3-Step Approach to Counseling Patients w/ Sexual Dysfunction Concerns - Essay Sample

What is a stepwise approach to counseling patients presenting with sexual dysfunction concerns? Include an explanation of the normal sexual response.

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Counseling for patients with sexual dysfunction concerns can be broken down into 3 stages. The first step is the establishment of rapport with the patient. This step is critical and should be carried out in comfortable surroundings to ensure privacy. Because the client is likely to feel a bit of embarrassment, the counselor should demonstrate understanding, empathy and a non-judgmental attitude. It is during this stage that the counselor should assure the patient that sexual dysfunction is common and treatable. If a couple is visiting together, the counselor should take their sexual history information from each person separately for privacy purposes.

The second step involves the actual assessment and diagnosis. During this stage, the counselor gathers information about the patient regarding their problems and the reason for undergoing counseling. Normally, the client is likely to offer some assistance regarding when the problem started. The problems can be physical, social or psychological or a combination of several of these. While it is the role of the client to communicate their problem, the counselor has to observe and detect any signs of the manifestation of the problem.

The last step in the counseling process is the intervention and goal setting. During this phase, the client and the counselor initiate a solution to sexual dysfunction. During this stage, the counselor needs to ask the client about past failed interventions in dealing with the dysfunction and design an alternative approach. Termination and follow-up is a critical process in this stage and should not be abrupt. As Avasthi (2017) urges, the counselor should evaluate whether the patient is ready and discussing with them whether they are ready to terminate counseling.

Clarify the common sexual dysfunction disorders?

There are four common sexual dysfunction disorders. The first category is known as desire disorders (Avasthi, 2017). Here, sexual dysfunction is said to be a result of a lack of interest in sex or sexual desire. For example, the person affected by this sexual dysfunction may not be interested in sex at all even when in the presence of potential sex partners. The second classification of sexual dysfunction is due to arousal disorders (Avasthi, 2017). As per this category, both men and women are unable to be excited or physically aroused during sexual activity. In other words, the patient may be interested in sex but unable to experience arousal during sexual activity.

The third classification of sexual dysfunction is referred to as orgasm disorders. According to this disorder, the individual failed to experience or orgasm or experiences a delayed one. For example, the individual suffering from this disorder is likely to fail to orgasm despite being physically aroused and interested in sex. The last common sexual dysfunction disorder is known as pain disorders (Avasthi, 2017). According to this classification, the individual experiences pain during intercourse. The cause for these sexual dysfunction disorders can either be psychological or physical.

Illustrate the treatments/management options, both pharmacological and non- pharmacological, and complimentary?

The first management option for sexual dysfunction is lifestyle modification (Avasthi, 2017). This treatment technique is aimed at modifying lifestyle elements that may be contributing to the disorder. For example, on top of being a risk factor for cardiovascular diseases, a sedentary lifestyle is also a risk factor for sexual disorder. Obesity is also believed to lead to sexual dysfunction in men. Other changes to lifestyle may include dropping smoking on top of losing weight and increasing exercise. It is recommended that physical exercise need both be regular and longer to deal with sexual disorders (Balon, 2008).

In regards to pharmacotherapy treatment, Phosphodiesterase type 5 (PDE5) inhibitors are believed to be the most effective in the treatment of sexual dysfunction. These include tadalafil, vardenafil, and sildenafil. In particular, sildenafil is the most effective and safe in cases where the dysfunction is related to diabetes mellitus and spinal cord injury (Avasthi, 2017). It has also been known to improve the frequency of intercourse attempts and improve erections. However, up to a third of men with sexual disorders do not respond to therapy with these inhibitors. Some of the side effects include dizziness, headaches, and abnormal vision.

Surgical and procedural therapy has also been found to be effective in treating sexual dysfunction disorders. However, most of the surgical operations are moderate to high risk and are invasive. As a result, vacuum pump devices have become popular due to their low risk and non-invasive nature (Wincze & Weisberg, 2015). The vacuum pumps are especially effective among men taking anticoagulants and those suffering from sickle cell anemia. If well used, the potential risk is negligible according to Avasthi (2017). Other alternative therapies include behavioral therapy including sex with a partner other than the one with whom one experiences erectile dysfunction. It is recommended that patients should undertake both medications with behavioral therapy because studies indicate that higher success rates have been found among those who take medicine and attend group therapy with their partners compared to those who only receive medication.

Is there equality in the availability of resources and treatment for sexual health dysfunction in women compared to men?

A close look at the availability of treatment and resources for sexual health dysfunction reveals that there is a level of inequality between men and women. Apart from lifestyle modification to treat sexual disorders, most pharmacotherapy and procedural and surgical treatments seem to heavily target the men. In other words, there seem to be fewer stigmas regarding sexual dysfunction to the point that treatment and other therapies targeting men are more advanced and popularized while in comparison to those affecting the women. It is no wonder that the sales of sildenafil, popularly known as Viagra approached 1.4 billion dollars back in 2007 (Avasthi, 2017). No pharmacotherapy medication for women has neared these high sales.

Also, vacuum pump devices have emerged to be popular in recent years due to their noninvasive nature and their potential risks are negligible. However, no such technology has been pursued in such an aggressive manner to deal with sexual dysfunction among women. In short, a lot of research into treatment options including medical, surgical and procedural therapy seems to have been geared towards dealing with sexual disorders among men. This focus on only one of the genders ignores the fact that sexual dysfunction is a problem that affects both men and women alike (Rowlan & Incrocci, 2008).

What does the evidence say? Are practice guidelines available to help guide the care you will provide?

Evidence suggests that there are ample practice guides available to help guide the care that I will provide. To begin with, there are detailed outline recommendations of what the counselor should adopt depending on the outcome depending on the cause of the dysfunction. For example, most guidelines recommend that in case of sexual dysfunction, the first line of therapy should include oral phosphodiesterase type 5 inhibitors.

Besides, there are summary tables that indicate the common risk factors for sexual disorders among men and women, making it convenient for the counselor to quickly refer to this table when exploring the possible causes of sexual dysfunction with the client. The table usually comes in handy during the second phase of the counseling process. For example, most tables indicate that advancement in age is one of the most common if not the most common cause of sexual dysfunction. Having the table makes it easy for the counselor to have a list of possible causes of the disorder at his or her fingertips.

Besides, evidence suggests that there are practical guides on how to approach the questioning of the client when recording their sexual history. With a scoring chart of 1-5 based on a neutral language, the questionnaire comes in handy when exploring possible causes of sexual dysfunction. The guidelines also highlight that the client's reply should be limited to responses that relate to the past six months. There are even guidelines as to the recommended dose of the phosphodiesterase type 5 inhibitors and the duration of use. For example, most guidelines urge for a 50-100mg of sildenafil (Viagra) that should be taken one hour before intercourse and is expected to work up to four hours (Avasthi, 2017). Hence, there are sufficient and detailed guidelines available to help guide the care that I will be providing.

Discuss the gaps in the literature.

There is a considerable gap in the literature regarding sexual dysfunction in women besides pain during intercourse. While the absence of orgasm, lack of desire and arousal problems are also common problems in the sexual health of women, most of the research seems to be concentrated on pain during sexual intercourse when it comes to women. More trials and experiments need to be carried out in women-targeted research into these three areas.

Secondly, there is very little concentration of research into sexual dysfunction in two important demographics- the young and the aged. There is growing recognition that sexual health among the aged and the youth entails a broad range of psychosocial, emotional, and physical responses to sexual interaction yet little is known regarding sexual disorders and wellbeing in these two populations. In particular, with the size of the older population demographic expected to keep expanding in the foreseeable future as people live longer, sexual dysfunction among this population is expected to become a concern in public health care.

What are the implications for practice as a Family Nurse Practitioner (FNP)?

As a Family Nurse Practitioner (FNP) the sexual wellbeing of the public is an area of interest to my profession and some issues of importance have emerged here. First, it has emerged that some recommendations for overall wellbeing being are also essential to sexual wellbeing including lifestyle changes such as seizing of smoking and regular exercise. This revelation is a remarkable addition to the body of research that has urged the public to reduce or stop smoking altogether. The implication is that more aggressive campaigns into lifestyle changes should be launched because these changes not only address sexual health but also overall wellbeing in general.

Also, the youth and the aged populations have emerged as important populations for practice, demanding for more detailed literature into their sexual well being. With more people now from these two age brackets expected to seek for treatment and other therapy interventions, it is expected that the practice requires additional experiments into this area.

Lastly, the role of counseling has emerged as being central to the family nurse practice because as revealed, addressing sexual dysfunction disorders entails addressing the root cause of the problems most of which are psychological. Hence, counseling will continue to be the backbone of the family nurse practice for the foreseeable future.

References

Avasthi, A. (2017). Clinical practice guidelines for the management of sexual dysfunction. Indian journal of psychiatry, vol. 59 (Suppl 1), S91-S115. doi:10.4103/0019-5545.196977

Balon, R. (2008). Sexual dysfunction: The brain-body connection. Basel: Karger.

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