5 Tips for Clinicians Addressing Sexual Dysfunction: Geriatric Edition

By Gina Ianniello, MS, OTR/L, LSVT, CDP

Occupational Therapist

As physical, occupational, and speech therapists, it is imperative that sexuality is assessed when working with geriatric patients. According to the World Health Organization, sexuality encompasses sex, gender identities and roles, sexual orientation, intimacy, and reproduction. Sexuality can be influenced by the interplay between psychological, biological, social, economic, political, cultural, legal, historical, religious, and spiritual factors. And sexuality can be expressed in attitudes, values, beliefs, behaviors, practices, roles, and relationships.

Sexuality and intimacy are fundamental aspects of human life. Since sexuality is a contributing factor to a person’s overall health, wellness, and quality of life, it is safe to assume that when an illness, injury, condition, or new life stage occurs, it can potentially compromise sexuality and intimacy as well.

It can be very difficult to bring up sexuality with patients due to the fragile and unique nature of the topic. Here are some of the techniques I have found useful when it comes to addressing/assessing sexuality:

5 Tips for Addressing Sexual Dysfunction

1. Use education as a conversation tool. Educate your patient on the definition of sexuality and provide examples aspects of their daily life that they may not recognize as sexuality (i.e. grooming their hair to feel their best self or the clothes they choose to wear that makes them feel good about themselves)”. As mentioned above, the World Health Organization provides a clear definition of sexuality. Utilize this information to bring up the topic of sexuality to facilitate an objective conversation. Guide your patient through a conversation of the various subcategories of sexuality to improve their understanding and hopefully improve their comfort level of talking about their sexuality with you.
2. Utilize a formal tool to encourage the patient to feel like they are not alone. By completing an assessment with a formal tool you can guide the conversation through the use of the components of the outcome measures. Some assessment tools are the Multidimensional Sexuality Questionnaire. This tool is best used to look at a patient’s view of their sexual health/relationships. Another tool is the Oswestry Low Back Pain Disability Questionnaire that can be used to assess pain and its contribution to sexual health/abilities.
3. If you are uncomfortable, they are uncomfortable. Do your best as a medical professional to always maintain the appropriate language, both verbal and nonverbal. It is important to avoid laughter and judgment in your tone in order to facilitate a safe space for the patients to share their experiences/concerns while maintaining dignity.
4. Take an interdisciplinary approach to address sexuality with patients by familiarizing yourself with the roles of your team members. For example, you have a patient with physical intimacy concerns related to severe hip pain due to arthritis. A physical therapist can address pain management and orthopedic concerns as it may relate to sexual intercourse. And an occupational therapist can provide education and environmental modifications to improve safety and reduce the risk of injury during sexual activity.
5. Establish a routine with all patients to create a habit of asking questions related to sexuality with all patients. It is an unfair assumption that as age increases or medical conditions become more complex, sexuality disappears. It may not be a habit for you to bring sexuality up during an initial evaluation now, but consider addressing it from the beginning. Discussing issues and concerns with all patients and/or caregivers will ensure you are treating the whole person.

As mentioned above, the topic of sexuality can be awkward or uncomfortable to address. However, that does not discredit how important it is and the impact it can have on our patient’s quality of life.

I hope these tips alleviate some of the stress or discomfort that comes along with addressing sexual dysfunctions with your patients!