After this she reported a reawakening of a pleasurable response to physical intimacy.

Ben’s buried loss

Ben, a young man in his late twenties with a long-term partner and child, presented for general counselling for intermittent low mood over many years. He described how masturbation to images of women on the internet provided relief from stress. The counsellor asked about his current sexual relationship. Ben explained that he avoided sex although he loved his long-term girlfriend, Jessica, very much. They had discussed the sexual difficulty together and felt their problems were due to Ben’s use of pornography.

During their frequent arguments, whenever Jessica cried, Ben described feelings of deep distress and impotence. When the therapist asked if he had ever felt like this before, after a moment of thought Ben recalled an incident that had happened when he was four years old. He talked of hearing an agonising scream when his mother discovered the lifeless body of his baby sister. She was inconsolable. Following this event, despite his four-year-old’s efforts to make her feel better, he did not succeed. His mother was so wrapped up in her grief that she was unable to notice or respond to him. In his current relationship Ben made every effort to be a helpful partner and dad, despite continuing to feel a deep sense of loneliness. During the course of his therapy, he recognised that this awful feeling of impotence was relieved momentarily by masturbating to sexual images and this means of finding comfort and control had subsequently diverted his sexual attention away from Jessica. But more than this, he realised that his mother’s rejection of him was now playing out within his own intimate relationship: Ben was rejecting Jessica without knowing it. Over a period of time, having recognised this pattern, Ben was able to initiate enjoyable sex with Jessica and his compulsion to masturbate using pornography for relief and comfort was significantly reduced.

REFLECT

The consequence of unexpressed emotion can have a powerful effect throughout life and within intimate relationships. The details of Amanda’s and Ben’s presentations illustrate the negative impact of previously buried memories of earlier life experiences and their potential effects on intimacy in adult life (see Jamie’s case study in Chapter 3).

RESPOND

Asking about early life relationships can often open up important connections to current difficulties.

Childhood sexual abuse

Childhood sexual abuse (CSA) and sexual exploitation is a sad and complex reality for many and can have a lifelong effect on sexual health and wellbeing. Through our practice, we have often observed patients internalising rage and resentment towards family members and significant adults whom they feel should have prevented or stopped it, resulting in low self-esteem and other mental health difficulties. Walker argues, ‘Anger towards the abuser and often also towards those adults who did not prevent it can persist either consciously or unconsciously, when it may be turned against the self and incorporated into self-loathing’ (Walker, 2001: p. 85).

As well as mental health and emotional difficulties, we have found a variety of persistent physical symptoms which may be linked to unspoken pain and sexual trauma: palpitations, shortness of breath, chest, abdominal, genital and pelvic pain, skin conditions and frequent headaches are only some of many examples. All these require medical attention when discovered through the psychosexual consultation. The Patient Health Questionnaire Somatic Symptom Severity (PHQ-15) can help to reveal the physical burden and what can be done about it through further discussion (Kroenke, Spitzer and Williams, 2002).

An HP who observes signs of physical distress and listens without judgement may allow for an important disclosure (see Figure 0.3 in the Introduction). This brief cooperative rapport can be instrumental in supporting the patient to begin the journey of recovery. Although the disclosure may bring back painful memories, the non-judgemental approach of the HP will bring relief and confidence to the patient to break their silence and then move forward. Loca...

Table of contents

• Cover
• Half-Title
• Title
• Copyright
• Contents
• List of illustrations
• List of case studies
• Preface
• List of abbreviations and clarification of terms
• Introduction
• 1 Experiences in early years
• 2 Reproductive years
• 3 Losses in reproductive years
• 4 Unexpected outcomes and sexual development
• 5 Mental health
• 6 Gender identity, sexuality and difference in sexual desire
• 7 Sexual health
• 8 Women’s health
• 9 Marriage and civil partnership
• 10 Hidden loss
• 11 Mid-life
• 12 Older age
• 13 Supervision
• Epilogue
• Index