Thursday, March 12, 2009

Sexual Health and the EAPA professional

This is an article I submitted to the Journal of EAP professionals.

Sexual Health and the EAP professional
Weston Edwards, PHD

Addressing sexual health concerns identified in the workplace.

The relationship between the work environment and sexual health issues is a significant but taboo area. The presence of minimal training and expertise in sexuality is a significant problem for EAP professionals. Consider the following: It is estimated that approximately 8-10% of the population struggle with sexual compulsivity/addiction behavior problems (SASH.NET). The use of the Internet at work for virtual sex is well documented (Cooper, 2002). The rise of social networking to cope with loneliness highlights the striving for human connection (Hu, 2008). Sexual satisfaction is correlated with relationship satisfaction (Rosen &Bachmann, 2008). Eberhart (2008) highlights how interpersonal stress impacts overall mood, with the corresponding impact on work productivity. One in four women and one in sex men report some type of sexual assault in their lifetime (Elliot, Mok, & Briere, 2004). The increase in the use of erectile dysfunction medications for both men and women highlight the importance of the sexual health concerns for clients. Furthermore, most researchers believe the statistics referenced are actually underreported. Taken together, this data suggest that the prevalence and incidents of sexual health concerns are significant. The EAP clinician needs a basic understanding of sexual health to address concerns for the client. When faced with a sexual health concern, accurate conceptualization and awareness is important for appropriate treatment and care. It is not expected that the EAP professional provide these services; however the quality and effectiveness of any referral can be improved by an awareness and assessment of sexual health issues.

Defining and Creating Sexual Health
The field of sexology has engaged in an ongoing dialogue defining sexual health over the past 25 years (see Edwards, 2004). Toward the goal of helping the EAP professional conceptualize sexual health, it is important to have a working understanding of sexual health. The World Health Organization published the most recent definition of sexual health. They define sexual health as a . . .
“. . . state of physical, emotional, mental and social well-being related to sexuality; it is not merely the absence of disease, dysfunction or infirmity. Sexual health requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination and violence. For sexual health to be attained and maintained, the sexual rights of all persons must be respected, protected and fulfilled” (WHO, 2002).

This definition highlights the multi-dimensional aspect of sexual health incorporating nearly 200 different variables. The major weakness of the field and the definition is the relative newness of the concepts. The exact nature and relationship between the variables is complex and not always understood. The chicken-and-the-egg phenomenon regarding causality between sexual health issues and other issues highlights the difficulty in conceptualizing and treating sexual health issues. For example, does one’s sexual functioning contribute to depression and anxiety resulting in chemical dependency; or does chemical dependency as a form of self-medication of anxiety lead to sexual functioning issues creating relationship concerns and ultimately depression? This multi-faceted reality highlights the need for increased awareness of sexual health by the EAP professional.

The Sexual Health Model (Robinson, et al, 2002)
In an attempt to better understand the definition of sexual health, Robinson et al created a model of sexual health that has 10 components. Of the 10 components, 7 are relevant for the EAP professional.

1. Talking About Sex is a cornerstone of the Sexual Health Model. Many times the level of shame and fear about sexuality leads the client to withdraw and avoid any discussion of their sexuality concerns. Appropriate assessment questions tempered by clinical judgment should be created to help increase the accuracy of treatment placement. For example when working with someone with a chemical dependency problem, asking about the relationship between his or her chemical use and sexual behavior might provide information for better treatment placement.
2. Culture and Sexual Identity are instrumental to understanding one’s sense of sexual self. It is important that individuals examine the impact of their cultural heritage on their sexual identities, attitudes, behaviors, and health. EAP professionals need to be sensitive to different sexuality cultures. This includes awareness of gender specific programming (women’s treatment programs) as well as sexual minority (Lesbian, Gay Bisexual, Transgender, LGBT) programming.
3. Sexual Health Care and Safer Sex assumes a basic knowledge, understanding, and acceptance of one’s sexual anatomy, sexual response, and sexual functioning. This component covers a broad perspective encompassing knowing one’s body, regular self-exams and responding to physical changes with appropriate medical intervention. Examination of one’s safer sex behaviors is critical. Admittedly, the EAP professional may have less focus in this area. The role of EAP professional can facilitate referral to a medical provider skilled in addressing these concerns; a rich referral network of medical providers may be helpful.
4. Challenges and Barriers to Sexual Health includes the major areas of sexual abuse, substance abuse and compulsive sexual behavior. Other challenges might include a history of sex work, harassment, and discrimination. Too often sexual health issues interact with depression, chemical dependency and/or abuse that are the source of mental health concerns requiring treatment. By recognizing the depth of the issues, the EAP professional might increase the effectiveness of appropriate referrals.
5. Positive Sexuality recognizes that all human beings need to explore their sexuality in order to develop and nurture who they are within a positive and self-affirming environment. Too often depression, anxiety, fear, and relationship satisfaction is negatively impacted by a fear of sexuality. By demonstrating a respect and awareness of sexuality, the EAP clinician can model sexual health for the client and provide a safe place to put the issues on the table.
6. Intimacy and Relationships. Intimacy can take many forms and is a universal need that people meet through relationships. Sexual health requires knowing which intimacy needs are important for the individual and appropriate ways to meet these needs. As highlighted by Rosen and Bachman, relationship satisfaction is positively correlated with overall mood.
7. Spirituality and sexual health assumes congruence between one’s ethical, spiritual, and moral beliefs and one’s sexual behaviors. Spirituality may or may not include identification with formal religions, but always addresses moral and ethical concerns and deeper values in order to integrate a person’s sexual and spiritual selves. The respect of individuals in the workplace is ultimately an ethical value. The high levels of sexual harassment require ongoing monitoring and awareness for treatment that can facilitate growth versus simply consequences and termination.
Strategies for the EAP professional
Recognizing the importance of sexual health in your work is the first step in the process. The following strategies are offered for professional development as well as enhancing the care for clients.
Self Assessment. Complete a self-assessment of your ability and comfort level in talking about sexual health concerns. What are your interests, strengths and weaknesses in the above areas? Clients will intuitively follow your lead in talking about sexuality. They may defer or minimize any concerns until the provider addresses the topic.
Training. What journals, seminars, conferences or other materials can you access to improve your clinical skills? Knowing where you can find the information to improve your skills is an ongoing part of continuing education.
Consultation and Referral. Who in your professional network has the necessary skills to work with clients in any of the areas? Developing the necessary referral network is necessary for long-term client care.
Supervision. Who in your network can provide clinical supervision addressing sexual health concerns? This might include seeking supervision for you in light of the self-assessment. If you have struggles talking about sex, seeking supervision in developing these skills is important.
Resources. What resources do you have to help clients with sexual health concerns? In your waiting room or on your website do you have resources for HIV/STD prevention, pregnancy, rape and abuse centers, 12-step groups or couples therapists. Many times clients are seeking information and specialized services that require expertise. By identifying resources for clients, clients may volunteer information that the professional can then follow-up.
Creating a safe environment. Through the professional development, the EAP professional can create a safe environment to allow the client to disclose information as appropriate. Developing skills, identifying resources, and setting the stage help create a resource that says, “it’s OK to talk about sex.” These steps provide a safe environment for client disclosure.
Informal Assessment. The EAP professional has two options in developing an assessment process. The first is an informal process. The EAP professional can ask the appropriately timed questions in the existing process. For example, in a chemical dependency assessment, simply adding a question similar to “How often are sexuality concerns linked with your chemical use?” Similarly for depression, asking “How much of the feelings of depression are linked with sexuality concerns?” This approach is less threatening, and likely to get a response when the question appears to be natural part of the process.
Developing a formal sexuality assessment. A more formal assessment might also be developed in the EAP professional assessment process. This section of questions would be like any other section regarding the intake and referral process. A great place to start is with the following statement: “I’m now going to ask questions about sexuality concerns that may be present. I want to affirm the importance of confidentiality and that this information is gathered to help in the appropriate referral.” The questions that follow reflect a series of specific questions that address common sexuality concerns. The content of the formal assessment is dictated by the needs of the setting so universal suggestions are difficult to provide. You might look at the 10 components of the sexual health model as a starting place. Questions might include issues about relationships, sexual functioning, sexually transmitted illnesses, sexual abuse, and so on. Given the limited role of the EAP professional, this approach might be less helpful in a brief therapy/intake model and more appropriate to a longer-term treatment setting.
Summary and conclusion
The breadth of sexual health highlights the need for the EAP professional to have a basic awareness. Both the definitions of sexual health as well as the components of sexual health model are a beginning place to understand the numerous variables. The goal is accurate assessment for appropriate referral and treatment ultimately resulting in increased quality of life for the client. Given the probability of underreporting of current sexual health concerns, the EAP professional is on the front line and a valuable person to triage these issues for clients. The specific strategies provided are a place to start.


Cooper, Al (Ed) (2002). Sex and the Internet: A Guidebook for Clinicians; New York: Brunner-Routledge.

Eberhart, N. (2008) Interpersonal predictors of stress generation and depressed mood. University of California, Los Angeles.

Edwards, W., & Coleman E. (2004). Defining sexual health: A descriptive overview. Archives of Sexual Behavior, 33(3), 189-195.

Elliot, D., Mok, D. & Briere, J. (2004) Adult Sexual Assault: Prevalence, Symptomatology, and Sex Differences in the General Population. Journal of Traumatic Stress. 17:3, 203–211. DOI: 10.1023/B:JOTS.0000029263.11104.23

Hu, M. (2008) Social use of the internet and loneliness. The Ohio State University.

Robinson, B. E., Bockting, W. O., Rosser, B. R. S., Miner, M., & Coleman, E. (2002). The Sexual Health Model: Application of a sexological approach to HIV prevention. Health Education Research, 17(1), 43-57.

Rosen, R. & Bachmann, G. (2008) Sexual well-being, happiness, and satisfaction, in women: The case for a new conceptual paradigm. Journal of Sex & Marital Therapy, 4, 291-297.

No comments:

Post a Comment