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How Sexuality and Non-Sexuality Professionals Can Better Work Together

How Sexuality and Non-Sexuality Professionals Can Better Work Together

By Steph Auteri | From the June 2014 Issue

Over time, AASECT-certified counselors and therapists often see clients whose needs regarding sexual issues were not adequately met with another mental health practitioner, and so they set out seeking something more. Or members see clients whose medical provider did not consider issues of sexuality to be pertinent to a larger conversation about health and well-being, and so these clients went home feeling unsure that what they were experiencing was worth talking about.

And then there are our organization's educators. In the course of teaching others about human sexuality, they encounter those with varying levels of comfort regarding sex. Those who are uneasy in talking about sex. Or, on the other end of the spectrum, those so used to sex-positivity that teaching to them is like preaching to the choir. 

Of course, if these educators are lucky, they also see their classrooms filled with non-sexologists... non-sexuality professionals who want to enrich the work they already do by furthering their education in an area that many of their colleagues perhaps consider tangential or even irrelevant.

The question then becomes: how can sexuality professionals most effectively share their knowledge with non-sexuality professionals to the benefit of these practitioners' clients, patients, and students? How can professionals collaborate in a way that ensures a higher quality of treatment and education?

In seeking out the answer, I spoke to several professionals whose careers successfully straddle the line between their areas of expertise and larger issues of sexuality.

For example, Pepper Schwartz, PhD, is a professor of sociology at the University of Washington. She has written 20 books and numerous articles, and does workshops and lectures around the world on her various research topics. Her work almost always bumps up against areas of sexuality as it relates to marriage and family relationships; political scandals; policy planning for reproductive rights; and more. "My field is highly diverse," she says, admitting that not all sociologists would benefit from additional education in human sexuality. "But there are still a lot of places where it should be included," she says.

Then there's Susan Wysocki, WHNP, FAANP, who has been a women's health nurse practitioner for over 30 years. "Early on," she says, "I attended an NP program co-sponsored by Planned Parenthood and the NJ College of Medicine and Dentistry. In that program, we actually had quite a number of lectures on sexual issues." She has also attended AASECT meetings and did a SARs training to further her education in the area of sexuality. But not all nursing professionals have as strong of a foundation in sexuality. 

"I commonly hear clinicians say that bringing up sexual issues will open Pandora's Box and take up too much time" says Wysocki. "Yes, there are competing interests for that 7-15-minute visit, but a longer visit could be scheduled. The truth," she says, "is that most clinicians are not well prepared with even basic information about sexual function. Further, there is little to no practice to become comfortable with discussing sexual issues. Sexual issues are given very little attention in most nursing and medical school programs except perhaps with regard to infections and disease. It's always the last chapter in the textbook. It's always the thing that is the least talked about. We are failing to emphasize the importance of sex as integral to health and well-being. Sex is good for both the mind and body. Yet, it is ignored at most health visits."

Andrea Singer, MD, is the Director of Women's Primary Care at MedStar Georgetown University Hospital, and an associate professor of medicine, obstetrics, and gynecology at Georgetown University Medical Center. Through the course of her work, she regularly handles issues of sexuality going across the life span, from young women coming of age to those with fertility and infertility issues to those experiencing menopause.

"There are no absolute standards when it comes to the inclusion of sexual health in a medical health curriculum," says Singer. "It's difficult because, even in programs that don't focus on sexual health, we obviously address pieces of it. But we approach things from more of a purely medical point of view. We don't necessarily learn to explore it with more of a multifaceted approach in terms of what else might be going on. But you have to know what to do with the information you gather." 

Singer actually developed a course at Georgetown that at the very least gives medical students an introduction to human sexuality. Through this course, they learn skills such as how to talk to a patient, how to take a sexual history, and how to approach people respectfully. "Anything that introduces those topics is a move in a positive direction," says Singer.

Ruth Neustifter, PhD — an assistant professor in couples and family therapy at the University of Guelph in Ontario, Canada — brings up an entirely different issue when it comes to the exclusion of sexuality education in various ancillary professions. In telling of her time as a volunteer at a domestic violence shelter in Athens, GA, she says she started a group on sexual health and well-being. "After all," she says, "a lot of the residents there had certainly had experiences with sexual violence. But what they were really interested in had more to do with pleasure. Pleasure and intimacy." 

This is when Neustifter realized that the common lack of formal training in the area of sexuality wasn't the only issue. It went deeper than that. "At that point," she says, "I realized how this was an area where people felt we didn't need to be talking about sex, because these people at the shelter allegedly had bigger problems. But life goes on at the same time. I started thinking more and more about these populations we don't reach out to because we don't sexualize them in our minds. Cancer survivors. Those in menopause. New moms. All these groups who want nice, intimate sex lives, like most people do, but who are underserved."

Luckily, those like Neustifter, Singer, Wysocki, and Schwartz saw the lack in their professions and set out to remedy it. But filling a hole that large for an entire industry can be an uphill battle, partially because sexologists often assume a comfort level in others that may not exist around issues of sexuality, just because it's a topic they're so immersed in themselves. How can AASECT members better bridge that gap?

How can we better disseminate sexuality information to non-sexuality professionals?

Eli Coleman, PhD, a professor and the director of the Program in Human Sexuality at the University of Minnesota, stresses the importance of knowing your audience, saying that you have to gear the information you're teaching to their level of knowledge and their interests. "You have to have a working knowledge of their field and their language," says Coleman. 

He also says he finds it helpful to co-teach with someone from his students' background, a practice Robert Friar, PhD, also advocates. Friar teaches a course on human sexuality and, every fall, he gives an hour and a half program on Sex and the College Student to all incoming freshmen. He likes to invite non-sexuality professionals to guest lecture during his classes on their own areas of expertise. He sees this as a way to get professionals more involved and interested in an area they may not have felt comfortable with at all.

But what about the comfort levels of the students themselves? Robin Milhausen, PhD, a colleague of Neustifter's at the University of Guelph, talks more about teaching style. An associate professor in the university's Department of Family Relations and Applied Nutrition, a sex educator who speaks at colleges and universities, and to community groups, and the chair of the Annual Guelph Sexuality Conference, the largest sexuality conference in Canada, she's dedicated to helping people get additional training in sexuality so that they're confident working in areas that touch on the topic.

"I think being really comfortable with sexuality sets the tone," says Milhausen. "Still, you have to accurately assess the level of the audience you're speaking with and keep in mind the experience level of the people you're speaking with. I use a fair bit of humor," she says. "But it's been really important for me to judge the audience. Are they happy and relaxed? Then I can keep going with this. Or I can back up or change my approach if they look uncomfortable."

Milhausen is also mindful of being inclusive of whatever her students' experiences may be. "One thing I constantly work to improve," she says, "is being inclusive in my language and not making assumptions about the audience. I don't assume heterosexuality. I don't make assumptions about gender identity, because that can alienate people. I have given talks where I've made assumptions and I could see people shutting down, because my assumptions were inaccurate. Those are the talks I remember and work really hard to improve upon."

Adds Neustifter, "It's really essential to appreciate people who perhaps are coming from a more modest place, to understand where they're coming from and recognize that maybe that mainstream person can still be very interested in these topics. We can't just remain within our sex-positive bubbles." 

Says Schwartz: "I find it embarrassing when [sexologists] plunge ahead with vivid descriptions without asking permission. People might have sensitivities and they have the right to their sensitivities. The conversation will be more productive if both people are all about having that dialogue."

"When it comes to more charged topics, like sex," says Singer, "those of us who are in the field and do this all the time... it comes naturally. What we're comfortable talking about may make others take pause for a moment. Just as when we talk to patients, trying to figure out where they are, where their baseline level of knowledge is, what their comfort level is... I think we need to do the same thing with other professionals. We need to assess how the practitioner has or has not addressed this in their own practice, and then start there."

Wysocki advocated going back to basics, and focusing on facts. "Sometimes, statistics help," she says. "Having some of the data can normalize various sexual behaviors. That can help."

Singer also suggests starting with basic knowledge and definitions, the common terminology sexologists use, and the data we have from health surveys. "People just aren't familiar with how sex has been studied," she says. "I don't think many people are necessarily familiar with sexology as a field, what [sexologists] necessarily do. Explaining those basic parameters as well can be a place to start."

Sexuality professionals also need to be mindful that those they're teaching may have experienced some form of trauma and abuse. "We need to recognize and acknowledge that not all experiences are positive," says Milhausen.

Neustifter elaborates, telling of a particularly effective approach she herself observed as a workshop attendee. "A presenter I once saw told the group how appreciative he was of having the honor of being able to address something so intimate and private in nature to them," says Neustifter. "He said he recognized how some people would be more comfortable than others. I was so struck by that approach. Telling your audience: you're trusting me with this. Communicating that in some way. That's really important." 

Singer uses a similar approach. "When I start the human sexuality course at Georgetown each year," she says, "part of that introductory discussion is that this can be a topic that will have different meaning or different comfort levels for lots of different people in the room, and that's okay. There's no right or wrong way to feel. It's an individual experience."

How can we improve collaboration between sexuality and non-sexuality professionals?

Moving back out of the classroom, it's important to acknowledge that despite existing educational opportunities, not all non-sexuality professionals seek to further their education in this area. So how can they better serve their clients and patients considering this gap in their knowledge?

"It would be most helpful if we could advocate that non-sexual professionals receive some basic education in human sexuality as part of their training," says Coleman. "It is very disturbing to realize that most allied health professionals do not receive any coursework in human sexuality as part of their professional training." But he acknowledges that this is a difficult task.

"I think all people working in mental and physical health have to take responsibility for learning," says Milhausen, "or finding people they can refer to if they don't feel comfortable or confident."

"In my experience," says Neustifter, "many mental health professionals will say, well, my clients don't ask me those questions. But it's the therapist's responsibility to bring it up." She also says that different therapists specialize in different topics, which is why referrals are so important. "You have to get your own training or have a good list of referrals."

And perhaps there — in the mention of referrals — is the key. "The interdisciplinary work I do is important," says Neustifter. "We may be proud of what we do as sexuality professionals, but we need to recognize the value in working with others. I try to pair up with other professionals who have a part I don't." She goes on to say, "Referral networks are really important. You don't have to expect everyone to be savvy about sexuality."

Still, it's heartening to see that some fields are making the effort to strengthen the sexuality education they offer. For example, the American Congress of Obstetricians and Gynecologists (ACOG) and their Council on Resident Education in Obstetrics and Gynecology (CREOG) — which is the guiding force in what OB/GYN residencies teach and get tested on — has increasingly added more sexuality education requirements for their residents, including sexual, lesbian, and transgender health. 

Perhaps in the end — before pushing for more in-depth sexuality curricula and before building up that community of professional collaborators — we should focus on spreading the concept that sexuality is relevant to the work others are doing... even if it's not immediately apparent how this might be. In this way, non-sexuality professionals will inevitably become more open to strengthening their education in this area. Says Singer: "The biggest thing is that sexual health is an important part of general health."

What do you think? Do you have more to add to this discussion? We encourage all members to click over to AASECT Express and continue the conversation there. We'd love to hear what you have to say!

"We are failing to emphasize the importance of sex as integral to health and well-being. Sex is good for both the mind and body. Yet, it is ignored at most health visits." - Susan Wysocki, WHNP, FAANP