Sexual Health SIG: How to break the taboo of discussing sexuality?

‘To have sex with your partner, communication is key’ was the first subject she pointed out. It is difficult to talk about sex and what gives you pleasure when you have sex. Even with your own partner it can be difficult, due to the culture you grew up in, having the idea that sex is dangerous or prohibited.

Healthcare workers experience often a lack of knowledge, what makes it difficult to bring up the subject with their patients. Assoc. Prof. Dewitte suggested that sexual knowledge should be a mandatory aspect of the basic healthcare training. She makes clear that men and women experience sexuality in very different ways with experiencing the orgasm differently. Sex is about pleasure, so talk about pleasure! Women need stimulation of the clitoris to get arousal and reward during sexual intercourse. Men most of the time are focused on penetration to get that reward. Sex is more than penetration, fore play is the most important part of sex, penetration is the dessert. You can start the conversation by bringing up the subject, depersonalised, by telling your patient that similar patients experience sexual problems also. This will give the patient the opportunity to bring up his situation whenever he is ready. You can refer your patient to a specialist if necessary.

Ms. Helen Attard-Basson (BT) addressed the topic of erectile dysfunction (ED) in men in relation to disease or comorbidity. She gave an overview of causes of ED including vascular diseases, hypogonadism, surgeries, and drug induced/drug abuse. Risk factors like smoking, obesity, and alcohol abuse were mentioned. The management of sexual dysfunction starts with diagnostic evaluation, including medical, psychosexual history, lab control and physical examination. Management of ED includes lifestyle management, education & counselling and pharmaceutical management. The first line treatment of ED is with PDE5i like Sildenafil or Tadalafil. Failure of medication is often due to miss expectation or side effects. Second line treatment contains vacuum erection devices, intra urethral suppositories or intra cavernous self injections with vasodilator erection stimulating medication. Side effects and contra indication were mentioned, as well as the last line of treatment, which is surgical.

Finally, Ms. Rebecca Martin (GB) spoke about sexuality in women in relation to bladder cancer and cystectomy, which gets little attention within urology. Symptoms of sexual dysfunction in female patients presents as loss of libido, vaginal dryness, difficulty in achieving orgasm and dyspareunia. Causes of dysfunction is menopause (forced or early), medication (i.e. SSRI), blood supply, neurological diseases like MS, psychological. Research indicates that this is a multifocal problem with psychological and physical aspects like loss of desire, difficult intromission, dyspareunia, reduced clitoral sensation and orgasmic disorders. It is often seen in bladder cancer patients due to treatment in the urology practice.

Healthcare workers are not that good at talking about sexual dysfunction, especially in women. In men, treating ED has more options than treating sexual dysfunction in female patients. Especially when patients have had a cystectomy. There is only vaginal moisturising or dilators. In medical therapy topical oestrogen creams or oral mediation can be prescribed. The Plissit model was presented, where permission is the first step. The healthcare worker is the one starting the discussing on sexual dysfunction by asking the right question. Ms. Martin’s take-home message stressed the need to talk about the subject of sexuality with patients.

Every healthcare professional can start the conversation on sex when a treatment leads to sexual dysfunction or whenever the healthcare worker has the feeling sexuality may be an issue to the patient. You can refer your patient to a specialised professional if you are not comfortable or able to help your patient further.

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Ms. Jeannette Verkerk Geelhoed (NL)