October 16, 2011
Although most people just want to do it (that is, have sex),
communication is the key to understanding sexuality. Counseling individuals and couples through
sexual difficulties requires an understanding of the issues they face and the
stage of life they are in. For example counseling
young people contemplating their sexuality is different from reintroducing older
couples or even individuals with disabilities to sexuality. A therapist must consider many things about
sexuality to assist someone with good decision-making processes and to be
informative about the physical and psychological changes that occur while
taking into consideration the patients feelings and emotions about their own
sexuality. For example Anna, an
adolescent girl, Tom and Susan, an elderly couple, and Bill, paralyzed from the
waist down; each at a different life stage, and yet sexuality is an influence
on them all.
Adolescent girls, such as Anna may be under a large amount of
pressure to engage in intercourse from their peers and significant other, while
also receiving messages about their vulnerabilities from parents and
caregivers. Encouraging Anna to consider
her decisions about having sex should include discussions on emotional and
physical maturity (e.g. feelings about sex and hormonal influences), cultural
and spiritual beliefs (e.g. family values, morals, and ethics), and her
knowledge about sex, diseases, and birth control (formal education versus
miseducation). Although difficult and
possibly awkward Anna should try and keep an open communication process with
her mother, which should include discussions about sex, family beliefs, and
eventually birth control. This type of
open communication can also provide relief of the mother’s anxiety in not understanding
what Anna’s thoughts are. A therapist’s
role in Anna’s situation can be essential in helping her to understand her own
thoughts instead of giving in to sexual pressures one way or the other.
After building a life together, a routine is commonly developed;
children, work, and home-life. Tom and
Susan, past the childrearing stages, have recently retired; Tom three years ago
and Susan more recently. More relaxed
and unpressured for time, Susan wants to rekindle their sexual activities while
Tom is anxious about ability at his age. Although most people do not typically think
sex and seniors, many older individuals retain their sexuality for a lifetime;
interest, and ability (Rathus et. al., 2005).
While there are physical and psychological changes that occur as people
age intimacy, love, and a life shared together can far outweigh any
changes. Men, such as Tom may be apprehensive
about achieving an erection, the length of time it takes to achieve orgasm, or that
he may somehow injury his aging wife.
Visions of the youthful exuberance they once shard may be blocking a
renewed outlook on his now matured passions.
As indicated by Rathus and colleagues (2005), “coital frequency is not
synonymous with sexual satisfaction” (p. 483).
Barring any health related issues, there are pharmaceutical aids to help
with some of the minor physical symptoms associated with aging (e.g.
lubrication, erection). For many aging couples
sex can be enjoyable and is a good way to learn new ways to please each other while
maintaining intimacy.
Individuals with disabilities may be unaware of his or her
sexuality until confronted with intimate situations. Reports from Margaret Nosek et. al., (1994)
as restated by Rathus et. al., (2005) indicate that many disabled people are
kept in a sexless, childlike state because of his or her dependence on
others. Bill, paralyzed from the waist
down as a child would like to become intimate with his romantic partner. His nervous behavior and lack of comfort in
talking about sex is normal and could be related to any of Nosek and colleagues
five factors: a lack of knowledge about sex, having never been thought of as a
sexual person, lack of a positive sexual self-concept, lack of a positive yet
productive relationship, never having learned how to cope with sexual barriers
(social, environmental, physical, and emotional), and maintaining general and
sexual health (Rathus et. al., 2005).
Disabilities come in different forms: physical and psychological. All require understanding and the ability to
learn to overcome the challenges associated with the disability. Discussing what and how sexual function is
capable in a man paralyzed from the waist down will be helpful to Bill;
allowing him to understand that men have two erectile centers in the spinal
cord: one for psychogenic erections and one for reflexive erections, and that
he may still be capable of both with direct stimulation to the penis (Rathus
et. al., 2005). Disability does not mean
nonsexual; however, it may require some considerations in position and
technique.
Sexuality can be maintained throughout the different life stages
with intimacy, understanding, and communication. In the adolescent stages, from peer pressure
to the fears of parents and caregivers, sexuality involves an understanding of
feelings, thoughts, and cultural, moral, and ethical beliefs. A therapist can help a young person to
understand what sexual maturity means. Sexuality
in the elder stages of life can be rewarding and fulfilling when both partners
are willing to communicate and understand the normal symptoms of aging. Anxiety over function can be reduced when a
person ceases to compare frequency with function and satisfaction. However, intimacy, love, and life experience
far out way most symptoms of ageing.
Disabled does not mean sexless; even a paralyzed person can have a
normal sex life with understanding and knowledge. A therapist who understands the issues faced
by individuals and couples, regardless of the stage of life can provide
knowledge, guidance, and understanding leaving people with their sexuality
intact.
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