Sexual health and the EA professional: developing an understanding of sexual health and taking steps to recognize its importance can improve the treatment of clients with sexual health concerns.

The relationship between the work environment and sexual health issues is a taboo topic in the United States and most countries. The employee assistance professional, however, needs a basic understanding of sexual health to address clients' concerns and provide appropriate assessment and referral services.

Consider the following: It is estimated that approximately 3-6 percent of the U.S. population struggles with sexual compulsivity/addiction behavior problems (sash.net). The use of the Internet at work for virtual sex is well documented (Cooper 2002), while the rise of social networking to cope with loneliness highlights the striving for human connection (Hu 2008). One in four women and one in six men report some type of sexual assault in their lifetime (Elliot, Mok and Briere 2004). Meanwhile, the increasing use of erectile dysfunction medications by both men and women underscores the importance of sexual health concerns for clients.

Taken together, these data suggest that sexual health issues are significant. Furthermore, most researchers believe these statistics actually underreport the incidence of sexual health concerns.

When faced with a sexual health issue, accurate conceptualization and awareness are important for appropriate treatment and care. It is not expected that the EA professional will 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 been engaged in an ongoing discussion for the past 25 years to define sexual health (see Edwards 2004). If EA professionals are to conceptualize sexual health, it is important that they have a working understanding and definition of it.

The World Health Organization (2002) published a definition that highlights the multi-dimensional nature of sexual health. Sexual health, according to WHO, is 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."

The major weakness of the sexual health field (and of the many definitions that have been advanced) is the relative newness of the concepts. The exact nature of, and relationship between, the many variables of sexual health are complex and not always understood.

The chicken-and-the-egg phenomenon regarding causality between sexual health issues and other concerns highlights the difficulty in conceptualizing and treating sexual health problems. For example, does one's sexual functioning contribute to depression and anxiety, thereby resulting in chemical dependency? Or does chemical dependency as a form of self-medication of anxiety lead to sexual functioning issues, thus creating relationship concerns and, ultimately, depression?

THE SEXUAL HEALTH MODEL

This multi-faceted reality highlights the need for increased awareness of sexual health by the EA professional. In an attempt to better understand the definition of sexual health, Robinson and others (2002) created a model of sexual health that has 10 components. Of the 10 components, seven are relevant for the EA professional:

1. Talking about sex is a cornerstone of the Sexual Health Model. Often, feelings of shame and fear about sexuality lead the client to withdraw and avoid any discussion of sexual concerns. Appropriate assessment questions (tempered by clinical judgment) should be posed 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 that leads to better treatment placement.

2. Cultural 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. EA professionals need to be sensitive to different sexual cultures. This includes developing an awareness of gender-specific programming (e.g., women's treatment programs) as well as programming for sexual minorities (such as gay, lesbian, bisexual and transgender individuals).

3. Sexual health care and safe sex assume 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, conducting regular self-exams, and responding to physical changes with appropriate medical intervention. An examination of one's sexual behaviors is critical. Admittedly, the average EA professional may have little expertise in this area, but s/he can facilitate referral to a medical provider who is skilled in addressing these concerns. A rich referral network of medical providers can be helpful.

4. Challenges and barriers to sexual health include not only the major areas of sexual abuse, substance abuse and compulsive sexual behavior but also a history of sex work, harassment and discrimination. Too often, sexual health issues interact with depression, chemical dependency and/or abuse, which themselves are sources of mental health concerns that require treatment. By recognizing the depth of the issues, the EA 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 their identity within a positive and self-affirming environment. Frequently, depression, anxiety and relationship satisfaction are negatively affected by a fear of sexuality By demonstrating respect for, and awareness of, sexuality, the EA professional can model sexual health for the client and provide a safe place to put these issues on the table.

6. Intimacy can take many forms and is a universal need that people address through relationships. Sexual health requires knowing which intimacy needs are important for the individual and finding appropriate ways to meet these needs. As highlighted by Rosen and Bachman (2008), relationship satisfaction is positively correlated with overall mood.

7. Spirituality and sexual health assume 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.

STRATEGIES FOR THE EA PROFESSIONAL

Recognizing the importance of sexual health in your work is the first step in the process of ensuring appropriate assessment, referral and treatment. The following strategies are offered for professional development as well as to enhance care for clients.

Conduct a self-assessment. Complete a self-assessment of your ability and comfort level with respect to 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 EA professional raises the topic.

Enroll in training. What journals, seminars, conferences or other materials can you access to enhance your clinical skills? Improving your skills in the area of sexuality is an important part of continuing education.

Develop a referral network. Who in your professional network has the necessary skills to work with clients in the sexual health areas mentioned in this article? Developing a strong referral network is necessary for long-term client care.

Seek supervision. Who in your network can provide you with clinical supervision to help you in addressing sexual health concerns? If you struggle when talking about sexual health, seek supervision to develop this skill.

Identify resources. What resources do you have to help clients with sexual health concerns? In your waiting room or on your Website, do you have information about HIV/STD prevention, pregnancy, rape and abuse centers, 12-step groups, or couples therapists? Many clients are seeking information and specialized services that require expertise. When clients recognize that resources are readily available, they may volunteer information that the EA professional can then target for follow-up.

Create a safe environment. The EA professional needs to create a safe environment to allow the client to disclose information as appropriate. Developing sexual health skills, identifying resources, and "setting the stage" help create a climate that says, "It's okay to talk about sex."

Develop an informal assessment process. The EA professional has two options in developing an assessment process. The first option is an informal process, in which the EA professional asks an appropriately timed question as part of the existing assessment. For example, during a chemical dependency assessment, the EA professional could simply ask a question similar to this one: "How often are sexuality concerns linked with your chemical use?" Similarly, for depression, the EA professional could ask, "To what extent are your feelings of depression linked with sexuality concerns?" This approach is less threatening and more likely to elicit a response when the question appears to be a natural part of the assessment process.

Develop a formal sexuality assessment. A more formal approach might also be developed as part of the assessment process. The content of the formal assessment is dictated by the needs of the setting, so universal suggestions are difficult to provide. Nonetheless, 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 being gathered to help make an appropriate referral." The questions that follow would address common sexuality concerns.

EA professionals might want to look at the 10 components of the sexual health model as a starting place for dealing with sexual health issues. Questions for clients might include issues about relationships, sexual functioning, sexually transmitted illnesses, sexual abuse, and so on. Given the role of the EA professional, this approach might be less helpful in a brief therapy/intake model and more appropriate to a longer-term treatment setting.

TRIAGING SEXUAL HEALTH

The breadth of sexual health issues highlights the need for the EA professional to have a basic awareness of the topic. Both the definitions of sexual health as well as the components of the Sexual Health Model are places to begin understanding the numerous variables. The goal is accurate assessment for appropriate referral and treatment, ultimately resulting in a better quality of life for the client.

Given the likelihood of underreporting of current sexual health concerns, the EA professional is on the front line and a valuable person to triage these issues for clients. The specific strategies provided in this article are good places to start.

Online Resources

LGBT issues: Human Rights Campaign (www.hrc.org).

Sexual addiction and compulsivity: Society for the Advancement of Sexual Health (http://sash.net).

Sexual assault: National Center for Victims of Crime (http://www.ncvc.org/).

Relationship resources: The Help Guide (http://www.helpguide.org/)

References

Cooper, A. (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. Los Angeles: University of California, Los Angeles.

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

Elliot, D., D. Mok, and J. Briere. 2004. Adult Sexual Assault: Prevalence, Symptomatology, and Sex Differences in the General Population. Journal of Traumatic Stress. 17(3): 203-211.

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

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

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

by Weston Edwards, Ph.D.

Weston Edwards is a licensed psychologist and director of program development at the Pride Institute, which provides sexuality and chemical dependency treatment for the lesbian, gay, bisexual and transgender (LGBT) community. He is also in private practice at the Sexual Health Institute. He specializes in individual couples and group counseling, working in the areas of sexuality, spirituality, chemical dependency and mental health.