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Human sexuality is a vital ingredient of self-identity and self-acceptance. Despite the ready availability of sexual information and sexual images in Western society, many myths and misconceptions remain. Moreover, internalized messages from childhood will often continue to affect current behavior even though one may learn that these messages may be largely or totally misguided. One persistent myth is that humans, as the highest order of species, do not require information about sex—it should just come naturally—when the time is right.

Sexuality and sexual concerns are frequently encountered in many healthcare settings, counseling and psychotherapy practices. These concerns may be the impetus for clients to seek the help of the clinician, or there may be factors that arise as treatment progresses. Unresolved issues from the past may appear unexpectedly in the form of a sexual difficulty.

Example: A young woman who, as a child, had been genitally fondled by her father under the family dinner table, developed a sexual desire problem following the birth of her son many years later. The woman and her husband had been married for eight years prior to the birth, and both described their sexual relationship as very good. With in-depth exploration, what became evident was that the family dynamic had changed with the birth of the child—the woman became a mother who had to protect her child, and the husband, although there had never been any indication of such behavior, became a possible perpetrator. The birth of the child had triggered what the woman believed was in her past and largely forgotten. She had also downplayed the impact her father’s behavior had had on her. Because his actions had never gone beyond fondling, she minimized her experience stating, “So many people have it so much worse.”

Sexuality can be affected by many factors across the lifespan. Professionals who work in the sexology field say that most people may benefit from some type of sexual counseling at times along the way:

- Parents struggling with their child touching his or her own genitals
- Children having sex play with one another
- Teens grappling with body image issues and with appropriate ways to express sexual feelings
- Young adults in committed relationships who are now supposed to be “knowing” all about sex and free to do whatever they want,
- Couples dealing with pregnancy
- Parents making time for sexual intimacy along with the busy lives and demands of raising a young family
- Middle age partners with physical changes that impact sexuality
- Aging lovers and the belief that sex should and/or will end

Communication about sexuality in relationships is frequently difficult, because most people have grown up not talking about sex in productive ways, and open discussions about sexuality and sexual performance can be threatening to both men and women. Personality factors - how outgoing the person is, how well s/he handles uncertainty and risk, body image issues for both men and women, and the presence of depression or anxiety can all impact sexuality communication.

In addition, women may be fearful of hurting someone’s feelings or of being seen as too demanding. Men may be concerned about not knowing enough or not being considered great lovers. In courting interactions as well as later in relationships, people may have uncertainty about the signals they are sending or about what the other person means or intends.

An intended message may not be what the other person receives. In working with communication issues and patterns, it can be helpful to state and expand on a statement such as, “It’s human nature to judge ourselves by our intent and to judge others by their effect.”

In other words, when one says or does something that involves another person, generally the speaker/doer has an awareness of what his/her intent is in the action. On the other hand, the recipient of words or actions may have a totally different reaction than that which was intended. The speaker/doer may be very surprised at the response.

For example, one partner might say, “You used to want sex all the time, and now you never want it.” The intent in this situation may be to bring to the partner’s awareness a change in behavior that is creating problems. The partner’s response to this statement, rather than being accepting and empathic, might be something defensive and angry such as, “All you do is yell and nag, and all you ever want is sex.” The first partner may then become defensive in return, and conflict may ensue.

Sexuality Factoid

Males 30-44 report an average of 6-8 female sexual partners in their lifetime

Source: Mosher WD, Chandra A, Jones J. Sexual behavior and selected health measures: Men and women 15–44 years of age, United States, 2002. Advance data from vital and health statistics; no 362. Hyattsville, MD: National Center for Health Statistics. 2005

Human beings are all different and see things through different and individual lenses. This can create problems in the communication and the interpretation of messages. In relationships it is very important to be aware of differences in perspective. One of the clinician’s tasks is to acknowledge that these differences exist for human beings and then to explore the sender’s intent and the subsequent effect on the receiver.

So, the sender judges him/herself as clear and understandable, whereas the sender judges the receiver by the way the message affects him/her. Translated, “I’m communicating clearly: you just don’t understand.”

Healthcare professionals’ comfort with their own sexuality and their awareness of the importance of sexuality in their clients’ lives are fundamental elements in basic assessment and treatment. To provide holistically based sexual health services, clinicians must respect and take into account the physical, mental, emotional, relational, cultural, and spiritual aspects of each individual. However, many clinicians have been raised in sexually closed or repressive environments and may harbor their own uncertainties in this area.

As a result, sexuality issues in clients may be overlooked and not addressed, or if these issues do surface during assessment and treatment, clients may be referred to other professionals, perhaps sex therapists. While referrals to specialists may certainly be appropriate for complicated and complex cases, many sexual concerns can be dealt with and many clients can be helped by trusted clinicians who are comfortable with the topic of sexuality and who are willing to broach and explore sexual issues.

Research in sexuality has proven to be difficult for a number of reasons, and statistics about sexual behaviors, attitudes, and problems have been difficult to determine. Laumann, Gagnon, Michael, and Michaels (1994) noted, “It is both surprising and disturbing how empirically ill informed we as a nation are about important aspects of sexual behavior”. (p. xxvii)

In the 1970s, when Masters and Johnson were doing their sexuality research, they stated, “A conservative estimate would indicate half the marriages [in this country] as either presently sexually dysfunctional or imminently so in the future” (Masters and Johnson, 1970). Sex therapists were saying that at least 50% of marriages have serious sexual concerns, and that if the truth were actually known, it would likely be closer to 75%.

Viewed in terms of the patients/clients seen in healthcare settings, these are significant numbers. While actual percentages are unknown, what is recognized is that a significant number of people do have sexual concerns, and these concerns often remain unexpressed and unresolved. Because sexuality is a common concern of clients, either initially expressed or silently harbored, it is important for clinicians to develop the understanding and skills to address sexuality issues.

Throughout this course attempts have been made to address wide-ranging aspects of sexuality issues and to present a comprehensive, balanced view of options currently available to clinicians for choosing the most effective interventions. The reader is encouraged to keep in mind that sexuality can be impacted by many factors, including sociocultural, relational, psychological, physiological or medical. It is important to keep all of these in mind when working with clients.

NOTE: There is no “one authentic story” about sex and sexuality. It is important for the conscientious and thorough professional to know his/her clients’ stories and to work with them individually and in their relationships to promote an optimal outcome.