What’s sex got to do with it?

As I was preparing a draft for this blog, a young woman asked to speak with me in private. She was soliciting signatures for a petition in our area to ban all sexual content in our public library. She reported that there were books that depicted and encouraged masturbation. When I commented that I thought masturbation was a safe and healthy way of learning about our body and sexual feelings, she interrupted to say that masturbation leads to child abuse. Along with politely disagreeing, I did not sign her petition. Many of us had sex education in school or at home, which was primarily a medical review of the sexual organs of the human body, and how they are involved in conception. If you were born in last four decades you also were taught some basics about sexually transmitted diseases. In other words, sexual education was and still is primarily limited to conception and illness; sexual pleasure is rarely discussed let alone encouraged. Sexuality is an important component of quality of life For centuries, many health- and wellness-minded practitioners and organizations have come to understand that adult sexuality is an important determinant to one’s quality of life and standard of living (Khajeei, et. al., 2019; Moreno, et. al., 2015). Sexual quality of life also involves more than just physical sex. It can involve the emotional sexual relationship with a partner and the behaviours resulting in sexual stimulation or sexual pleasure (Moreno, et. al., 2015). In fact, did you know sexual health is considered a basic human right? Sexuality is defined by the World Health Organization (WHO) as that which is “experienced and expressed in thoughts, fantasies, desires, beliefs, attitudes, values, behaviors, practices, roles and relationships.” Sexual health requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination and violence (WHO, 2006). We are all sexual beings; but how that is expressed differs by age, gender, relationship status, social norms and health status. Health status is where we come in. You may recall – deeply buried under organic chemistry—that both disease and pharmaceutical treatments can affect sexual health. Despite the evolving research in sexual health and wellness, this generally remains a neglected topic in health care. Disease can impact sexual health A wide variety of health conditions have a known impact on sexual health, such as cardiovascular disease, urogenital disorders, depression, anxiety, stress, obsessive compulsive disorder, migraines, tension headaches, fatigue, menopause, benign prostatic hyperplasia, other diseases of aging, neurological diseases (multiple sclerosis, Parkinson’s disease), spinal cord injuries, brain injuries, sleep disorders, gut issues, acne, renal disease, inflammatory diseases, sexually transmitted diseases, obesity, combat injuries, and cancer (Katz, 2022). Sexual functioning is dependent on healthy vascular, neurologic, and hormonal functioning. There is strong evidence that diseases affecting these processes adversely affect all aspects of the human sexual response cycle. For example, diabetes is a condition that profoundly affects both nerves and blood vessels, resulting in problems with sexual arousal. It is well established that erectile problems in an otherwise healthy man predicts cardiovascular disease and recognition of this association can prevent a significant cardiac event. Medical treatment’s impact Chemotherapy, calcium-channel blockers, selective, serotonin reuptake inhibitors, oral contraceptives, opioids, anti-epileptics, antipsychotics, anti-androgens (ketoconazole, cimetidine, spironolactone), selective estrogen receptor modulators, methylphenidate, trazodone, methadone, tetrahydrocannabinol, alcohol, substance use or abuse, and nicotine use all have the potential to adversely affect sexual health. (If I’ve missed any, please add to comments below.) An interesting issue, that is not always predictable, is when a patient who has experienced long-term erectile dysfunction is prescribed a phosphodiesterase-5 enzyme (PDE5) inhibitor, and the partner then discovers their own sexual health issues once sexual activity is resumed. It is advisable to include the partner in consultation for their readiness to reengage in sexual activity with a now firm erection. Barriers to sexual healthcare Two of the most common reasons that health care providers report for avoiding a discussion about the sexual side effects of illness and the treatment thereof are embarrassment and not wanting to be seen as invading a patient’s privacy. An introductory approach could be to say: “This medication/treatment has been known to affect sexual health. Have you noticed any changes in your sexual health while taking it?” If the patient engagement or need extends beyond your scope, then refer to a local Sexual Health Counsellor or if needed to a Sex Therapist. Asking the question, at least lets your patient know that you understand that sexual health is important and that there may be a solution. It also provides for the opportunity in the future to ask questions about sexual health, like accessing the human papillomavirus vaccine as an older adult, condom use, lubrication issues, PEP or PrEP, etc. Non-pharmacological recommendations to improve sexual function Some interesting findings in the literature that have some evidence for possibly improving sexual function or health include dietary measures, herbal supplements, supplements and physical activity. The Mediterranean Diet has been shown to improve sexual function in women with diabetes (Landa, et.al., 2016). The herbs that have been known to stimulate sexual function, include: ashwagandha, gotu kola, American ginseng, and devil’s club (Landa, et.al., 2016). Important nutrition for a healthy neuro-immune system includes: B vitamins, zinc, magnesium and omega fatty acids which can all have an impact on sexual health (Landa, et.al., 2016). Kegel exercises is a great and easy way to strengthen the pelvic floor muscles and increase blood flow to the vaginal/vulva area, which in turn will improve sexual health (Brotto, Mehak, & Kit, 2009). Pharmacological approaches Most readers will be fully aware of the PDE5 inhibitors, hormone replacement therapy, inserts and the like, so I will only remind you to consider their implications and place in therapy. On the other hand, some lesser-known approaches are worth noting here. Intravaginal prasterone is relatively new to the Canadian market. This vaginal suppository is an inactive steroid that is converted into active androgens and/or estrogens. The mechanism of action in postmenopausal patients with vulvar and vaginal atrophy is unknown, but trials demonstrate benefit for dryness and discomfort leading to easier orgasm and increased sexual desire (Basson & Gilks, 2018). Other interesting over the counter products are vaginal preparations with sodium hyaluronate for relieving vaginal dryness; and some with the addition of lactic acid to help relieve and prevent symptoms of bacterial vaginosis. Some ob-gyns are familiar with their use as they are recognized by the Society of Obstetrics and Gynaecologists of Canada. Bringing awareness to sexual health in a medical setting will help to change attitudes to reinforce the reality that sexuality is a component of general health. Inviting patients/clients to discuss their sexuality helps normalize their concerns, and it provides an opportunity to provide information. Whether you are trained in the medical model that focuses on harm reduction, disease prevention, or pregnancy issues; or you have adopted a more sex positive approach that focuses on choices to enhance quality of life with a comprehensive non-judgmental lens—you can draw the current up and give sexual health a spot on the stage. Sexual health is an important area of human health, and earlier identification of reduced sexual quality of life would lead to earlier interventions targeting long-term quality of life. References: Landa, J., Faubion, S.S., Rullo, J., Simon, J.A., Yarnell, E., Khamba, B., Ganpat, T.S., & Kandhan, L. (2016). Clinical roundup: Selected treatment options for sexual dysfunction. Alternative & Complementary Therapies. 22(1), 37-42. DOI: 10.1089/act.2016.29042.cru Katz, A. (2022). Sexuality and Illness. A guidebook for health professionals. Routledge. Brotto, L., Mehak, L., & Kit, C. (2009). Yoga and sexual functioning: a review. Journal of Sex & Marital Therapy, 35, 378-390. DOI: 10.1080/00926230903065955 Khajeei, D., Smith, D., Kachur, B., and Abdul, N. (2019). Sexuality re-education program logic model for people with traumatic brain injury (TBI): synthesis via scoping literature review. Sexuality and Disability, 37, 41-61. DOI: 10.1007/s11195-018-09556-1 Moreno, J., Arango-Lasprilla, J., McKerral, M. (2015). The relationship between postconcussion symptoms and sexual quality of life in individuals with traumatic brain injury. Sexuality and Disability, 33, 483-498. DOI: 10.1007/s11195-015-9411-8 Basson, R. and Gilks, T. (2018). Women’s sexual dysfunction associated with psychiatric disorders and their treatment. Women’s Health, 14. DOI: 10.1177/1745506518762664

What’s sex got to do with it?

Register for free access or login.

More Blog Posts in This Series

Is there a crack in the Act?

Dear imminent apothecary . . .

How I'm planning not to burn out in 2023 in a profession where it's all too easy

Blog Author

Lisa Zaretzky

Related Topics