Sexuality and Illness

A Guidebook for Health Professionals

Anne Katz

• Publisher: Routledge
• Year: 2021
• ISBN:
  9781000432015
• Edition: 1
• Topic: Medicine
• Subtopic: Nursing

This evidence-based guide educates and informs health professionals about promoting sexual wellbeing in the context of challenges from physical and mental health.

Sexuality is an important aspect of quality of life for many people but can be affected by a wide variety of health conditions, such as cardiovascular disease, mental illness, menopause, diseases of ageing, neurological diseases and spinal cord injuries, combat injuries, and cancer. Building readers' confidence in initiating and encouraging open communication on this often-neglected topic, Sexuality and Illness includes case studies that illustrate how to talk about sexuality and support patients with concerns about it. Making recommendations for practice and further reading, it takes into account gender, sexual, race and ethnic diversity.

This accessible text demystifies a topic that is sometimes difficult to discuss. It is essential reading for healthcare practitioners interested in providing comprehensive and person-centred care.

1 Introduction

DOI: 10.4324/9781003145745-1

Sexuality is defined by the World Health Organization as that “experienced and expressed in thoughts, fantasies, desires, beliefs, attitudes, values, behaviors, practices, roles and relationships.” On the other hand, sexual health is

a state of physical, mental and social well-being in relation to sexuality. It requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination and violence

(WHO, 2006) ( https://www.who.int/teams/sexual-and-reproductive-health-and-research/key-areas-of-work/sexual-health/defining-sexual-health).

We are all sexual beings, from infancy to death; but how that is expressed differs by age, gender, relationship status, social norms, and health status. The latter is the context for this book. It is well established that illness impacts on physical and emotional sexual function in multiple ways. Despite the evolving research in this area, this generally remains a neglected topic in health care.

Sexual health is a very important aspect of quality of life in healthy adults as well as those experiencing health problems (Flynn et al., 2016). Sexual dysfunction in both men and women carries with it burdens that are poorly researched, articulated, and largely ignored (Balon, 2017). These include interpersonal conflict and distress, quality of life, emotional functioning, and financial costs. In men, sexual dysfunction is associated with both psychological and physical health (Tan, Tong, & Ho, 2012). In turn, physical and mental illnesses are risk factors for sexual dysfunction (McCabe et al., 2016). This bi-directional relationship should spur health care providers to consider sexual dysfunction in their clinical assessment of individuals presenting for care (Brotto et al., 2016).

Why should you read this book?

If sexuality is an important part of quality of life and if it is both a factor contributing to and a negative response to disease, as well as acute and chronic ill health, then should health care providers of all types consider this when treating patients? I hope that your response would be a resounding ‘yes’!

This book is divided into three sections. The first section provides an overview of human sexuality, from the past to our present understanding of how sex ‘works.’ Four models of the human sexual response cycle are presented with an additional two models that conceptualize sexual dysfunction. Chapter 3 addresses communication about sexuality and sexual functioning by health care providers. Five models are presented to facilitate the conversation with patients/clients as well as providing guidance on how to take a sexual history. Chapter 4 discusses sexual development from a lifespan perspective, from adolescence to old age, including sexual aging.

The second section provides the latest evidence on the role that many different diseases/conditions impact on sexuality. These include medical and mental conditions as well as the impact of trauma and disability. Cancer treatment in both men and women is known to have a significant impact on sexuality and sexual function and this is described in two separate chapters. Chapter 11 discusses cancer in adolescence and young adulthood, a time when sexual identity and relationships are established and where developmental milestones are impacted during treatment. The section ends with a chapter on infertility and the sexual challenges of treatments to enable conception.

The third section of the book focuses on interventions for sexual dysfunction for men and women in two separate chapters. This is important as many health care providers have limited knowledge of what can be done when a patient/client discloses that they are having sexual problems.

All chapters include resources that can be suggested to patients/clients but that also serve to further increase knowledge and confidence for the health care provider.

References

1. Balon, R. (2017). Burden of sexual dysfunction. Journal of Sex and Marital Therapy, 43(1), 49–55. doi: 10.1080/0092623x.2015.1113597
2. Brotto, L., Atallah, S., Johnson-Agbakwu, C., Rosenbaum, T., Abdo, C., Byers, E.S., … Wylie, K. (2016). Psychological and interpersonal dimensions of sexual function and dysfunction. Journal of Sexual Medicine, 13(4), 538–571. doi: 10.1016/j.jsxm.2016.01.019
3. Flynn, K.E., Lin, L., Bruner, D.W., Cyranowski, J.M., Hahn, E.A., Jeffery, D.D., … Weinfurt, K.P. (2016). Sexual satisfaction and the importance of sexual health to quality of life throughout the life course of U.S. adults. Journal of Sexual Medicine, 13(11), 1642–1650. doi: 10.1016/j.jsxm.2016.08.011
4. McCabe, M.P., Sharlip, I.D., Lewis, R., Atalla, E., Balon, R., Fisher, A.D., … Segraves, R.T. (2016). Risk factors for sexual dysfunction among women and men: A consensus statement from the fourth international consultation on sexual medicine 2015. Journal of Sexual Medicine, 13(2), 153–167. doi: 10.1016/j.jsxm.2015.12.015
5. Tan, H.M., Tong, S.F., & Ho, C.C.K. (2012). Men’s health: Sexual dysfunction, physical, and psychological health: Is there a link? Journal of Sexual Medicine, 9(3), 663–671. doi: 10.1111/j.1743-6109.2011.02582.x

2 Our understanding of human sexuality in the 21st century

DOI: 10.4324/9781003145745-2

This chapter will explore how we view sexuality and sexual functioning. From the work of Masters and Johnson in the 1960s to the present day conceptualization of sexuality, our thinking about sexuality has changed from a linear, male-oriented perspective to a more bio-psycho-social approach from researchers such as Dr Rosemary Basson. Four models of the human sexual response cycle are presented with an additional two models that conceptualize sexual dysfunction. All of these models present insight into the ‘how’ of the human sexual response. As with all conceptual models, they have limitations and should be seen as resources to support our understanding rather than being the definitive explanation of any particular circumstance. A ‘one size fits all’ approach should be used with caution.

The past: Masters and Johnson and Kaplan

For centuries, sexuality and sex remained unexplained, mysterious, and often misunderstood. At times it was celebrated and accepted as part of life while for many years, sexuality was condemned, vilified, controlled by religion, and by the norms and values of society. In the middle of the 20th century, Alfred Kinsey, a focus of some notoriety, was perhaps the first sex researcher; he conducted qualitative interviews with students in one of his courses in which they provided him with detailed sexual histories. From these interviews he published, along with colleagues, the landmark book, Sexual Behavior in the Human Male in 1948 and a second book, Sexual Behavior in the Human Female in 1953 (Brown & Fee, 2003). Both books were academic; however, they garnered a great deal of public interest, not to mention criticism from religious leaders. The backlash against the second book in particular is believed to have led to his early death from stress contributing to cardiac disease and ultimately, pneumonia.

A few years later, a scientific approach to understanding sexual functioning, albeit from a strictly heterosexual perspective, was initiated by William Masters and Virginia Johnson. An entertaining if not completely accurate depiction of their work was presented on the Showtime series, Masters of Sex. This TV series gave audiences a glimpse of their research from which much of our understanding of sexual functioning persisted until the early years of the 21st century. Masters and Johnson described a four-phase model of the human sexual response. The first phase, excitement refers to vascular engorgement of the genitals and breasts. The second phase, plateau, is described as advanced arousal in which further engorgement occurs as well as raised heart rate and respiration. The third phase is that of orgasm with intense contractions of the pelvic floor muscles and whole-body pleasurable sensations. Finally, in the fourth phase, resolution occurs, and blood leaves the genitals and the body returns to its pre-arousal state. This model was assumed to be the same for both men and women and the phases were presented as linear. This model has been accepted for decades, and is still found in text books, and the four phases used as the basis for clinical enquiry into sexual problems, even though it leaves out an important aspect of sexuality, the mental processes that are involved in wanting sex as well as experiencing sexual satisfaction.

A student of theirs, Helen Singer Kaplan, added an important component to her model of the human sexual response, that of desire (Kaplan, 1979). Her three-part model encompassed desire, excitement, and orgasm. While inclusion of desire was a significant contribution to our understanding of the human sexual response, her model was generally understood to be linear. While she never intended it to be interpreted that way, instead suggesting that any of the three phases could occur independently of the others. This has led to the common (mis)understanding that desire is a precursor to arousal; newer models suggest otherwise as presented in the next section.

Zilbergeld and Ellison (1980) proposed a five-and-a-half-part model with distinct stages – interest, arousal, physiologic readiness (erection in men and vaginal lubrication in women), orgasm, and satisfaction. The phase of orgasm was divided into two – physiological (muscle contractions) and subjective (pleasurable sensations) – hence the ‘five-and-a-half part.’

A bio-psycho-social approach in the 21st century

A more comprehensive approach that includes not only physical or emotional experience but also contextual factors is the circular model described by Basson (2015). This model focuses on the experience of desire or libido as part of the female sexual response cycle and suggests that women do not follow the linear experience of spontaneous desire as the norm but rather that reactive desire occurs in an overlapping fashion with arousal. The key to understanding this model is that rather than experiencing spontaneous desire, it is often only felt when the woman is physically and/or psychologically aroused. Further, Basson suggests that women have multiple reasons to engage sexually that are psychosocial in nature and include factors such as avoiding conflict with a partner, wanting emotional intimacy with the partner, and/or as an expression of love. According to the model, if the result of sexual activity is perceived as rewarding to the woman, this increases her motivation for another encounter, whether she experiences an orgasm or not (Chivers, 2017).

Given that both the Masters and Johnson and Kaplan’s models are seen as more reflective of male sexual functioning, can Basson’s circular model of responsive desire be applied to men? Connaughton and colleagues (Connaughton, McCabe, & Karantzas, 2016) found that men with sexual problems were more likely to endorse responsive rather than spontaneous desire and they tended to focus on relational and contextual factors. This may be indicative of their need to find non-sexual motivation to engage in sexual activity. Similar findings were described by other researchers (Giraldi, Kristensen, & Sand, 2015) who report that men endorse the Masters and Johnson or Kaplan mo...

Table of contents

• Cover
• Half-Title
• Title
• Copyright
• Dedication
• Contents
• List of boxes
• 1 Introduction
• 2 Our understanding of human sexuality in the 21st century
• 3 Communicating about sexuality with patients
• 4 Sexuality across the lifespan from adolescence to old age
• 5 How medical conditions affect sexuality and sexual functioning
• 6 How mental illness affects sexuality
• 7 Trauma and sexual dysfunction
• 8 Disability and sexuality
• 9 Cancer in women
• 10 Cancer in men
• 11 Adolescents and young adults with cancer
• 12 Sexuality and infertility
• 13 Interventions to treat sexual dysfunction in men
• 14 Interventions to treat sexual dysfunction in women
• Index