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Sexual Health & Intimacy

Sexual Dialogue Bridging the Gap Between Physicians and Patients

Jennifer L. Giordano, EdD, NCC

Intimacy refers to a feeling of emotional and/or sexual connectedness toward another person.¹ One of the hallmarks of intimacy is the freedom to be oneself in relating to the other person. From adolescence through mid-adulthood, opportunities for intense physical and emotional closeness abound. However, as women age, although their minds and souls may crave sexual intimacy, their bodies may not be as "ready" to express it. Many women in mid-life and beyond report that, without hormone replacement therapy or other treatments to diminish menopausal symptoms, their ability to engage in and fully enjoy genital or coitus-centered sex is hindered.¹

Intimacy is by no means limited to romantic relationships.² It can also be manifested in the relationship between women and their physician. In fact, physicians who share an intimate professional relationship with their female patients are in the best position to help these patients if they are experiencing problems of a sexual nature. Loss of sexual desire can diminish women's self-esteem, resulting in a feeling of disconnection from people around them. This can spiral downward into sexual dysfunction and intimacy problems.³

Women who are feeling awkward, vulnerable, and powerless when it comes to achieving intimacy or functioning sexually in a romantic relationship will be more likely to seek help from their physician if they feel that he or she is attentive, trustworthy, and respectful. If they are confident that they can communicate with their physician, they will be more likely to solve their problems. Without such confidence, they may hesitate to share concerns about sexuality and intimacy. They will conclude that their bodies have failed them and that they are forced to surrender their femininity and sexuality.⁴

After reaching menopause, many women experience sexual dysfunction, intimacy problems, marital strain, family stresses, isolation, diminished communication skills, and a lowered self-image.³ Reports of sexual problems in perimenopausal and postmenopausal women have been appearing in the literature for the past 40 years.⁵ Unfortunately, many physicians have not received adequate training in providing these patients with guidance and information regarding their sexuality. However, the medical community is finally "waking up" and heeding the call to properly train medical students and residents in these areas.

Sexuality is an integral part of human existence and a crucial quality-of-life issue.⁶ As women get older, they need up-to-date information to help them understand and manage the changes that are occurring in their bodies and their psyches. Physicians must be willing and able to address such issues, and to foster a sexual dialogue with their patients. If their own values or "hang-ups" preclude them from discussing sexuality with their patients, then they should refer these patients to a psychologist or sexologist. However, physicians need not feel that they are alone in the effort to educate their female patients. A strong therapeutic alliance among the medical, psychological, and educational communities is extremely useful in helping these patients to lead healthy and satisfactory sexual lives.⁷

Not all women will want or need extensive education in this regard, but many will want more information than they have.¹ For them, as well as for those women who have yet to confront sexuality and intimacy issues as they relate to their individual medical conditions, it is imperative to develop a treatment protocol that includes sexuality education and counseling, resources, and topics for women to discuss with their partner or family members. Without such a fund of knowledge, the physiologic, emotional, and social changes women face as they age will become even more frightening, discouraging, and depressing.⁶

Sexuality is a complex blend of physical and psychological components. Therefore, patients who present with disorders involving the sex organs, including their function, may have underlying emotional issues that are causing or contributing to the problem.⁸ Conversely, patients may present with psychosexual problems that have an organic cause. Either way, physicians should be equipped to deal with these problems by making an accurate diagnosis, providing appropriate treatment, offering useful recommendations, and providing educational resources. To accomplish this goal, physicians must maintain a healthy, constructive sexual dialogue with their patients. They should try to explore patients' fears and anxieties regarding their sexual behavior, experiences, and partnership issues. Providing a comfortable forum is critical to comprehensive patient care. In this way, physicians acknowledge the necessity of treating the whole person, not just the physical body, which will enable them to render better overall care.

REFERENCES

1. Giordano J. Intimate Approaches to Breast Cancer Recovery. Philadelphia, Pa: University of Pennsylvania Press; 1999.
   
2. Wilmoth MC. Strategies for becoming comfortable with sexual assessment. Oncology Nursing News. Spring 1995.
   
3. Lerner H. The Dance of Intimacy: A Woman's Guide to Courageous Acts of Change in Key Relationships. New York, NY: Harper & Row; 1989.
   
4. Scharf DE. The object-relations of sex and intimacy. In: Carlson J, Sperry L, et al, eds. The Intimate Couple. Philadelphia, Pa: Brunner/Mazel; 1999.
   
5. Caffarella RS. Psychological development of women: linkages to teaching and leadership in adult education. Information Series No. 350. Columbus, Ohio: ERIC Clearinghouse on Adult, Career and Vocational Education, Center on Education and Training for Employment, The Ohio State University; 1992.
   
6. Oliver H. Sexual counseling following disfigurement surgery. Medical Aspects of Human Sexuality. 1977;11 (10):55-56.
   
7. Kaplan HS. The New Sex Therapy: Active Treatment of Sexual Dysfunction. New York, NY: Brunner/ Mazel; 1974.
   
8. Grassel H, Scholtz B. Pedagogical and psychological aspects in gynecological practice. Eur J Surg Med. 1981;24:9-14.

Jennifer L. Giordano, EdD, NCC, is a sexologist and intimacy management specialist, The Pelvic Floor Institute, Graduate Hospital, Philadelphia, Pa.

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