It’s right up there with spirituality discussions for most palliative care providers to ask about spirituality. But we are able to put aside any squeamishness and regularly ask about spiritual identity.
So what makes asking patients about sexuality and intimacy so difficult? Because we don’t talk about it in our culture at large. We don’t correctly identify our “parts”, we feel guilt/shame due to cultural/spiritual message we have received about our sexuality, and we as humans tend to avoid things that make us feel uncomfortable.
In our palliative care practice, we see many people who are gravely impacted not only by their illness but their loss of intimacy, physical touch and connection. Sexuality and intimacy span many areas of the palliative care whole person including spiritual, physical, emotional, psychological and functional aspects. For some, sexuality is interconnected with their spirituality and this form of intimacy brings people closer to divinity as well as their partner. Others find the loss of sexuality entangled with their loss of identity and their role as a spouse or the end of their ability to have children. Loss of sexual function can be perceived as a failure and just one more way to lose control of a person’s body.
Normalizing the questions and conversation around sexuality and intimacy can be so validating to patients who are struggling in silence. Just as with spirituality, it is a private and sacred realm where people can experience distress. We have the opportunity as palliative care community specialists to open up the conversation and hold a brave space for the patients.
Harri Brackett CNS and I are giving an in person presentation on Oct 16th at UC Health Palliative Care Days if you are interested in hearing more and talking about the topic:
Palliative Care Days 2024
Here are two great ways to start thinking about how to integrate sexuality and intimacy more readily into our palliative care (and personal) discussions:
Why Is It So Hard To Have Honest Conversations About Sex? : NPR an 8-minute listen to two sex educator talk about healthy ways to discuss the topic
Assessing the Impact of Serious Illness on Patient Intimacy and Sexuality in Palliative Care - ScienceDirect (ucdenver.edu) Ann Kelemen is a palliative care social worker, and this is just one of several papers she has published on the topic of sexuality and palliative care