Sunday, September 26, 2010

Let's Talk about Sex

I thought I would post on what I hope will turn out to be an occasional series on sexuality here on Pallimed. We've covered sexuality some before. A post that leaps to mind is one by Christian in 2007 about the controversy that arose over a case where the staff at the world's first hospice designed specifically for young adults openly deliberated and decided to facilitate a 22-year-old patient's request to have sex before he died.

So, my foray is on an article that came out in the July-September 2010 issue of
Sexologies. This English-French bilingual publication is, and I quote, "the official organ of expression of the European Federation of Sexology (EFS), published with the scientific cooperation of the Inter University Hospital Association of Sexology (AIHUS), which has gathered French academic teachings of Sexology since 1983." So, it's scientific, it's academic and it's French. Need I say more?

It turns out, that this article actually was available online this past April, but there's no time like the present. Titled, "Sexuality of individuals in the end-of-life stage," it was authored on this, our very own continent by M.-I. Rothenberg, PhD, a psychotherapist and clinical sexologist in private practice in Orlando, FL and A. Dupras, PhD, a professor in the Department of Sexology, Université du Québec, Montréal, QC.

The article is a theoretical and often psycho-dynamic discussion with case studies, which uses the Kübler-Ross "Five Stages of Death" model as a framework. I particularly appreciated the part in the introduction that highlighted the common experience of reticence and hesitancy on the part of professionals to address sexuality in palliative care, and that if we do address it, we tend to medicalize it, rather than offer information and support that is responsive, reflective and anticipatory. I also found that the narratives from the case studies were interesting, illuminating, some even compelling.

After our humanity, sexuality is our next great category of being, ranging from gender through sex roles, attachment and reproduction. It is at once social and deeply personal. The physiology of aging, life-limiting-disease pathology, pharmacology, surgery, radiation therapy, pain, family dynamics and existential suffering can all have bearing upon one's sexuality. Our reluctance to address these issues, to contextualize and normalize them, particularly our diffidence to even bring it up, creates a sound of silence that can be deafening.

The Kübler-Ross model has been criticized as non-scientific, i.e., that it did not arise as a predictive model accounting for validated, objective data of a phenomenon, but rather from reflection on global interviews of dying people. A lot of criticism also centers on attributions of progression and linearity. However, Kübler-Ross herself wrote that not everyone goes through every stage, that their order and direction is often fluid, alternating and circuitous, and above all individual. I think the main boon of the Kübler-Ross model, as a starting point, and this application of it with regard to sexuality is they lead us to give some thought and allow some room. They poise us to better grasp, accommodate and support the complex, individualized and sometimes confounding needs and behaviors that come up in taking care of patients and family members living with death and dying.

ResearchBlogging.orgRothenberg, M., & Dupras, A. (2010). Sexuality of individuals in the end-of-life stage☆ Sexologies, 19 (3), 147-152 DOI: 10.1016/j.sexol.2010.03.006

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