Canadian Nurse

 View Only

Tackling the taboo: sex in acute care settings

By CN Content posted 05-30-2019 00:00
May 30, 2019, By: Rachel Ollivier
Blue curtains in a white room.

In my experience as a medical-surgical nurse, I have been faced with some uncomfortable situations involving patients’ needs for sexual activity or sexual pleasure in the course of attending to their overall health. Most often, the topic has arisen when I or a colleague has accidentally witnessed someone’s sexual activity on the unit, when the patient may have thought the space was private. These situations have caused me moments of tension because I saw something that I wasn’t supposed to see and felt I had invaded the patient’s privacy.

Lessons Learned

  • Sexual health and sexual needs are not adequately addressed in acute care settings, though they may be important to patients.
  • Nurses play an essential role and are well-positioned to open up conversation about sexual health, including possible sexual activity or other sexual needs, with patients while in hospital.
  • Further guidance, education, and support for staff is needed from health care institutions so that sexual health may be promoted for patients in a safe, individualized, and appropriate way.

As a nurse, I understand the importance of holistic health and well-being, which includes sexual health. But the lack of unit-specific or institutional policies surrounding sexual activity, for example, has made the issue difficult to navigate. Is sexual activity, such as masturbation or intercourse, “allowed” or not? How should I react to these situations?

It is also difficult for patients because they are subject to the schedule and routines of the unit, often with little time or opportunity for privacy. In an environment that is new and strange to them, they may feel there is no place for ordinary home life, despite the fact that their stay may be prolonged (for example, while being wait-listed for community placement). Thus, patients are left on their own to find ways to address their sexual needs. The societal taboo surrounding sexual matters also makes the topic difficult for patients and nurses to discuss. That said, I think it’s our responsibility as healthcare providers to initiate these conversations as a way of supporting holistic health, which includes sexual health, in inpatient settings. The conversations might be with our patients and their families, our colleagues or supervisors.

Given the current taboo, sexual needs and activity may be discussed between nurses and patients only in certain ways, such as in educational settings where a nurse may provide information about safe sexual practices, negotiating sexual relationships, or STI testing. But talking more privately about a patient’s ‘sex life’, whether that involves masturbation or sexual interactions with others, is difficult for nurses to do without training and support in the workplace. In this regard, it’s important to note that these issues do not only affect front-line nurses, and therefore healthcare institutions must include sexual health in their care policies as well as in their training for staff.

Some ways that nurses might help patients attend to their sexual health in a safe and appropriate way could be to begin the conversation by mentioning that sexual needs are a common concern for patients. Then, they might set aside private time with the patient to discuss whether and how privacy is desired. Sexual activity is only one way of caring for one’s sexual health. Because patients don’t usually plan on staying in hospital long enough to make sexual needs an immediate concern (or they may be feeling too ill to consider sexual activity at all), it’s therefore important for nurses not only to assess and address the need for conversation and support, but also to advocate for such attention in health policies, guidelines, and unit procedures.

Whether or not patients view their sexual needs as important considerations in their care, avoiding the subject doesn’t solve the issue; it merely renders it invisible. The unique position of nurses as partners in health in the front lines of care, administration, and research presents an opportunity to dispel the taboo and promote sexual health not as an inconvenience but as complementary to care and treatment.

As healthcare professionals, nurses witness and influence caregiving issues in all areas and at all levels. We therefore must promote progressive inclusion of sexual health, and patient needs surrounding that, because we know it is a quality-of-life issue that has not been given the attention it deserves. Ignoring it compromises not only the patient’s experience while in hospital, but also the patient’s overall health.

Additional Resources

Ollivier, R., Aston, M., & Price, S. (2018). Let’s talk about sex: A feminist post-structural approach to addressing sexual health in the health care settingJournal of Clinical Nursing, 28(3-4), 695-702.

Rachel Olliver is a Registered Nurse on the Adult Surgery Unit (Women’s Health) at the IWK Health Centre in Halifax, NS. She is also a PhD student in the School of Nursing at Dalhousie University and her doctoral research will aim to explore postpartum sexual health.