All healthcare professionals need training to deal with the sexual needs of patients, study finds

ScienceDaily (Oct. 11, 2012) — Providing healthcare staff with a one-day training course on dealing with the sexual needs of people with an acquired physical disability gave them greater understanding of the issues patients faced and enabled them to address intimate questions more comfortably and proactively.
The findings were so encouraging that the authors of the study, published in the November issue of the Journal of Advanced Nursing
, are calling for all healthcare practitioners to receive sexuality training, regardless of their role or the area of healthcare they work in.
Researchers surveyed 29 nurses, allied health professionals and care staff, before and after the course, on their ability and confidence to address sexual issues with patients. They also held in-depth interviews with 12 of them. All age ranges were represented (20 to 55 plus), the majority were female (79 per cent) and most had been working at their current hospital for one to five years (41 per cent).
"Changes associated with an acquired physical disability can diminish a person's self-esteem, sense of attractiveness, relationships and sexual functioning" explains lead author Agnes Higgins, Professor of Mental Health at the School of Nursing and Midwifery, Trinity College Dublin, Ireland.
"Previous research suggests that people with physical disability are dissatisfied with the quality of information and support around sexuality during their rehabilitation."
Subjects addressed during the course included the impact of disability on sexual expression, how to deal with patients' sexual behaviour in the hospital setting and responding to questions such as whether they will be able to have sex in the future.
Key findings included:
Participants rated their knowledge of 13 key areas related to patients' sexuality, including rights, aging, communication and help with specific medical conditions. The mean score was 1.9 out of four before the course and 2.5 after the course -- the equivalent of a 31.5 per cent increase in knowledge.The biggest rises in knowledge were in sexual rights and disability and brain injury and sexuality (both up 0.8 out of four). Other top increases included the impact of a stroke on sexuality and managing 'inappropriate' sexual behaviour (both up 0.7).Participants also rated their ability to deal with 15 situations, ranging from seeing a patient engaging in sexual behaviour to seeking advice on their future sexual ability. The mean score was 2.1 out of four before the course and 2.6 after the course -- the equivalent of a 23.5 per cent increase in ability.The biggest rises in ability were how to deal with walking in on a patient who was masturbating or engaged in sexual foreplay with their partner (both up 0.8). Other top increases included how to respond to a patient who asked if it was OK for them to have sex and advising young and old patients who wonder if they will ever have an erection or orgasm again (all up 0.7).
Staff reported finding the course very helpful.
One participant said it made them more able to respond to difficult issues in a sensitive manner. "I'm less uncomfortable and if they [patients] raise an issue, even in a joking manner, I'm kind of happy to say 'Well is that an issue for you… would you like to talk about that a little bit more?' rather than just kind of laughing and then moving onto the next subject, which is easy to do."
Another said it made them think of more than a patient's medical needs, citing the example of a woman who was incontinent and keen to return home and to work. Normally they would have suggested a urinary catheter, without further exploring the impact of this on the person's life, but the staff member said: "Because I'd done the sexuality course it made me think well actually one of the person's goals is she's got a fiancé, and relationships are important, and that [catheter] would be a huge barrier."
This was reinforced by other staff members. "I like to think I see the patient as a person, but you don't always, you honestly don't" said one. "That [course] made me very, very aware that there is a person here."
It also made it easier for them to deal with sexual comments from patients as one participant illustrated with a pre-course experience. "We are in a room and a young nurse is passing by and she is good looking but he [patient] expresses that in a way that is not exactly inappropriate. He's a young guy… I feel a little bit embarrassed and do not know how to react."
"Patient sexuality is an area that many healthcare practitioners may be reluctant to address or discuss because of embarrassment, particularly when patients have a disability" says Professor Higgins.
"Our study suggests that systematic education and training in sexuality leads to statistically significant changes in health care practitioners' knowledge, skills and comfort. Participants also reported numerous incidents where they were more willing to raise issues for discussion and create a supportive listening space for patients.
"This course provided an effective learning experience for the healthcare practitioners and could easily be replicated elsewhere. We believe that practitioners require education in patient sexuality, regardless of their discipline."
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Journal Reference:
Agnes Higgins, Danika Sharek, Maeve Nolan, Barbara Sheerin, Paul Flanagan, Sniguole Slaicuinaite, Sinead Mc Donnell, Heather Walsh. Mixed methods evaluation of an interdisciplinary sexuality education programme for staff working with people who have an acquired physical disability. Journal of Advanced Nursing, 2012; 68 (11): 2559 DOI: 10.1111/j.1365-2648.2012.05959.x
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How to prove a sexual addiction: Criteria for diagnosing 'hypersexual disorder' tested

ScienceDaily (Oct. 18, 2012) — The idea that an individual might suffer from a sexual addiction is great fodder for radio talk shows, comedians and late night TV. But a sex addiction is no laughing matter. Relationships are destroyed, jobs are lost, lives ruined.

Yet psychiatrists have been reluctant to accept the idea of out-of-control sexual behavior as a mental health disorder because of the lack of scientific evidence.

Now a UCLA-led team of experts has tested a proposed set of criteria to define "hypersexual disorder," also known as sexual addiction, as a new mental health condition.

Rory Reid, a research psychologist and assistant professor of psychiatry at the Semel Institute of Neuroscience and Human Behavior at UCLA, led a team of psychiatrists, psychologists, social workers, and marriage and family therapists that found the proposed criteria to be reliable and valid in helping mental health professionals accurately diagnose hypersexual disorder.

The results of this study -- reported in the current edition of the Journal of Sexual Medicine -- will influence whether hypersexual disorder should be included in the forthcoming revised fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), considered the "bible" of psychiatry.

The importance of the study, Reid said, is that it suggests evidence in support of hypersexual disorder as a legitimate mental health condition.

"The criteria for hypersexual disorder that have been proposed, and now tested, will allow researchers and clinicians to study, treat and develop prevention strategies for individuals at risk for developing hypersexual behavior," he said.

The criteria, developed by a DSM-5 sexual and gender identity disorders work group for the revised manual, establish a number of symptoms that must be present. These include a recurring pattern of sexual fantasies, urges and behaviors lasting a period of six months or longer that are not caused by other issues, such as substance abuse, another medical condition or manic episodes associated with bipolar disorder. Also, individuals who might be diagnosed with this disorder must show a pattern of sexual activity in response to unpleasant mood states, such as feeling depressed, or a pattern of repeatedly using sex as a way of coping with stress.

Part of the criteria also states that individuals must be unsuccessful in their attempts to reduce or stop sexual activities they believe are problematic.

"As with many other mental health disorders," said Reid, "there must also be evidence of personal distress caused by the sexual behaviors that interfere with relationships, work or other important aspects of life."

In order to evaluate the criteria for hypersexual disorder, Reid and his colleagues conducted psychological testing and interviews with 207 patients in several mental health clinics around the country. All of the patients were seeking help for out-of-control sexual behavior, a substance-abuse disorder or another psychiatric condition, such as depression or anxiety.

The researchers found that the proposed criteria for hypersexual disorder accurately classified 88 percent of hypersexual patients as having the disorder; the criteria were also accurate in identifying negative results 93 percent of the time. In other words, the criteria appear to do a good job of discriminating between patients who experience hypersexual behavior and those who don't, such as patients seeking help for other mental health conditions like anxiety, depression or substance abuse.

"The results lead us to believe that the proposed criteria tend not to identify patients who don't have problems with their sexual behavior," Reid said. "This is a significant finding, since many had expressed concerns that the proposal would falsely classify individuals."

Reid also noted that the ability of the criteria to accurately identify hypersexual disorder in these patients was quite high and compared favorably to other psychiatric diagnoses.

Another significant finding of the study, he said, was that patients who met the criteria for hypersexual disorder experienced significantly greater consequences for their sexual activities, compared with individuals with a substance-abuse diagnosis or a general medical condition. Of the 207 patients they examined, 17 percent had lost a job at least once, 39 percent had a relationship end, 28 percent contracted a sexually transmitted infection and 78 percent had interference with healthy sex.

"So an individual meeting the criteria for hypersexual disorder can experience significant challenges and consequences in their life," Reid said. "Our study showed increased hypersexual behavior was related to greater emotional disturbance, impulsivity and an inability to manage stress."

Interestingly, the researchers found that 54 percent of the hypersexual patients felt their sexual behavior began to be problematic before the age of 18. Another 30 percent reported that their sexual behavior began to be problematic during their college-aged years, from 18 to 25.

"This appears to be a disorder that emerges in adolescence and young adulthood, which has ramifications for early intervention and prevention strategies," Reid said.

The study also examined the types of sexual behavior that hypersexual patients reported. The most common included masturbation and excessive use of pornography, followed by sex with another consenting adult and cybersex. The study noted that hypersexual patients had sex with commercial sex workers, had repeated affairs or had multiple anonymous partners -- amounting to an average of 15 sex partners in the previous 12-month period.

"It's not that a lot of people don't take sexual risks from time to time or use sex on occasion to cope with stress or just escape, but for these patients, it's a constant pattern that escalates until their desire for sex is controlling every aspect of their lives and they feel powerless in their efforts to change," Reid noted.

Other authors on the study included Heather McKittrick, Margarit Davtian, and senior author Dr. Timothy Fong, all of UCLA; Bruce N. Carpenter and Randy Gilliland of Brigham Young University; Joshua N. Hook of the University of North Texas; Sheila Garos of Texas Tech University; Jill C. Manning, in private practice; and Erin B. Cooper of Temple University. Dr. Fong has the following relationships: speaker's bureau for Reckitt Benckiser, Pfizer Pharmaceuticals, and grant support from Psyadon Pharmaceuticals. The other authors report no conflict of interest.

Most of the study was unfunded; researchers donated their time. Some travel expense was funded internally through the UCLA Department of Psychiatry.

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The above story is reprinted from materials provided by University of California - Los Angeles. The original article was written by Mark Wheeler.

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Journal Reference:

Rory C. Reid, Bruce N. Carpenter, Joshua N. Hook, Sheila Garos, Jill C. Manning, Randy Gilliland, Erin B. Cooper, Heather McKittrick, Margarit Davtian, Timothy Fong. Report of Findings in a DSM-5 Field Trial for Hypersexual Disorder. The Journal of Sexual Medicine, 2012; DOI: 10.1111/j.1743-6109.2012.02936.x

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College students' sexual hookups more complex than originally thought

ScienceDaily (Oct. 17, 2012) — Between 60 to 80 percent of college students have experienced some kind of sexual 'hook-up,' according to new research published in the Review of General Psychology.

Researchers from Binghamton University and The Kinsey Institute for Research in Sex, Gender and Reproduction at Indiana University, collaborated on a comprehensive academic review of the sexual hookup culture. Their finding concluded that these encounters, which are increasingly becoming the 'norm,' mark a shift in the openness and acceptance of uncommitted sex among U.S. "emerging adults" during the transitional developmental period between adolescence and young adulthood.

"What we were able to see in the literature was a real change to dating culture," said Justin R. Garcia, a research fellow at The Kinsey Institute. "Since the 1920s, we've seen a gradual movement away from dating under parental supervision, in fact, taking it out of the house completely. This project provided a very colorful snapshot of where we are today by focusing on a unique transitional period in an emerging adult's life -- the college years. What we found presents a new take on sexual behavior today, which is that we're dealing with a culture among emerging adults that views sex in a non-committal way, emphasizing experience over committed relationships."

Drawing a team of researchers from a broad range of disciplines, the project presented an opportunity to look at the issue of uncommitted sex from a multifaceted theoretical perspective.

"We brought together a real mix of forces to tackle this project," said Sean Massey, research associate professor of women, gender and sexuality studies at Binghamton University, and co-author of the study. "We tapped into the expertise of an evolutionary biologist, an anthropologist, a social psychologist and a developmental psychologist -- people who were able to collaborate intellectually but able to draw from different spheres and methodology. The result is a comprehensive view that we believe offers a much better understanding of sexual activity and perspectives."

The anthropologist -- Chris Reiber, an associate professor -- and the developmental psychologist -- Ann M. Merriwether, both of Binghamton University -- joined Garcia and Massey in conducting a full review of studies and opine from each of their respective fields to formulate a comprehensive snapshot of the cultural phenomenon known as 'hook-ups.'

"Even though a large percentage of emerging adults 'hookup,' it's not just about the sex," said Garcia. "Many men and women are looking for something more -- in essence, looking for love, a romantic relationship. With dating culture being so dramatically different among youth today, we're left to ask how emerging adults achieve both sexual and romantic goals -- as desires for both are at the core of the human condition."

And it's not all about the stuff emerging adults see on TV or listen to on their iPods. Tapping into the barrage of cultural references in movies, television shows, and music that emerging adults are subjected to, the study suggests that pop culture is pulling double-duty, simultaneously representing aspects of actual sexual behavior while providing sexual 'scripts' for young adults.

The researchers also found that alcohol and drugs had a lot to do with uncommitted sex. In fact, alcohol was involved in over a third of the hookup cases. "It certainly wasn't a surprise to us," said Chris Reiber. "But what was interesting was the role alcohol played in many hookups: sometimes consumed on purpose to facilitate hooking up, and other times given as a reason why hookups went further than expected or wanted." The researchers say alcohol and drug use can drastically increase the risks associated with hookups.

But according to the researchers, it's not all bad news. The study presents a unique opportunity for parents and anyone dealing with college-aged populations to have a better understanding of this stage of a young person's development.

"We neither condemn nor condone any consensual sexual activity," said Garcia. "But we do endorse the need for emerging adults to be aware of, and honestly communicate, their own intentions, desires, and the comfort levels of themselves and of their partner(s) during engagement in sexual activity."

Massey hopes the study will help parents and those who interact with emerging adults to be better educated about sexual behavior.

"Hookups have become a major part of today's social discourse, and to the sexual development of many young people," said Massey. "We hope this review and our other studies on the hookups provide an entry point to talk about this issue much more openly, and based on the available data. There are both negative and positive sides of the issue, but more importantly, the data demonstrate tremendous variety in human sexual expression."

The interdisciplinary research group is currently working on several empirical studies regarding sexual hookup behavior, with several articles recently completed on the topic. Future studies aim to understand the relationship between hookup culture and sexual satisfaction, sexual orientation, risk and condom use, alcohol use, and pregnancy, amongst other issues.

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The above story is reprinted from materials provided by Binghamton University, State University of New York, via Newswise.

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Journal Reference:

Justin R. Garcia, Chris Reiber, Sean G. Massey, Ann M. Merriwether. Sexual hookup culture: A review.. Review of General Psychology, 2012; 16 (2): 161 DOI: 10.1037/a0027911

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