Sexuality Issues in MS Nursing

Transcription

1 Sexuality Issues in MS Nursing Dr. Edna Astbury-Ward, PhD, M.Sc. RGN, Dip. H.E, Cert Sexual & Relationship Therapy, Cert Counselling. Chronic diseases and degenerative conditions are often strongly linked to problems with sexuality and intimacy. Although discussion of sexual issues with patients is theoretically within the realms of nurse capability, the subject is rarely broached in practice. Many nurses feel uncomfortable discussing sexuality and intimacy with their patients, or feel that they don t have the necessary time or experience to provide advice. A qualitative study investigating communication about psychosexual health between healthcare professionals and patients with ovarian cancer found that although the majority of healthcare professionals believed that they should discuss sexual issues with their patients, only 25% of clinicians and 19% of nurses actually did so. 1 However, most patients felt that a healthcare professional should have provided written information or discussed sexual issues with them. Evidence suggests that patients would like sexuality to be addressed in consultations where appropriate. The Royal College of Nursing document Sexuality and Sexual Health in Nursing Practice states that nurses have a professional responsibility to address sexuality in clinical practice. Another document, entitled Sexual Health Strategy recognises that nurses have varying levels of skill to deal with issues of sexuality, but emphasises that all have a duty to use evidence-based practice at their own level of competence. This duty is reinforced by the finding that many patients with a sexual problem would prefer to seek advice from a nurse than from their GP. 2 The PLISSIT model is an approach to communication with patients that allows healthcare professionals to tailor the discussion to their own level of comfort and competence (figure 1). The successive levels of communication in the model require

2 increasing depths of knowledge, training and skill on the part of the healthcare professional. The first level, Permission Giving, can reassure the patient and gives them permission to ask questions and raise specific issues and concerns. The second level, Limited Information gives appropriate information to dispel myths or misconceptions that may be causing the patient concern. The third level, Specific Suggestion involves action steps and suggestions for management of the problem. The fourth level, Intensive Therapy is appropriate when the patient appears to have a complex emotional or psychological problem. This may necessitate referral to a specialist. Figure 1. The PLISSIT Model. P LI SS IT Good communication is the key to establishing a comfortable patient dialogue. The interaction between the healthcare professional and patient should be relaxed and unhurried, non-judgemental and conducted using terminology that the patient will understand. Some patients may respond positively to brochures and appropriate posters or displays in waiting or examining rooms. However, many patients may need initial encouragement to open the dialogue. A variety of questioning skills should be used. Open-ended questions invite patients to discuss specific concerns

3 about sexual problems, while closed questions may help to focus on specific aspects of the problem, such as onset and duration. Loss of self-esteem, fear of forming new relationships and anxiety about current relationships are common psychosexual issues in chronic neurodegenerative conditions such as MS. These issues can in turn have a devastating impact on relationships and quality of life for people with MS, but they are rarely addressed by healthcare professionals in practice. MS nurses can help by recognising the communication obstacles between patients and healthcare professionals and taking steps to overcome them. Reassurance and appropriate advice can in many cases, be sufficient to ease psychosexual fears and problems provoked by MS and its treatment. 1. Stead ML, Fallowfield L, Brown JM et al. BMJ 2001; 323: Astbury-Ward EM. Nursing Standard 2000; 15: Uro-Gynaecological Issues in MS Edna Astbury-Ward Problems with sexual function are relatively common in women with MS. These result not only from the primary disease process but also from the psychosocial impact of the condition. Sexual problems can have a major impact on quality of life, self-esteem and social engagement of the individual concerned. However, both healthcare professionals and people with MS are reluctant to raise sexual problems in routine consultations. Couples affected by MS might benefit from prior counselling about the potential impact of the disease on sexual expression and experience, to reduce anxiety and distress if these problems occur. Sexual arousal originates in the central nervous system in response to a variety of sensory stimuli (figure 1). In MS, primary sexual dysfunction can occur as a direct result of degeneration of the multiple nervous pathways carrying these impulses

4 from the central nervous system to the sexual organs. Decreased vaginal lubrication and loss of genital sensation are common examples of this. Prolonging foreplay and use of alternative tactile techniques, such as massage, may help to alleviate these problems. Alternative means of sexual stimulation, such as use of a vibrator, may also help to overcome slow arousal and impaired sensation. Vaginal dryness can be relieved by the use of silicone or water-based personal lubricants. Lesions in the central nervous system and loss of sensory receptors in erogenous zones can also directly affect the ability to achieve orgasm. Couples may find it helpful to identify and focus stimulation on those parts of the body that are not affected by sensory impairment. The non-sexual symptoms of MS can also interfere with sexual activity or arousal. This is termed secondary sexual dysfunction. Fatigue, muscle weakness, body or hand tremors, impaired attention or concentration and non-genital sensory changes may all adversely affect the sexual response, while bladder and bowel incontinence may cause distress or embarrassment. Abnormal sensations and spasms may be controlled with medication where necessary. Restricting fluids, intermittent catheterisation or medication can control urinary leakage during intercourse. Although these solutions may prove helpful to some couples, others dislike the lack of spontaneity with these approaches. Tertiary sexual dysfunction occurs when disability-related psychosocial or cultural issues interfere with sexual activity and experiences. In MS, pain, fatigue and loss of sensory, motor or neurological function can result in mood swings, depression and poor body image, which can in turn lead to problems with sexual expression. Body image, which is developed during childhood and refined during adult years, can be viewed as the sum of the body ideal, body presentation and body reality. Body image problems result from a marked discrepancy between the body reality and body ideal. It is important to realise that altered body image is not always a direct consequence of the disease or its treatment. MS and its treatment can have a profound impact on the sexual function of an individual. MS nurses should appreciate the importance of these issues and take

5 steps to discuss them with patients. Many problems with sexual function in MS can be relieved with reassurance, advice and simple interventions.