Let’s Talk About Sex: What CL Psychiatrists Can Do to Promote Whole Health

Abstract: Addressing sexual health and well-being in the medically ill is an important part of comprehensive medical care yet largely gets overlooked by clinicians, including consultation liaison psychiatrists (CLP). Sexual disorders are highly prevalent in medically ill populations due to pathophysiological mechanisms affecting the hypogonadal-pituitary-adrenal axis, psychological barriers, psychiatric symptomatology, medication side effects, and physical disability, among other etiologies. Sexual health may further be complicated by interpersonal dynamics (e.g., caregiver-patient dynamic in a spousal patient where one patient is a recent transplant recipient), body disfigurement (e.g., related to cancer treatment or transplant surgery), psychosocial stressors, cultural factors, and other contributing determinants. Thus, sexual health and well-being are multidimensional and are a critical part of the interface of medicine and psychiatry.

CLP are uniquely positioned to initiate these sensitive and important conversations with their patients by fostering a psychologically safe space to discuss sex, sexuality, sexual identity, and challenges in sexual functioning. CLP are experts in medical interviewing and thus may be more likely to effectively explore potential causes, develop a differential diagnosis, facilitate therapeutic interventions, and validate the medically ill patient’s concerns.

In this general session, the presenters will discuss sexual disorders common in several medical subspecialties, including pulmonary medicine, cardiology, psycho-oncology, liver disease, substance use, and neurologic disorders. Each speaker will provide the participants with diagnostic challenges and solutions that clinicians encounter when initiating conversations and investigating sexual problems with their patients, while mapping out a differential diagnosis and developing treatment plans and providing therapeutic support. Cases will be used to facilitate learning and audience participation.

Dr. Roy will review the neuroanatomy and neuromediators involved in sexual disorders and discuss the distinction between primary, secondary, and tertiary sexual dysfunction. She will present the challenges and potential solutions in the diagnosis and management of sexual dysfunction in neurological diseases by exploring multiple sclerosis, epilepsy, Alzheimer’s dementia, and Parkinson’s disease. She will integrate the emotional and behavioral disturbances that present in common neuropsychiatric disorders with mechanisms of reduced sexual desire, autonomic dysfunction, and mood disorders in these conditions.

Dr. Sher will discuss sexual disorders in patients with pulmonary and cardiac conditions, highlighting some unique contributors, including pathophysiology and contributing medications, as well as approaches to empathic interviewing.

Dr. Lahijani will discuss the psychological impact that a cancer diagnosis may have on a patient’s sexual functioning. She will describe examples of how cancer and its associated treatment may affect patients and their dyadic relationships by focusing on the Human Sexual Response Cycle. Dr. Lahijani will conclude by discussing the role of communication surrounding sexual issues and its impact on sexual functioning in cancer.

Dr. Winder will discuss presentation of sexual disorders in patients with liver disease and substance use disorders, with a special attention on how substances can affect sexual functioning.

The session will consist of four 15-minute lectures by each speaker, followed by a 15-minute question and answer session.