Nurse practitioner counselling and therapy at the University Hospital Bern
The Department of Urology of the University Hospital of Bern uses an approach based on the model ‘Sexocorporel’ for nurse practitioner (NP) counselling in sexual health. The present article describes this counselling approach and how it integrates into traditional NP counselling approaches. Its potentials and limitations are discussed. In brief, the approach of Sexocorporel supports patients in the process of change and adaptation, so that they have a mindful self-perception and are aware of the situation and future challenges with a focus on body state. This article introduces a ‘real’ patient to describe the concept of Sexocorporel in more detail.
Mr. T, aged 68 years old, has no more spontaneous erections 6 months after radical prostatectomy for prostate carcinoma. The tumour was completely removed; no biochemical recurrence was noticed. When he masturbates or has sex with his partner, he is able to increase the physical arousal to a climax and he experiences sexual arousal. Tumescence and rigidity are so impaired that usual penetration practice is not possible anymore. Mr. T‘s wishes to have his sexual functioning back as it was before the surgery. Importantly, he says he does not feel as masculine anymore. His perception is that his penis is ‘broken’ and he does not have any feeling in his penis. Because he is afraid he has to ‘perform’ sexually, he can no longer stand any tenderness from his partner. The idea of not being able to fulfil anyone’s expectations proves to be an unmanageable barrier. The social withdrawal is perceived as burden for Mr. T and his partner.
Traditional NP counselling includes a coaching process which works on relationship topics, with the goal of accepting and coping with the situation. The aim of NP counselling is to familiarise the patient with his transition phase. This means the direct passage from one stage of life, circumstance or status to the next. It is indicative of change processes in the context of health and illness. In clinical practice, the need for change or transition becomes visible by formulated concerns or care problems. As part of clinical decision-making, a cognitive evaluation of the personal situation of affected patients is important to assess the perceived mental and physical burdens. The questions that often come up, related to urology, reveal a knowledge deficit around diagnosis and treatment, dealing with mortality salience, pelvic and genital rehabilitation after cancer treatment, as well as dealing with sexual dysfunction and the experience of manhood. Therefore, expertise in sexological knowledge and body therapy is needed in addition to specific knowledge in oncology nursing.
The approach of Sexocorporel greatly extends the traditional counselling approach as follows. Firstly, a clinical assessment of the arousal function aims for a better understanding of how Mr. T was able to feel his genitals prior to surgery and how he created a sense of masculinity before. A deeper exploration of the usual body behaviour of Mr. T results in a holistic picture of how his concerns are interconnected with his burdens. Secondly, this knowledge translates into specific regular exercises to experience how body states (muscle tension, breath, movement rhythm) correlate with certain emotions. Awareness exercises lead to perception exploration, consciousness training and perception modification. Thirdly, this body experience – or extended ability to create self-efficacy – is transferred to the actual concern. For Mr. T this could be, for example, the relief in the learning process that his personal feeling of power and manhood can be fuelled by increasing pelvis mobility and a deeper abdominal respiration during arousal regulation. Being a man who can be aroused and experience pleasure is a priority whereas ‘just’ functioning sexually is no longer a goal from Mr. T. Focus on arousal In clinical practice, we observe that men with successful focus on arousal instead of an absent erection, show a more reliable erection function and PDE-5 inhibitors are more effective. The most important premise is that sex and arousal can be learned.
Advantages of this approach compared to traditional NP counselling are broader and more holistic assessments of patient burdens by including body states. Men provide positive feedback and often state: “I have no mental problems, my body changed”. Therefore, it seems logical to work with the body first and to experience how cognitive and perceived changes (i.e. the assessment of burdens) are affected in parallel to body-related learning. On the other hand, this NP counselling approach requires specific expertise and demand together with a master degree in nursing science combined with a specialised education in body therapy, sexology or the Sexocorporel approach. Furthermore, this counselling approach is not paid by insurance companies and needs future research developments.
Sexual health in primary care
Sexual counselling is not a paid service in Switzerland and is not covered by health insurances. In the context of a serious illness such as cancer, the need for support for relationship issues or sexuality is socially accepted. For health issues, access through a uroclinic offers an important opportunity for men to strengthen their health literacy. Gender-sensitive health research shows that humans socialised as males tend to respond poorly to traditional prevention programmes. There is a tendency for men to see health as the absence of disease: healthy is someone who is functioning. If something is not functioning, it is broken. When male sexuality is affected, it seems less threatening to them to see a urologist than a sexual therapist.
The Department of Urology at the University Hospital Bern therefore has an important role in helping humans socialised as men to adequately triage their health issues with interdisciplinary consulting and with patient-oriented health care. In our clinical practice, we observed that the integration of knowledge from Clinical Sexology into patients‘ treatment plans successfully managed transitions. The effectiveness of Clinical Sexology consultation is currently investigated in research projects, carried out together with the Department of Health Psychology and Behavioural Medicine at the University of Bern.
Chiara Marti, Clinical Sexologist, Nurse Practitioner, Dept. of Urology, University Hospital Bern, Berne (CH), firstname.lastname@example.org