RP101 – Sexuality (Sept 2019)



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.  We use this topic in Reflective Practice to consider where our unconscious or implicit bias around sexuality lies, what has influenced it, and how our 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. Rachel Rubin is a urologist practicing in Washington, DC, with fellowship training and a clinical focus on male and female sexual dysfunction.
  • Dr. Alia O’Meara is a Pediatric Critical Care physician and Co-Director of the Children’s Hospital Foundation Center for Pediatric Neuroscience at Virginia Commonwealth University.
  • Dr. Kevin Semelrath is a board certified Emergency Medicine physician, Assistant Professor at Uniformed Services University and a veteran of the US Air Force.

Assignment

Reaction:  As you reflect on the panel and supplemental resources, identify your reaction to the topic of sexuality and to discussing it with others.  In identifying these reactions, consider to what extent your reaction varies when considering discussing sexuality with people of different ages, gender, sexual preference, sexual identity, as well as those who have physical and/or mental challenges. Please ensure you include at least two (2) reactions.

Sources: Through the medium of your personal narrative, explore the sources of these reactions. Be specific and make sure to write in the first person.  You might consider the following:

  • your own experiences with sexuality
  • your beliefs and values regarding sexuality
  • your 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 as well as your current community
  • how you perceive sexuality to be viewed in the healthcare community

Implications: Identify the positive and negative implications of your reactions to the topic of sexuality as well as the idea of discussing the topic of sexuality with others. In what ways might your reactions improve your communication with your patients and the quality of care you deliver?  In what ways might it detract from that quality of care?

Review: You’ve named your reaction and your context — so what is your bias or assumption with regard to this topic?  What surprised you about the topic? As you think about your reflection above, what have you learned about yourself?

MAKE SURE TO INCLUDE:  What question do you want to bring to the group discussion to further explore?

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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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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The Curbsiders: LGBT health Build your knowledge base to improve primary care for LGBT patients! This episode is chock full of clinical pearls and updates for LGBT health from SGIM presenters, Dr. Jenny Siegel (Boston University) and Dr. Megan McNamara (Louis Stokes Cleveland VAMC). They define common gender identity terms and provide tips on how to take a sexual history. You’ll develop an approach to the unique clinical concerns of LGBT patients and learn how to phrase medical information in a gender neutral framework. This is a must listen episode for all health care providers!
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Session originally created by: Adam Saperstein | Uniformed Services University | Admissions Medical Officer, USNA | Assoc Prof. Family Medicine