|Posted By Kenny Phelps and Tina Schermer Sellers, Yesterday|
Talking about sex...It is difficult to avoid the multiple sexualized images in American culture. From Janet Jackson’s Superbowl peepshow to the popularity of the Sex and the City episodes to television programs of young girls being dressed up like 21 year old beauty queens, the messages of sex are inescapable in recent years.
While professionals might recognize the importance of sexual health in the life of their patients, this is not equating to an increase in sexual education or patient assessment, treatment or referral. Sexuality is routinely overlooked in primary medicine (Owens & Tepper, 2007). Studies reveal that only 10%-30% of primary care physicians obtain sex histories (Lewis & H, 1987)(Gemson, Colombotos, & Elinson, 1991). Challenges to the progression of sexual health care range from a significant lack of sexual education for most ‘would be’ medical providers, a lack of adequate sexual education in medical school and residency, a shared ignorance and unease about sexual health between patient and provider, a lack of time (Morreale & Arfken, 2010; Foley, Wittmann, & Balon, 2010) and a complex set of biopsychosocial issues playing into a person’s sexual health and sexual satisfaction (Geraci, 2010). What role does integrated and collaborative care play in overcoming these challenges? How can medical and mental health providers working in tandem create small ripples of change that may lead to larger changes in our current rates of STIs, teenage pregnancy rates, and reports of relational discord?
We propose that integrated care and intensive collaboration between providers should be the rule rather than the exception when addressing sexual health. Providers can work together to: screen for sexual concerns (Are you currently sexually active? Are your partners men or women? Are you satisfied with your sexual life? How can I be helpful to address any sexual or relational problems you are having?); provide education on most common problems (desire, premature ejaculation, performance anxiety, erectile dysfunction, etc.); and frame intimacy/sexuality as part of a larger relational and cultural picture (How did what your parents or culture tell you about sex influence your current preferences?).
Due to the biopsychosocial nature of sex, it requires multiple providers who are wearing "different hats.” For instance, a patient with erectile dysfunction needs a thorough evaluation of current medical concerns and medications, psychiatric comorbidities, automatic thought prior and during sexual activity, and current relational satisfaction. Patients who are parents of young children also need our guidance providing age appropriate sex education to their children. Research shows that youth need 100 one minute conversations about sexuality versus one 100 minute conversation (Martino, MN, Corona, DE, & MA, 2008). The vast majority of our patients grew up in homes that were silent and often reactive to sexual curiosity. This leads to parents of young children who are unaware of how sexual curiosity is expressed by children and ill-equipped to provide ongoing sex education. This anxiety often leads to repeating the cycle, becoming mostly silent and reactive to the sexual interest of their children.
In our opinion, integrated care delivered by systemically minded professionals is an ideal place to facilitate this dialogue. In other words, let’s talk about sex with our patients…they want us to!
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