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Malhi GS. Psychiatrists and general practitioners perspectives on sexual wellbeing: Why it matters? Australas Psychiatry 2024; 32:454-458. [PMID: 39030680 PMCID: PMC11440782 DOI: 10.1177/10398562241261247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/21/2024]
Abstract
OBJECTIVE Sexual wellbeing is a fundamental component of overall wellbeing and is often impacted by common psychiatric disorders such as depression. Despite this, research suggests it is underexplored in clinical practice. This preliminary study aimed to examine whether this is the case in both psychiatrists and general practitioners (GPs). METHOD GPs and psychiatrists completed a survey examining the exploration of various sexual wellbeing domains with patients. It included open-ended questions regarding factors that influence this exploration, whether clinicians felt this was their responsibility, and their level of training in this area. RESULTS Clinicians who felt it was their responsibility to enquire about sexual wellbeing reported exploring it in more patients than those who did not endorse this perspective. Overall, clinicians from both specialties demonstrated a reluctance to explore most sexual wellbeing topics, and this appeared to be due to many factors including views held by clinicians themselves. Most clinicians felt they had not received adequate training in this area. CONCLUSIONS Domains of sexual wellbeing are largely underexplored by clinicians from both specialties. Educational materials and training for clinicians are needed to facilitate the exploration of this important area with patients, specifically in the context of mental health.
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Affiliation(s)
- Gin S Malhi
- Gin S Malhi, Academic Department of Psychiatry, Kolling Institute, Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, CADE Clinic Level 3, Main Hospital Building, Royal North Shore Hospital, Sydney, NSW 2065, Australia.
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2
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Gieles NC, Gerritse K, Zandbergen E, Both S, Kreukels BPC. "No one told me how this could be pleasurable" A Qualitative Focus Group Study into Experiences and Needs of Transgender People in Addressing Sexuality in the Context of Gender-Affirming Medical Care in The Netherlands. JOURNAL OF SEX & MARITAL THERAPY 2024:1-21. [PMID: 39262228 DOI: 10.1080/0092623x.2024.2402315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/13/2024]
Abstract
Various studies show that transgender people may experience diverse challenges to attaining sexual well-being. Receiving gender-affirming medical care (GAMC) may influence one's sexual experiences, but there is little insight into the way sexuality is addressed in GAMC. We conducted a qualitative focus group study among transgender individuals on their experiences and needs related to the way sexuality is addressed in the GAMC context. We included 28 participants (aged 21-60) who were assigned to six groups based on their GAMC trajectories and treatment goals. Each group convened twice for two hours (12 focus groups in total). We analyzed the data using reflexive thematic analysis and identified three main themes. Regarding sexuality in GAMC, participants articulated the need for 1) personalized and balanced information, 2) insight into the experiences of others, and 3) the opportunity for support and guidance concerning sexuality by a healthcare provider. This study highlights the necessity to improve information provision and guidance to promote sexual well-being of people receiving GAMC. Such information ought to transcend cis- and heteronormative sexual assumptions and needs to be tailored to an individual's experiences. Finally, GAMC organizations and their healthcare providers should foster an environment where questions and concerns related to sexuality can be discussed.
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Affiliation(s)
- Noor C Gieles
- Center of Expertise on Gender Dysphoria, Department of Endocrinology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Center of Expertise on Gender Dysphoria, Department of Medical Psychology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Karl Gerritse
- Center of Expertise on Gender Dysphoria, Department of Medical Psychology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Center of Expertise on Gender Dysphoria, Department of Child and Adolescent Psychiatry, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Eva Zandbergen
- Center of Expertise on Gender Dysphoria, Department of Medical Psychology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Sexology and Psychosomatic Gynecology and Obstetrics, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - Stephanie Both
- Department of Sexology and Psychosomatic Gynecology and Obstetrics, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - Baudewijntje P C Kreukels
- Center of Expertise on Gender Dysphoria, Department of Medical Psychology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Martínez-Giner G, Giménez-De Llano E, Romero-Rubio D, Abad-Pérez MJ, Sánchez-Martínez V. Sexual dysfunction in people treated with long-acting injectable antipsychotics in monotherapy or polypharmacy: a naturalistic study. Int J Ment Health Nurs 2022; 31:576-590. [PMID: 34973049 DOI: 10.1111/inm.12973] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 11/22/2021] [Accepted: 12/12/2021] [Indexed: 01/28/2023]
Abstract
Sexual dysfunction, psychosis, and antipsychotics are known to be related, but the precise association between them is still unknown. Most evidence about the prevalence of sexual dysfunction in people treated with antipsychotic drugs comes from studies with restrictive samples. That is why our main objective was to determine the prevalence of sexual dysfunction in a real-life sample of outpatients treated with antipsychotics, considering gender. A cross-sectional naturalistic study was developed, including people treated with long-acting injectable antipsychotics, with or without other psychotropic drugs. Participants were interviewed to assess sexual satisfaction through a Likert scale (0 to 10) and the presence of sexual dysfunction (the Psychotropic-Related Sexual Dysfunction Questionnaire, PRSexDQ-SALSEX). The participants also had a blood test to determine prolactin (men and women) and testosterone levels (men only). A total of 131 people participated in the study (90 men and 41 women). Some extent of sexual dysfunction was found in 62.2% of men and 51.2% of women. The most frequent sexual dysfunction symptom for both genders was the loss of libido (45%). Hyperprolactinemia was present in 56% of men and 61% of women. The presence of sexual dysfunction was associated with higher doses of antipsychotics, hyperprolactinemia, and smoking in men and with smoking and hyperprolactinemia in postmenopausal women. This study provides real-life evidence of sexual dysfunction and hyperprolactinemia in persons treated with long-acting injectable antipsychotics segregated by gender. The high rates of sexual dysfunction and hyperprolactinemia detected corroborate the need to consider these aspects in clinical practice.
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Tennille J, Bohrman C, Barrenger S, Compton E, Meduna E, Klein L. Behavioral Health Provider Attitudes and Beliefs about Sexuality and Intimacy: Findings from a Mixed Method Design. Community Ment Health J 2022; 58:444-453. [PMID: 34081264 DOI: 10.1007/s10597-021-00838-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 05/14/2021] [Indexed: 11/28/2022]
Abstract
Recovery-oriented services overlook a crucial health domain for persons with severe mental illnesses (SMI): sexuality and intimacy. Though this aspect of social recovery correlates with improved life quality and treatment outcomes, behavioral health (BH) providers avoid such topics. The study's purpose was to obtain an updated snapshot of their attitudes and beliefs about sexuality and intimacy communication. Utilizing a community advisory board, we adapted the Sexual Attitudes and Beliefs Survey (SABS) and distributed it via survey link to a national listserv. We used independent samples t-tests to examine differences on SABS mean scores by gender, age group, educational attainment, and previous training on sexuality and intimacy. We asked open-ended questions and coded responses using content analysis. Participants with more education and previous exposure to training on sexuality and intimacy were more likely to hold open views on communication. Findings offer directions for addressing this neglected aspect of recovery.
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Affiliation(s)
- Julie Tennille
- College of Education and Social Work, West Chester University of Pennsylvania, 327 Dawson Street, Philadelphia, PA, 19128, USA.
| | - Casey Bohrman
- College of Education and Social Work, West Chester University of Pennsylvania, 327 Dawson Street, Philadelphia, PA, 19128, USA
| | - Stacey Barrenger
- Psychiatry, Northeast Ohio Medical University, Rootstown, Ohio, USA
| | - Emma Compton
- College of Education and Social Work, West Chester University of Pennsylvania, 327 Dawson Street, Philadelphia, PA, 19128, USA
| | - Evan Meduna
- College of Education and Social Work, West Chester University of Pennsylvania, 327 Dawson Street, Philadelphia, PA, 19128, USA
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Urry K, Chur-Hansen A, Khaw C. 'It's Not Really a Part of Standard Practice': Institutional Silencing of Sexuality Within Australian Mental Health Settings. QUALITATIVE HEALTH RESEARCH 2022; 32:543-555. [PMID: 34904865 DOI: 10.1177/10497323211061340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Research seeking to understand and improve sexuality-related practice in mental health settings has paid little attention to the institutional context in which clinicians' practice is embedded. Through a social constructionist lens, we used thematic analysis to examine how 22 Australian mental health clinicians implicated the wider institutional context when discussing and making sense of sexuality-related silence within their work. Interviews were part of a study exploring participants' perceptions of sexuality and sexual health in their work more generally. Broader silences that shaped and reinforced participants' perceptions and practice choices were situated in professional education; workplace cultures; and the tools, procedures and policies that directed clinical practice. We argue that sexuality-related silence in mental health settings is located in the institutional context in which clinicians learn and work, and discuss how orienting to this broader context will benefit research and interventions to improve sexuality-related practice across health settings.
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Affiliation(s)
- Kristi Urry
- School of Psychology, Faculty of Health and Medical Sciences, 1066University of Adelaide, Adelaide, SA, Australia
| | - Anna Chur-Hansen
- School of Psychology, Faculty of Health and Medical Sciences, 1066University of Adelaide, Adelaide, SA, Australia
| | - Carole Khaw
- School of Medicine, Faculty of Health and Medical Sciences, 1066University of Adelaide, Adelaide, SA, Australia
- Adelaide Sexual Health Centre, Infectious Disease UnitRoyal Adelaide Hospital, Adelaide, SA, Australia
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Brand E, Nagaraj D, Ratsch A, Heffernan E. A Qualitative Study on Sexuality and Sexual Experiences in Community Forensic Mental Health Patients in Queensland, Australia. Front Psychiatry 2022; 13:832139. [PMID: 35432027 PMCID: PMC9008211 DOI: 10.3389/fpsyt.2022.832139] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 03/09/2022] [Indexed: 11/23/2022] Open
Abstract
This qualitative study reports on the sexuality and sexual experiences of community-based forensic mental health participants. The findings indicate that these participants feel the need for intimacy and want to engage in sexual activity more often than their neurotypical Australian peers. Participants identified their mental health and the side effects of compliance with prescribed psychotropic medications were barriers to achieving their desired level of sexual activity. Participants supported the notion that mental health teams were positioned to assist patients navigate the psychological, cultural, education and physical barriers to achieving sexual health and wellbeing. We propose several interventions to support these participants and other community forensic mental health patients in attaining healthy relationships, understanding their sexual health, and gaining more fulfilling sexual experiences. These interventions, which include sex education, upskilling in socialization and communication, and regular medication reviews, could be delivered as part of the holistic care provided by mental health teams. Mental health clinicians should be offered appropriate training to assess patients and have discussions related to sexuality, sexual experiences and sexual health needs.
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Affiliation(s)
- Elnike Brand
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Dinesh Nagaraj
- Community Mental Health and Addiction Services, Waikato District Health Board, Hamilton, New Zealand
| | - Angela Ratsch
- Wide Bay Hospital and Health Service, Research Services, Hervey Bay Hospital, Hervey Bay, QLD, Australia.,Rural Clinical School, The University of Queensland, Brisbane, QLD, Australia
| | - Edward Heffernan
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
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Evans AM, Quinn C, McKenna B, Willis K. Consumers living with psychosis: Perspectives on sexuality. Int J Ment Health Nurs 2021; 30:382-389. [PMID: 33047501 DOI: 10.1111/inm.12795] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 09/04/2020] [Accepted: 09/14/2020] [Indexed: 12/14/2022]
Abstract
Mental health clinicians work within a recovery framework that is rights based and emphasizes positive and respectful approaches to working with mental health consumers. Mental health nurses' practice is also predicated on holism and inclusiveness, yet consumers' sexuality is sometimes neglected and rights in this area overlooked. Also overlooked is sexuality as an area for investigation, particularly from a consumer perspective, even though it constitutes part of consumers' broader remit of sexual health. This paper reports findings from a case study where consumers were asked about their ability to negotiate and sustain sexual expression while residing in a long-stay mental health rehabilitation facility. There were three main findings. First, the physical space of the facility, inclusive of consumers' bedrooms, was policed by mental health clinicians with ongoing intrusions into consumers' privacy, which inhibited their sexual expression. The creation of barriers to sexual expression is counter to polices that promote recovery. Second, consumers reported significant medication-related weight gain which negatively affected their self-image and sexual sense of self. Third, the consumers spoke about their sexuality in ordinary, everyday language devoid of any hallmark of psychosis. This highlights the importance of relating to consumers about their sexuality and sexual needs from a humane rather than technical framework. Further, it foregrounds the relational aspect of the mental health nurses' role rather than the technical aspect. Yet sexuality is a topic that is often neglected, indicating that an upskilling of the mental health nursing workforce is required, to strengthen communication and relationship skills.
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Affiliation(s)
- Alicia M Evans
- Australian Catholic University, Fitzroy, Victoria, Australia
| | | | - Brian McKenna
- Auckland University of Technology, Auckland, New Zealand.,Auckland Regional Forensic Psychiatry Services, Waitemata District Health Board, Auckland, New Zealand.,Centre for Forensic Behavioural Science, Swinburne University of Technology, Melbourne, Victoria, Australia
| | - Karen Willis
- La Trobe University/Royal Melbourne Hospital, Melbourne, Victoria, Australia
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Brand E, Ratsch A, Heffernan E. Case Report: The Sexual Experiences of Forensic Mental Health Patients. Front Psychiatry 2021; 12:651834. [PMID: 33897501 PMCID: PMC8062769 DOI: 10.3389/fpsyt.2021.651834] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 03/18/2021] [Indexed: 01/28/2023] Open
Abstract
The recovery-based approach to forensic mental health rehabilitation is to support the patient to achieve a fulfilling life-a principle which should include achieving a fulfilling sexual life. This paper presents four vignettes from forensic mental health patients. The four cases demonstrate the omission, avoidance and then judgement by forensic mental health clinicians around the intimate and sensitive, yet important domain of the patient's sexual life. The cases illustrate that gap in the clinical domain and demonstrate the requirement for forensic mental health clinicians to have a greater awareness, acknowledgment, and assessment of their patient's sexuality and sexual health needs. Incorporating sexual health into standard clinical assessments will contribute to improved patient management in addition to supporting the principles of holistic forensic mental health recovery and rehabilitation.
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Affiliation(s)
- Elnike Brand
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Angela Ratsch
- Wide Bay Hospital and Health Service, Research Services, Hervey Bay Hospital, Hervey Bay, QLD, Australia
| | - Edward Heffernan
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
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Landi G, Marchi M, Ettalibi MY, Mattei G, Pingani L, Sacchi V, Galeazzi GM. Affective and Sexual Needs of Residents in Psychiatric Facilities: A Qualitative Approach. Behav Sci (Basel) 2020; 10:E125. [PMID: 32756442 PMCID: PMC7464764 DOI: 10.3390/bs10080125] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 07/23/2020] [Accepted: 07/27/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The affective and sexual needs of psychiatric patients are often under-considered, although they contribute significantly to their general well-being. Such topics are critical for Residential Psychiatric Facilities Users (RPFUs), whose daily life is paced by therapeutic settings. The aim of this paper is to better understand how sexuality and affectivity are expressed by the RPFUs at the Mental Health Department of Modena, within psychiatric residential settings. METHODS Adult RPFUs took part into two audio recorded focus groups. Digital transcripts were analyzed using MAXQDA software in order to perform qualitative narrative analysis, so as to develop a hierarchical code system a posteriori (derived from the data). RESULTS Eleven participants (eight RPFUs and three investigators) attended the first focus group, and eight participants (5 RPFUs and 3 investigators) attended the second focus group. 175 interventions were analyzed and coded under seven thematic areas: (a) contraception and sexually transmitted disease prevention (N = 17); (b) affective needs (N = 11); (c) personal experiences (N = 61); (d) regulation of sexual relations (N = 18); (e) Mental Health Professionals' (MHPs) openness towards the topic (N = 17); (f) MHPs' responses to RPFUs' sexual behaviors (N = 33); and (g) RPFUs proposals (N = 18). The highlighted topics suggest that affective and sexual relations commonly occur within residential psychiatric facilities, even if mental health services often fail to recognize and address RPFUs' affective and sexual needs as well as to provide effective solutions to manage them. CONCLUSIONS RPFUs expressed a request for support to fulfill their affective and sexual needs and dedicated spaces for sexual activities to relieve their discomfort, while MHPs highlighted a need for awareness, training, and shared problem-solving strategies.
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Affiliation(s)
- Giulia Landi
- Department of Mental Health and Drug Abuse, AUSL Modena, Via San Giovanni del Cantone, 23–41121 Modena, Italy;
| | - Mattia Marchi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via Giuseppe Campi, 287–41125 Modena, Italy; (M.M.); (L.P.); (V.S.)
| | | | - Giorgio Mattei
- Department of Economics & Marco Biagi Foundation, University of Modena and Reggio Emilia, Via J. Berengario, 51–41121 Modena, Italy;
| | - Luca Pingani
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via Giuseppe Campi, 287–41125 Modena, Italy; (M.M.); (L.P.); (V.S.)
| | - Valentina Sacchi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via Giuseppe Campi, 287–41125 Modena, Italy; (M.M.); (L.P.); (V.S.)
| | - Gian Maria Galeazzi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via Giuseppe Campi, 287–41125 Modena, Italy; (M.M.); (L.P.); (V.S.)
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