Is it right to sexually assist a paralysed patient? - page 10

How do you deal with the paralysed patient with frequent erections? Have you ever been asked to assist? I've never faced this but have seen a heated discussion on another forum. Is it humane to bring... Read More

  1. by   Louisepug
    Now, I know that I actually read somewhere that the first nurses were prostitutes! :chuckle LOL!
    But, no, on the serious side. I personally would not be able to do this. I would be way to nervous being that intimate with a stranger or someone I do not love in that way. It would also make me feel "slutty," and immoral as well. But, being said I DO believe in the profound healing effects of touch. I don't think we do enough touching in our society as it is (and no, I don't mean THAT kind of touch !) Granted, it may not relieve someone in that way, but just giving a back massage, stroking the patients hair or hand can be just as intimate without being sexual. Louisepug
  2. by   suzanne4
    One thing that many of you are forgetting to think about. This patient has a spinal cord injury, and depending on the level of injury, the men can have frequent erections and not even know it. They will usually go down on there own as well as come back up again. The main concern occurs if the erection lasts too long and doesn't go down. Then that is a physiological problem and can become a medical emergency. So is the patient feeling things and asking for help, or is the nurse just supposing that he needs help?

    Just my two cents from a different perspective..................
  3. by   Roland
    Here is an article originally printed in the New York Times that describes how DOCTORS used to induce orgasms in women to relieve "hysteria". I think that it may have some relevence to this discussion at least from a historical perspective. My position is that prostitution should be legal, at least under certain circumstances, much in the same way that medical marajuana is SOMETIMES legal. However, it should NOT be done by doctors or nurses for reasons previously discussed.

    Yesterday's doctor treated 'hysteria' with vibrator
    Massage once was thought to relieve various symptoms
    New York Times
    March 29, 1999
    Electricity has given so much comfort to womankind, such surcease to her life of drudgery. It gave her the vacuum cleaner, the pop-up toaster and the automatic ice dispenser.

    And perhaps above all, it gave her the vibrator. In the annals of Victorian medicine, a time of "Goetze's device for producing dimples" and "Merrell's strengthening cordial, liver invigorator and purifier of the blood," the debut of the electromechanical vibrator in the early 1880s was one medical event that truly worked wonders -- safely, reliably, repeatedly.

    As historian Rachel Maines describes in her exhaustively researched if decidedly offbeat work, "The Technology of Orgasm: 'Hysteria,' the Vibrator, and Women's Sexual Satisfaction" (Johns Hopkins Press, 1999), the vibrator was developed to perfect and automate a function that doctors long had performed for their female patients: the relief of physical, emotional and sexual tension through external pelvic massage, culminating in orgasm.

    For doctors, the routine had usually been tedious, with about as much erotic content as a Kenneth Starr document. "Most of them did it because they felt it was their duty," Maines said in an interview. "It wasn't sexual at all."

    The vibrator, she argues, made that job easy, quick and clean. With a vibrator in the office, a doctor could complete in seconds or minutes what had taken up to an hour through manual means. With a vibrator, a female patient suffering from any number of symptoms labeled "hysterical" or "neurasthenic" could be given relief -- or at least be pleased enough to guarantee her habitual patronage.

    "I'm sure the women felt much better afterward, slept better, smiled more," said Maines. Besides, she added, hysteria, as it was traditionally defined, was an incurable, chronic disease. "The patient had to go to the doctor regularly," Maines said. "She didn't die. She was a cash cow."

    Nowadays, it is hard to fathom doctors giving their patients what Maines calls regular "vulvalar" massage, either manually or electromechanically. But the 1899 edition of the Merck Manual, a reference guide for physicians, lists massage as a treatment for hysteria (as well as sulfuric acid for nymphomania). And in a 1903 commentary on treatments for hysterical patients, Samuel Howard Monell wrote that "pelvic massage (in gynecology) has its brilliant advocates and they report wonderful results."

    Small wonder that by the turn of the 20th century, about 20 years after Joseph Mortimer Granville patented the first electromechanical vibrator, there were at least two dozen models available to the medical profession. There were musical vibrators, counterweighted vibrators, vibratory forks, undulating wire coils called vibratiles, vibrators that hung from the ceiling, vibrators attached to tables, floor models on rollers and portable devices that fit in the palm of the hand.

    They were powered by electric current, battery, foot pedal, water turbine, gas engine or air pressure, and they shimmied at speeds ranging from 1,000 to 7,000 pulses per minute. They were priced to move, ranging from a low of $15 to what Maines calls the "Cadillac of vibrators," the Chattanooga, which cost $200 plus freight charges in 1904 and which, in its aggressive multi-cantilevered design, is more evocative of the Tower of London than the Pink Pussycat boutique.

    A text from 1883 called "Health For Women" recommended the new vibrators for treating pelvic hyperemia, or congestion of the genitalia. Vibrators were also marketed directly to women, as home appliances. In fact, the vibrator was only the fifth household device to be electrified, after the sewing machine, fan, tea kettle and toaster, and preceding by about a decade the vacuum cleaner and electric iron -- perhaps, Maines suggests, "reflecting consumer priorities."

    Advertised in such respectable periodicals as Needlecraft, Woman's Home Companion, Modern Priscilla and the Sears, Roebuck catalog, vibrators were pitched as "aids that every woman appreciates."

    Maines, head of Maines and Associates, a firm that offers cataloging and research services to museums and archives, first stumbled on her piquant subject while researching a paper on the history of needlework. Thumbing through a 1906 needlepoint magazine, she found, to her astonishment, an advertisement for a vibrator. When she realized there was no scholarly history of the vibrator and related "technologies of orgasm," she decided to research the topic, consulting libraries around this country and abroad.

    Her investigations led her to conclude that doctors became the keepers of the female orgasm for several related reasons. To begin with, women have been presumed since Hippocrates' day, if not earlier, to suffer from some sort of "womb furie" -- the word "hysteria," after all, derives from uterus. The result was thought to be a spectacular assortment of symptoms, including lassitude, irritability, depression, confusion, palpitations of the heart, headaches, forgetfulness, insomnia, muscle spasms, stomach upsets, writing cramps, ticklishness and weepiness.

    Who better to treat the wayward female than a physician, and where better to address his ministrations than toward the general area of her rebellious female parts?

    Maines also proposes that women historically have suffered from a lack of sexual satisfaction -- that they needed somebody's help to have the orgasms they were not having in the bedroom. By the tenets of what she calls the "androcentric" model of sex, women were supposed to be satisfied by the motions of heterosexual intercourse -- the missionary position and its close proxies.

    Yet as many studies have shown, at least two-thirds of women fail to reach orgasm through coitus alone, Maines said. At the same time, religious edicts against masturbation discouraged women from self-exploration. "In effect," she writes, "doctors inherited the task of producing orgasm in women because it was a job nobody else wanted."

    The vibrator remained a staple of the doctor's office and the proper wife's boudoir until the 1920s, Maines said, when it began showing up in stag films and quickly lost its patina of gentility.

    Vibrators are still widely available, of course -- unless you happen to live in Alabama, Georgia and Texas, where state legislatures have banned the sale of vibrators and other "sex toys."

    The American Civil Liberties Union is now vigorously challenging the Alabama statute. If Alabama permits the prescribing of the anti-impotence drug Viagra, the ACLU argues, how dare it tell women that they can't have their own electromechanical prescription for joy?
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    Last edit by Roland on Apr 6, '04
  4. by   MultipurposeRN
    I too have been surprised by the judgemental and negative attitudes expressed here about things sexual in nature. It's certainly not something I feel appropriate for nurses to do for a patient..but I don't condemn anyone for questioning if it should be done, nor would I think poorly of a patient who had sexual needs, even if they were obnoxious about stating them. Sometimes there's underlying issues with that, too. How compassionate we are with a patient who is injured or has medical long as they don't ever want to have sex! Then, it seems there's an attitude of, "yuck, I'm not dealing with that, they won't die without it". Well, they might not 'die' without companionship, sunlight, fresh air, reading, etc. either. But that doesn't mean they might not be miserable without it. Think of never being wanted sexually or even touched affectionately by someone again. Think of how alone some of these injured ltc patients must feel in that respect. For many of them, a SO or spouse isn't an option. There's no easy answer...but I am surprised that most of the posts weren't more objective about this.
  5. by   LolaRN
    Uh, we have been asked to do this at the hospital where I work by the patient's family members. They do this for the patient and want us to. They got a resounding NO to that request.
  6. by   Roland
    I find it especially ironic that many of the people who are offended at the concept of dependent, patients desiring sexual relief, have absolutely no problem with abortion and wouldn't even consider making judgements about a person's motivations to have that procedure. It is true that they are seperate issues, but both involve moral issues at least in the minds of many. It is also true that abortion is legal and prostitution is not (at least in most of the United States, but consider that there are places where abortion is illegal, and other places where prostitution is legal, although I can think of no examples of where they coincide). The point is that the law, and morality are not necessarily one and the same (although they often are). I think virtually EVERYONE will concede that providing sexual relief IS NOT the proper function of Dr's and Nurses. However, whether or not those with disabilities should have access to some other modality of sexual expression (prostitutes or professional sex therapists) is an entirely different moral/ethical question. Many say that these people should seek such relief from family and friends, but what of the patients who do not have this as an option (but could afford to pay someone). We have Allied health professionals for virtually every other body function why not sex? Perhaps this could be an emerging subspecialty if not medical then at least professional in nature. Did anyone hear in the news tonight about a new, large study, that demonstrates that men who have sex more frequently have a REDUCED risk of prostate cancer? We may one day see a time when those with such disabilities that prevent them from having sex (or engaging in self stimulation) actually threaten litigation for this right on the grounds that not allowing or facilitating such expression has negative, definable medical ramifications. Keep in mind that until recently in America is was considered "unseemly" for older, normal people to engage in sexual activity.
  7. by   Marie_LPN, RN
    Quote from Roland
    I find it especially ironic that many of the people who are offended at the concept of dependent, patients desiring sexual relief, have absolutely no problem with abortion and wouldn't even consider making judgements about a person's motivations to have that procedure. .

    There's already enough abortion threads. Let's leave that subject out of this one and not bring the two together again?

    Two different SUBJECTS = possibillity of two different opinions.

    Just because you think one way about one subject doesn't mean that you should think in a related way of another subject. It's called well-rounded thinking.
  8. by   Roland
    Okay, but all I'm saying is that if your going to be nonjudgemental about one thing (that many find morally objectionable) then you should also be the same about another. If having a nonjudgemental attitude is the point, then the specific subject shouldn't matter. Again, I am not talking about nurses or doctors providing these services almost EVERYONE agrees that is not appropriate. Rather, we are addressing whether or not people who cannot provide self-stimulation, and who do NOT have significant others to provide such an experience SHOULD be able to procure that service like any other (from professionals willing to provide that service for a fee). Here are two possible scenarios that could overcome the "prostitution" objection:

    1. Create a volunteer organization that would provide manual stimulation to qualifying disabled individuals (the specific guidelines would need to be rather specifically, and exhaustively defined, and codified). In the same way that many volunteer to build homes, serve in Haiti, work in homeless shelters, and do other things it is likely that some would be willing to volunteer for this service.

    2. Apply research into direct, NEURAL stimulation designed to elicit physiological orgasm. There is a good deal of evidence to indicate that this can be done technologically, and this would overcome many if not most objections.

    I always try to propose concrete solutions rather than just engage in idle debate.
  9. by   Marie_LPN, RN
    Judgemental would be saying something like "any nurse that would do that is a S**t"

    Saying it's wrong is NOT judgemental. Pt. "relief" IS against the law.
  10. by   Roland
    LPN2BE2000, I'm not sure that it is clear that all forms of "patient relief" are in fact against the law. Cetainly, my two solutions might stand up to legal scruitiny. In addition, the law (as all of those who support homosexual marriage can attest) is subject to CHANGE when people are convinced that it is no longer sufficient to meet the needs of society or no longer coincides with the values of the majority. Generally, only the school known as "legal positivists" believe that the law and morals are one and the same. According to the Positivist school human rights exist solely because of laws and that there is no such thing as natural rights. Other "schools of thought" on the subject including those who subscribe to the "Legal Realism" school believe that the law is just one of many institutions in society and that it is shaped by social forces and needs. According to this perspective as presented in West's Business Law "the law is a human enterprise, and judges should take social and economic reality into consideration when deciding cases." Even the Natural Law, and Historical Schools of thought don't believe that the law as it exists in society is a force unto itself.

    Keep in mind that no one here is arguing (including the original poster) that Nurses or Dr's should perform these services, only that they should be made available via some modality.
  11. by   talaxandra
    Like most of us, I've had my fair share of sleazy and otherwise inappropriate patients, relatives and staff, who use inappropriate comments, innuendo and touch. The patient who spent most of this weekend masturbating springs (sorry! can anyone come up with a better word choice?) immediately to mind. I think this is a somewhat different case, and I don't think anyone has advocated that nurses become sex workers.
    I read the Carol Gino book just before or just as I was beginning my nursing training, and that story has stayed with me ever since (that and the one about the little girl who was burned in a Christmas tree fire).
    What I took from it was that real-life situations are often more complex than hypothetical cases, and that what looks black and white can be grey, and this is something I still find to be true.
    I haven't been in that precise situation, but I have been asked by a young patient who was unable to meet his own needs (and was alert, oriented and apologetic) if I had any suggestions. I am greatful that he trusted me enough that he had the courage to ask, and that I was experienced enough of a nurse that I didn't let my own discomfort affect the patient. I contacted social work, who arranged for a sex worker to visit him; I don't know what I would have done if I wasn't living somewhere with legalised prostitution. I'm fairly sure I wouldn't have participated, but I've done things in the past I never thought I'd do (nothing sexual or otherwise inappropriate, I hasten to add, but I once did mouth-to-mouth in a hospital arrest, for example), so I'm reluctant to state anything categorically.
    I can absolutely appreciate that this is something the vast majority of us feel uncomfortable, even outraged, about - not just because of personal and religious beliefs, but also the tradition and popular perception linking nurses and sex work.
    I can also understand how concern about registration, and the realities of other real-world issues, mean that discussion here is less permissive than on another, hypothetical board - it's easy to be laissez-faire when you know the situation isn't something you'll ever come across.
    One thing: caroladybelle drew an analogy with smokers, nervous gun owners, users of illicit drugs and peopel who behave abusively. Our first duty is the provision of a safe environment, so no, they can't light up anywhere, keep a gun, use unregulated substances that will interact with the licit medication, or assault anyone. However, if they have cigarettes we can provide them with a safe smoking area and, for patients where leaving the ward isn't safe, consider nicotine patches and access to a cease-smoking program. Well, provide access to the program to any smoker who's interested.
    Finally, providing a safe place should be something that extends to all of us - there are many situations that come up which we can be unprepared for, that definitely aren't covered in our education, and asking advice of colleagues with more or different experience than mine is something I value highly. It would be a shame to encourage isolationism by attacking people who seek second opinions. This isn't a dig at anyone, just an observation.
  12. by   momincabool
    I can not believe anyone would actually consider this as an option! I would definitely not be able to do this. It is definetly not premitted where I live and I would think that would be considered sexual abuse of some sort. It is appalling to think that anyone would do this to someone or for someone to me the person that would needs to seek some kind of help.

    Quote from DavidFR
    How do you deal with the paralysed patient with frequent erections? Have you ever been asked to assist? I've never faced this but have seen a heated discussion on another forum. Is it humane to bring the patient to ejaculation to relieve his frustration? Is it actually having sex with the patient? Is it permitted where you are? Could you do it?
  13. by   Roland
    Talaxandra, I would be interested in knowing what the implications for society have been in Australia with the use of sex workers and the disabled? Has this always been legal or was it made so at some point? Have any formal studies been conducted that evaluate the effectiveness of such programs on patient quality of life or other health related outcomes? Are there formal protocols in place that facilitate the disabled being able to obtain access to sex workers, and who pays for this service (for instance does the public health plan provide such services under certain, specific circumstances). Also, not having read Carol Gino's book what is her thesis on this subject? Thanks for the perspective.