Understanding Patients' Sexual Problems

Sexuality is openly flaunted and touted by the media on the worlds’ stage as being a wanton, blatantly obvious commodity sought primarily by men who are performance obsessed; where people, especially women, are openly objectified, and where sex is readily available and bought for a price, regardless of the type of sexual practice in demand. In actuality, for the majority of people, a person’s sexuality remains an extremely personal, precious, fragile and private issue that he or she is often hesitant to even mention, let alone discuss with others. Most healthcare providers rarely open up discussions with their patients about a sexual problem, and in so doing do not fully meet their patients’ physical and emotional needs. Sexual problems are usually avoided, misdiagnosed, diminished, or even blatantly ignored by healthcare providers. This book addresses 85 sexual problems, and defines each problem, its signs and symptoms, origins, background, therapeutic and supportive interventions, as well as the potential outcomes of those sexual topics. Its content, with supportive research URLs, is readily accessible, and written with relative simplicity, all of which facilitate increased comprehension for its readers and problem resolution for the individuals involved.

For many, a person’s sexuality remains a very private issue, and when people are not familiar with sexual terms or have no experience with sexual practices that are different from their own, awkward situations occur. Imagine how uncomfortable it may be for healthcare professionals (HCPs) to discuss sexuality with their patients or support the diverse sexual needs of patients whose behaviors they do not understand or accept. HCPs tend to avoid the patients’ sexual concerns, and while avoidance is not a malicious or conscious act, it happens as a result of their own sexual insecurities and lack of sexual knowledge, time, and confidence in their counseling skills. Consequently, I felt compelled to write this sexuality handbook, Understanding Patients’ Sexual Problems, so HCPs might gain a greater understanding of the patients’ sexual needs, concerns, and anxieties. I am an RN of fifty years, experienced at most levels of nursing practice (including 20 years in sexology), with a master’s degree in nursing and a Ph.D. in Human Sexuality, consequently I believe I am qualified. Chapter 1 presents the environment in healthcare arenas, and the many obstacles and barriers that some HCPs face as a result of their own and the sexual issues of others. Many misconceptions and misperceptions lead to harmful miscommunications. This chapter describes the professional power levels that exist; however, things are changing for the better. As the regimented, hierarchical atmosphere changes, the various disciplines work toward more teamwork and acceptance of the beliefs, practices, and mores of others. Chapter 2 describes the sexual behaviors and social factors that influence sexuality in American society, to include sexual attraction, orientation, associated behaviors and lifestyles. Chapter 3 identifies the proclivities of American adults, societal mores, and the mass media’s impact on sexual behavior. Sexual dreams/fantasy, flirting, masturbation, pornography, prostitution, sexual scripting, among others; all part of the many sexual activities in America today. The sexual issues of childhood and adolescence are identified in Chapters 4 and 5, with an emphasis in 5 on high risk sexual behaviors of teens. Chapter 6-11 provides easy, rapid access to 85 sexual behaviors/concerns and provides facts, attitudes and behaviors associated with those sexual issues. They are described in detail in an outline format which provides a similar pattern for information and topic location. Each topic outline contains a definition, signs/symptoms, origins, background, therapeutic and supported interventions, and potential outcomes. This format facilitates comprehension, understanding, problem interventions and discussion of the possibilities for treatment: to better understand the patient’s situation. Prejudice in the healthcare arena runs rampant, and HCPs must face their own prejudices and those of others that exist as a result of the patients’ engagement in perceived behaviors. However, lawful sexual behaviors by those who are gay, lesbian, bisexual, transgender or transsexual often receive prejudicial treatment. Prejudice also extends to the elderly, especially with illness--many people assume that senior citizens are asexual; not so. However, erectile dysfunction, cancer, diabetes, multiple sclerosis, and Alzheimer’s disease are translated to mean asexual. We are all sexual beings with sexual thoughts and feelings, and to deny or ignore that fact is simply inhumane; it is just that the vigor and passion of the flame fluctuates. This information will provide for more comfortable discussions between patients and HCPs, and in the process it will allow patients to heal better, physically and emotionally, which, after all, is the ultimate goal of the healthcare profession. I ask healthcare providers and lay people to identify and examine their own sexual inhibitions, misconceptions, and insecurities; the results might well be enlightening.

Dr. Gracie grew up in the outskirts of London, England, and from 1959 to 1962 attended nursing school at The Royal London Hospital (of Jack the Ripper and Elephant Man fame) in the East End of London. She emigrated to the U.S. the end of 1967 with her former husband, Joe, and her two sons, Mark and Paul. She married her husband of 40 years, Peter, in 1975, and with the two boys they moved to Salt Lake City, Utah, where they lived and worked for 17 years. Dr. Gracie and Peter had two more children, Kate and Jonathan, and are now the very proud grandparents of six wonderful granddaughters: Gillian, Avery, Maysea, India, Isabelle, and Lilly. They had the opportunity to move to beautiful Kaneohe, Hawaii, and exchanged the snowy winters for year-round sun and sea. After 22 years of living in Hawaii, they do not regret their decision, and they look forward to remaining in Hawaii for a wonderful retirement. Dr. Gracie is a seasoned healthcare professional, with over 50 years’ experience in the field of applied nursing and nursing education, combined with over 20 years’ experience in the discipline of human sexuality. Her time in the healthcare world spans from 1959 as a 19-year-old probationary nurse to the present, during which time her chosen profession has served her extremely well. Dr. Gracie obtained her registered nurse status in England in 1962, and her midwifery certification in 1966. When she first arrived in the U.S. in 1967, she worked as a staff nurse at Columbia Presbyterian Hospital, until she was promoted to a head nurse position there a few years later. She became a nurse educator and then medical/surgical nursing director at Roosevelt Hospital where she remained until their family moved to Salt Lake City in 1975. After their move to Salt Lake City and over the next 15 years, Dr. Gracie was a staff nurse, a head nurse, and then director of nursing for medical services and post-intensive care services at Holy Cross Hospital. She then developed a successful consultation business to prepare general and rehabilitation hospitals for review by Joint Commission evaluators. Dr. Gracie opened the University of Phoenix, Hawaii Campus, on Oahu, specifically for registered nurse students. As VP, she began the process with 18 students, and over the next 14 years, she developed and implemented undergraduate and graduate degree programs to grow the student body to approximately 900 students. Programs included business, practical nurse to RN, RN to BSN, family nurse practitioner, mental health counseling, teacher special education and others. During these years, she also opened a small private practice for the management of sexual issues. Her overall nursing experiences include medical-surgical, intensive care, rehabilitation, AIDS and HIV, nurse administration, nurse education, business education, human sexuality, obstetrics, and rehabilitation. Credentials include a RN to BSN, MSN, MBA, and a PhD in Human Sexuality.