Importance of Education on Patient Sexual Health

This article is currently under review and may not be up to date. Please come back soon to see the finished work! (6/02/2024)

Original Editors - Laura Ritchie posting on behalf of Micaela Cox, MPT Class of 2023 at project for PT9584. Lead Editors - Laura Ritchie, Vidya Acharya, Kim Jackson and Fatima Muhammad Bashir

Introduction

Pelvic physiotherapy is becoming increasingly popular and more widespread as a viable option for the population who experience pelvic floor dysfunction. Within this population there are many people who experience issues in their sexual health due to issues with their pelvic floor. Physiotherapists with a specialization in pelvic health have a responsibility to be open to discussing the sexual health of patients. With this it is important to provide accurate education because the general public frequently receives misinformation about sexual health, whether it be from the internet, family members, friends or co-workers. Knowing different tools to educate these patients is therefore important to be an effective pelvic physiotherapist.

Educational Program by Physiotherapists

Many patients who seek out pelvic physiotherapy do not know what can contribute to their pelvic floor or sexual dysfunction. It is important to put emphasis on education when discussing pelvic floor issues.

While educating the patient about pelvic health it should be effective in providing knowledge related to the pelvic floor such as the pelvic floor muscle function, dysfunction, and options for treatment.These benefits include increased chances of women seeking care, reduction of pelvic floor dysfunction symptoms, improvement in quality of life, and a better adherence to conservative treatments such as Pelvic Floor Muscles training.

Some important education pieces to consider are:

• You should not be straining or pushing when urinating or completing a bowel movement. This can affect the tone of the pelvic floor which can result in sexual dysfunction.
• Hypertonus does not necessarily mean you have “tight” muscles. It could be from weak muscles as well.

• Sexual intercourse should never be painful.
• Many foods and beverages can affect the pelvic floor and bladder such as alcohol, caffeine, acidic foods, concentrated sugars, artificial sweeteners and spicy foods.
• After prostatectomy, it is common to experience leakage which can interfere with sexual activity.

Multiple tools can also be used to ensure these patients are comfortable during a treatment session. A useful tool when treating a patient with pelvic floor issues is the five-step ALLOW algorithm introduced by Sadovsky and Mulhall, 2003. Only once the current step has been successful for both the patient and the physiotherapist is the next step initiated.

• Step 1: A - ask the patient whether you can proceed
• Step 2: L - legitimize each part of the body work in such a way that the patient feels completely in control
• Step 3: L - limitations, meaning that before and during body work the physiotherapist is, at all times, aware of his/her own competence and skill level and the patient’s emotions and feelings, referring, if necessary, to another professional
• Step 4: O - be open for further discussion and evaluation with the patient and, if necessary, other competent colleagues or disciplines of the multidisciplinary team
• Step 5: W - work to develop a treatment plan with the patient and other disciplines

Another tool that can be used to allow patients to record their sensitive information without having to say it out loud is the Initial Measurement of Patient-Reported Pelvic Floor Complaints Tool (IMPACT). There is a long and short version of the questionnaire.

Signs and Symptoms for Sexual Dysfunction

When explaining sexual dysfunction to a patient it is important to educate on different signs and symptoms they may experience and that those symptoms can get better with physiotherapy.  

Symptoms to watch for in females

• Pain with intercourse
• Pain with urination
• Difficulty defecating
• Decreased vaginal lubrication
• Difficulty obtaining orgasm
• Low sexual desire

Symptoms to watch for in males

• Difficulty maintaining or initiating an erection
• Pain with urination
• Difficulty defecating
• Painful orgasm
• Low sexual desire

Non-physical Factors

As a physiotherapist who takes a holistic approach to practice, it is also important to discuss the effects of emotional and social factors on sexual health. Some external factors that can impact sexual interactions and desire include but are not limited to cultural, socioeconomic situation, lifestyle and life events. Discussing the impact of anxiety on sexual health is also important as it can contribute to physical symptoms.

Conclusion

In conclusion, an emphasis on education needs to be made when discussing sexual health and dysfunction with patients during treatment session. There are many sources of misinformation, and it is part of a pelvic physiotherapist's job to educate on the facts when it comes to a patient's sexual and pelvic health.