Physical/Medical Issues in Sex Therapy

Introduction

Sexuality is a vital component of one’s self-definition and sense of wellbeing. Regrettably, sexual expression can be adversely impacted by cognitive and physical changes resulting from illness, aging, disability, or trauma. Historically, treating persons with physical or cognitive disabilities has been underemphasized in the clinical literature, specifically with respect to the impact on sexuality. More recently, however, increasing attention has been given to the rights of this population to experience sexual expression, satisfaction, and to receive sex therapy (Hughes & Lewinson, 2014). Hughes, Hertlein, and Hagey (2011) reported that physical, cognitive, and emotional issues affecting sexuality have also been addressed in the medical family therapy literature. Unfortunately, although the goals of medical and sex therapy are similar in clients with physical issues, the two domains have had little overlap in clinical literature and practice (see Moser & Devereux, 2012). It is our position that sex therapists become important collaborators with medical practitioners in the treatment of medically related sexual issues and cognitive disabilities.

For several reasons, we believe that sex therapists will see an increasing number of referrals for treatment of sexual issues among the aging, chronically ill, disabled, or differently abled clients. First, thanks to medical advances, people are living longer with chronic illnesses, particularly HIV, cancer, and diabetes. Second, the aging of the baby boomers has resulted in a greater prevalence of couples over age 50 who are committed to remaining as sexually active as they were decades ago. Third, advocates for disabled individuals have been vocal in demanding that society view this cohort as sexual beings with a right to sexual pleasure, resulting in more willingness on the part of the disabled to seek help when they face sexual difficulties (Mona, Cameron, & Clemency Cordes, 2017). Finally, as research continues to demonstrate the need for and effectiveness of sex therapy (Syme, Mona, Si Cameron, 2013), physicians are gaining greaterawareness about addressing sexual issues in medical practice and also understanding the need to collaborate with a sex therapist.

It is essential that sex therapists have at least a basic understanding of the ways in which medical, cognitive, and other disabilities can impact sexual functioning and satisfaction and also have basic knowledge of treatment issues within these populations from an Intersystem perspective. The Intersystem perspective emphasizes the intrinsic connections among the individual-biological-psychological, couple dyad, family, and cultural context. This chapter provides specific treatment strategies to address the most commonly occurring sexual dysfunctions related to particular health conditions: (1) how the specific medical problem affects sexual functioning, (2) the client’s perception of and beliefs about the problem, (3) the partner’s perceptions of the problem and how it affects their sexuality, and (4) the individual’s or couple’s resiliency and ability to adapt to change and reclaim sexuality.

The Medicalization of Sexuality

Medicalization refers to “the shifting of social and behavioral problem definition and management into the medical domain (for example, from drunkenness to alcoholism or from shyness to social anxiety; Conrad, 2007)” (Tiefer, 2012; p. 312). As physicians began to pay more attention to sexual dysfunction, the development of pharmaceuticals like Viagra and similar drugs started to offer medical solutions to sexual problems. Such a discoven' ushered in a new wave of marketing, media, and money poured into the development of these treatments and the dissemination of information.

Despite the advances that can come from pharmacological treatments to sexual problems, it is important to be cautious about implementing or considering a drug therapy or similar medical intervention for every sexual problem (Bancroft, 2002; Bradley 8c Fine, 2009). One risk of a medical model to sexual disorders is that it presumes the etiology of any sexual problem addressed by medication is solely biological, when in fact such dysfunctions tend to be a blend of biological and psychological factors (Winton, 2000). Reliance on medications for the treatment of sexual problems communicates that the emphasis for sexual issues in a couple are on one person’s symptoms and avoids relationship responsi-bility/attribution for the problems that are in the couple’s relationship (Pacey, 2008). Many of the medications currently available are intended to treat male disorders, placing an emphasis on men’s rather than women’s functioning adequately and experiencing pleasure (Farrell 8i Cacchioni, 2012; Graham, 2007; Pacey, 2008). Only recently has the emphasis shifted to medical treatments for women’s sexual disorders, specifically the lack of interest and arousal (Both, 2017). Recently, two drugs were approved for use in limited groups of women, each drug having considerable risk/benefit profiles (see Chapter 7). Sexual interest in women is multifaceted and poorly understood; pharmacotherapy alone is not a sufficient treatment option for women’s sexual disorders, particularly in the absence of sex therapy (Anderson & Moffatt, 2018; Both, 2017).