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Sexul este ultimul tabu pentru lucratorii din domeniul sanatatii si pune in pericol pacientii

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In calitate de medic primar care lucreaza in psihiatrie, sunt intotdeauna surprins de raspunsurile cinstite si de cunostintele pe care le impartasesc pacientii mei, oferind o privire asupra modului in care sanatatea lor mentala afecteaza fiecare aspect al vietii lor – de la finantele si dietele lor la modele de somn. , cariere si chiar rutine de mers pe caine.

Profesionistii din domeniul sanatatii pot fi si ei destul de sinceri si potriviti despre discutii despre subiecte tabu precum moarte, poo, sanatate mentala si comportament criminal. Cu toate acestea, sexul este inca un obstacol conversational pe care nu il gestionam bine. Poate ca suntem prea prudenti pentru a discuta acest lucru sau poate presupunem naiv ca, daca pacientii nostri nu mentioneaza viata lor sexuala, este pentru ca nu este relevant sau important.

Dar asta este. Pierderea libidoului si anorgasmia sunt printre cele mai cunoscute efecte secundare ale medicamentelor care ii determina pe oameni sa nu mai ia comprimatele. Familiile de pacienti cu dizabilitati intelectuale sau cei care gestioneaza simptomele de sanatate mintala, cum ar fi psihoza, isi exprima frecvent ingrijorarile cu privire la gestionarea adecvata a nevoilor lor sexuale ca supliment la sfarsitul unei intalniri. Sexul, varsta inaintata, boli mintale grave si dizabilitati intelectuale raman ultimele bastioane ale stigmatului in societatea noastra.

Fiecare are dreptul sa isi exploreze propria identitate personala si sexuala. Instinctul uman ne-a programat pe toti sa fim atrasi de confort, dragoste, securitate si acceptare, insa pentru unii oameni, echilibrarea acestui instinct alaturi de indemnurile biologice innascute este dificila. O tanara sub ingrijirea noastra psihiatrica a experimentat pe cont propriu o jucarie sexuala si a ajuns la A&E locala necesitand interventie chirurgicala. Un alt pacient s-a intalnit cu o prostituata pe care a contactat-o pe internet si a fost afectat, pierzandu-si cardurile bancare si portofelul.

Sex education for people with intellectual disabilities and significant mental illness is still subpar. Research has shown that they are at a significantly increased risk of contracting STIs – and a 2008 study in Wolverhampton, following teenagers from a school for those with moderate learning difficulties, showed that within 18 months of leaving school, 40% of the girls were pregnant.

La celalalt capat al spectrului de varsta, pe masura ce ratele de dementa in Marea Britanie cresc, unele studii sugereaza ca pana la 25% dintre persoanele cu dementa se pot comporta in mod inadecvat sexual. Cand dezinhibitia sexuala escaladeaza ca parte a declinului cognitiv al cuiva, acesta poate fi dificil pentru familii. Pacientii ne-au solicitat asistenta pentru angajarea prostituatelor si la sectiile noastre de sanatate mintala in varsta, avem pacienti care se propun sexual unul pe celalalt, sub convingerea ca cineva este sotul lor; problemele legate de salvgardare, capacitate si consimtamant continuu.

Across the world, there are varying approaches to addressing this issue in an accessible and inclusive way across the age and LGBTQ+ spectrum. One NHS psychiatrist told me about his experiences working in India, where he could refer patients to a sex clinic as part of their recovery or care plan. At this clinic a trained sex worker and psychologist teach male and female patients about anatomy, relationships and social skills within the realms of sexuality.

It’s the norm in Holland for health and social workers to advocate for a patient’s unmet sexual needs – and care packages can involve access to a vetted prostitute to cater to these requirements. In New South Wales, Australia, prostitution was decriminalised in 1979 – and this has contributed to the inception of charitable foundations focused specifically on providing safe, practical sex education for people with mental and physical disabilities.

In the UK, we often rely on support from organisations like Mencap and Enhance the UK to provide community education and support, and from a mental health perspective, things are managed on a case-by-case basis. There’s a lack of formal guidance in this area, so doctors and patients will often sit down together with key workers or community psychiatric nurses to work out the best way to safely support people’s needs, especially vulnerable young people, whether it be though arranging some quiet time or enabling access to materials and resources such as simple sex toys or access to pornography in private.

It’s more complicated for progressive cognitive decline in later life; medication is an ethical minefield and there’s a distinct lack of relevant evidence-based research. Some anecdotal evidence suggests the benefit of distraction techniques such as arts and crafts, cuddly toys or puppetry to keep wandering hands busy, but it’s not much of a long-term fix.

People with mental ill health shouldn’t be denied a sex life. Severe mental ill health or intellectual disability don’t mean someone automatically lacks the capacity to make related decisions – there are huge numbers of people with intellectual disabilities or mental illness in consenting, loving and fulfilling relationships – but for some people, extra support or adapted sex education enables them to explore their own identity safely.

We have a duty of care as healthcare professionals to educate and support our patients in an open-minded way across all aspects of their life – and sometimes that means we need to ask difficult questions.

If you would like to contribute to our Blood, sweat and tears series about memorable experiences in healthcare, read our guidelines and get in touch by emailing [email protected]

Sexul este ultimul tabu pentru lucratorii din domeniul sanatatii si pune in pericol pacientii

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