RP101 – Sexuality (Sept 2018)



Session Readings

 

Background:

Regardless of age, gender, sexual preference, or sexual identity, one’s sexuality is inherently tied to one’s sense of well-being. Addressing sexuality (defined, for our purposes, as the sexual habits and desires of an individual) with our patients is an essential component of providing them comprehensive, compassionate, high-quality care. Despite this reality, providers frequently avoid the topic, stating that their hesitancy stems from a belief that their patients are uncomfortable discussing the topic.  The reality it is just as often (if not more often), providers are the ones who are uncomfortable discussing sexuality. As such, it is essential that we consider our own reactions to discussing sexuality and examine the way these reactions might impact the way we care for our patients.

Prior to the session, consider your own views on sexuality and your comfort discussing sexuality with people of different ages, gender, sexual preference and sexual identity. I also ask you to consider your reaction to discussing sexuality with individuals who have sustained spinal cord injuries, amputees, those who have experienced trauma or surgeries, and those with mental disability.

How do you presently see sexuality fitting in patient care? How have you reacted to experiences you have encountered thus far with sexual overtones  – such as conducting (or omitting) a sexual history in your patient interviews, studying the anatomy of the genitalia, and performing examinations of the penis, vagina, and anus? How might your context impact the way you would (or wouldn’t) address the topic with one of your patients? How might this impact the quality of care you deliver?

Objectives: By the end of the session on the topic of Sexuality, students will demonstrate the ability to:

  1. Identify one’s reaction to sexuality in various populations and consider what factors impact this reaction, to include but not be limited to:
    • Your own or your patient’s age, impairment, gender, sexual preference and sexual identity
    • Your own or your patient’s view of sexuality
    • Your own or your patient’s apparent comfort/discomfort discussing sexuality
    • The relationship of the individual to you
  2. Reflect on the source(s) of those reactions, including:
    • your own experiences with your sexuality
    • your beliefs and values regarding sexuality
    • beliefs about who should and should not be sexually active
    • how you perceive sexuality to be viewed in the family/community in which you grew up
    • how you perceive sexuality to be viewed in the medical and/or military community
  3. Identify the implications (both positive and negative) of those reactions for your ability to address issues related to sexuality in the care of your patient(s).
  4. Identify a lesson learned about the topic of sexuality.

Panelists

  • Dr. James Ellzy, CAPT, USN, Chief Medical Information Officer for the Defense Health Agency, and a Navy family physician for the past 22 years.
  • Dr. Inger Rosner, COL, USA, is Director of Urologic Oncology and Prostate Disease research at Walter Reed.
  • Terry Glover is a retired US Navy CAPT, previous Surface Warfare Officer. He is also retired from General Dynamics and also does volunteer work with his bride of 50 years.

Assignment

There is no reflective paper due for this session but if you were not in the panel session, you must watch it. Please contribute questions/commentary to the shared Google doc for your group ahead of the small groups on the 18th.

Read through or listen to at least one of the supplemental materials provided. There are a wide range of topics around sexuality that we can’t cover in a 90 minute panel session but are equally as interesting and provocative for discussion. Be prepared to participate in the small groups!

PulseTaboo by Ralph B. Freidin Dr. Ralph Friedin addresses how sexual feelings may inevitably occur during an examination, and emphasizes the need to teach students how to navigate such reactions rather then ignore the subject entirely.
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The Next Part (17min) A look at intimacy, sexuality, and fertility for Kat and Aaron Causey, a family affected by the injuries of war.
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50513_2219590487_2204_n(Sex)abled: Disability Uncensored by Dan Nokavich This provocative documentary does an excellent job identifying and challenging some common assumptions about sexuality and disability.
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New York TimesToo Old for Sex? Not at This Nursing Home. Respecting the fact that the elderly still yearn for intimacy and relationships, this nursing home works to create guidelines and opportunity for those that are interested.
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New York TimesTransgender, at War and In Love. (12min) This short documentary shares the challenges of a transgender military couple, who are banned from serving openly.
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captureHow 'Don't Ask Don't Tell' is still an issue 25 years later Here’s a look back at how the DADT policy was put in the place, what the reaction to it was when it was introduced and how the conversation surrounding it has changed over the last two decades.
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New York TimesWhen Did Porn Become Sex Ed? If parents don't talk about sex, and doctors don't talk about sex, and abstinence is reinforced in schools, where are our kids turning for knowledge?
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Session originally created by: Adam Saperstein | SOM/GSN, Uniformed Services University | Director, Reflective Practice | Family Medicine