Maxfacts

What stops us approaching the subject of intimacy and sex either with health professionals or within one’s relationships? There are a number of reasons why we do not approach the subject. Individually it can be not knowing what to say, where to start opening the conversation, cultural taboos, or lack of confidence in knowing what to do if there is a problem. For health professionals it can be all of the above and them feeling they are not an expert to help in such a matter.

Most certainly a health professional does not need to be an expert to offer information that may be helpful. Just ‘opening the door’ allows a person to know that they can ask a question or know, if they have a problem it will be okay to raise this further down the treatment/recovery line.

Ways of just ‘opening the door’:

• During consent - ‘informed consent’ includes unwanted effects in the short and long term. To mention that if someone is having surgery in the mouth, this may impact on ability of tongue movement or ability to open mouth (trismus [diagnosis-list-trismus-level1]) and may not only affect eating and but also kissing … Or, if the health professional were feeling brave, they could say oral sexual pleasure.
• This could be followed up with a positive action, such as adding that the speech therapist’s exercises for tongue movement and mouth opening ‘will help with kissing too, if this is important’.
• When discussing medication, this should include the adverse effect profile. For example, codeine or other opioids may reduce a person’s libido. As health professionals typically discuss that these may make someone constipated or cause itchy skin, it could just be added that these may also reduce libido or sexual desire. There is no need to elaborate further but it lets the person make a decision for themselves if that is a problem and may also provide a reason why things may have changed.
• During rehabilitation and reducing opioid medication, it can be helpful if patients know the side effect profile as this may be the factor that helps somebody reduce analgesia.
• It could be very important for the person and their partner to hear that it is not that they are not interested in their partner any more, but that the medication they are taking takes the desire away. The relief to both patient and their partner can be huge. It also helps the person to make a choice about different medications.
• A nurse (in the UK at least) will often undertake a holistic needs assessment with a patient. On the assessment forms, there are sections for sex or relationship, this can open the door to understand the issues (if any) when completed.
• A dietician may deal with patients with feeding tubes and could ask if the times of the feeding regimen are okay and they do not get in the way of the person’s cuddle time with a partner. Many people have shared that the overnight feeding regimens have stopped cuddles as the equipment gets in the way.
• For long term feeding tube patients, this can also cause body image problems.

It is not necessary to be an expert in psychosexual therapy to open the door to allow these conversations to happen. If this door is opened, a person will often feel more confident to share any problems further down the line. It should not be presumed that intimacy and sexual function is only for the young.

A number of medications can affect sexual function and desire:

• opioids;
• anti-depressants (tricyclics and selective serotonin reuptake inhibitors (SSRI));
• neuropathic pain relief (amitriptyline, gabapentinoids).

Basic health promotion is also interlinked to sexual function and may help somebody to be motivated if they were aware that some habits negatively affect sexual function as well as their general health. Two powerful and well recognised examples would be drinking alcohol to excess and tobacco use. Alcohol may help with inhibitions, but it can significantly reduce vaginal secretions, causing dryness and discomfort. If sexual penetration is painful these are things to be aware of. Smoking can reduce the ability to gain and maintain an erection due to poor circulation. A first sign of heart disease can be loss of early morning erection.

There are many tactics to address these issues.