Let’s Talk About Sex.

“Let’s talk about sex, baby
Let’s talk about you and me
Let’s talk about all the good things
And the bad things that may be
Let’s talk about sex
Let’s talk about sex
Let’s talk about sex
Let’s talk about sex

Let’s talk about sex for now to the people at home or in the crowd
It keeps coming up anyhow
Don’t decoy, avoid, or make void the topic
Cuz that ain’t gonna stop it
Now we talk about sex on the radio and video shows
Many will know anything goes
Let’s tell it how it is, and how it could be
How it was, and of course, how it should be
Those who think it’s dirty have a choice
Pick up the needle, press pause, or turn the radio off
Will that stop us, Pep? I doubt it
All right then, come on, Spin” ~Salt N Pepa

The second sheet of the Patient assessment can be daunting.  However, it is the part that I love best.  I love people and it’s important for me in my role as a student nurse to find out what is really going on with them on a personal and psychosocial level.  All the issues that concern them when they return home can hit like a freight train and returning to daily living can provide numerous challenges.  The second sheet can give them the opportunity to start thinking, marinating – if you will – about reentry into their roles and relationships after their hospital stay, procedures, and subsequent home care.  Sexuality is one of those issues.

We are all sexual beings.  That’s how we are created.  Our identity is tied into our intimate life whether with a partner, or with ourselves and physical and emotional trauma effect the way that we perceive ourselves and our roles in our relationships.  “I feel like I’m not whole.”  “Who would want me looking the way that I do?”  “I can’t even bear to look at myself, how is my partner ever going to find me attractive again?”  These are just the tip of the iceberg when it comes to the questions patients have about their sexual identities and their roles as a partner with whom they have an intimate relationship.

I love the second page.  Sometimes, I can nonchalantly ask very personal questions during the assessment.  Sometimes not.  Patients in a hospital setting can feel very vulnerable, but they can also feel a desperate need to talk with someone about their pressing and sometimes embarrassing questions.  Only a select few patients will initiate a conversation about intimacy, but gently developing a rapport and a feeling of mutual trust can powerfully influence their ability and willingness to open up about such deeply personal issues. 

Often, I introduce the subject when I am doing something else.  They don’t have to look me in the eye.  I gauge their receptiveness in their response.  I revisit the subject when we discuss their discharge from the hospital, again, gently.  I leave the conversation open for further discussion and I remind them that they can talk with me –confidentially- about anything that is on their minds, or hearts.  I follow-up late with an open-ended question about how they are feeling about resuming daily life activities and again state my willingness to talk about any concerns they may have and list a couple of pertinent topics, slipping intimate relationships into the conversation.

In my work in the cancer community, one of the topics I speak about and have participated in panels and radio programs about is sexuality.  In these settings, I have the benefit of creating a completely safe environment and offering myself up for additional time to share in their questions, or concerns after the session, via  facebook, by email, etc. 

I primarily work with young adult cancer survivors who have LOTS of questions about resuming sexual activity, psychosocial effects, partnering, parenting, fertility, the whole gambit.  Honoring that time together, listening to their concerns, reframing, and asking questions to gain more insight into their situations and deeper issues is important to me.  I think that this is one reason that I love the second sheet.  Co-creating a safe environment where a patient can offer up very personal and intimate concerns and have them listened to, addressed, and normalized is a gift to me.

Today, after clinical in post-conference I had a moment to reflect about why the second sheet comes so easily to me when so many students struggle with it.  I think the answer lies in that that I have done this, I have read and researched, I have had my own personal experiences where I wished that someone had discussed the myriad effects that a procedure, or treatment would have on my self-image, immediate effects on my body, long term psychosocial effects and late effects.  My nurses seemed so busy.  So unavailable.  I didn’t want to “bother” them with issues that were not applicable to their job, or care.  There were no bonds formed and certainly no place to think about, or discuss what might happen next.  The second sheet came as a complete surprise to me.  I would have never fathomed that we could, or should introduce these types of conversations.

So, I relish the opportunity to incorporate the second sheet.  To delve into a patient experience on a holistic level.  The reality of time constraints for RNs is becoming more real to me as clinicals progress.  Nurses are busy.  There is little, or no time –often- to ease into delicate, yet important subject matter.  I am relishing the opportunity to forge these relationships, to create a space for learning, understanding, teaching, and support that I hope to continue to create space for as a practicing RN.