Is it right to sexually assist a paralysed patient? - page 11

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   talaxandra
    Hi Roland. The Carol Gino story is summarised by neneRN (post #54 in this thread - beautiful job, BTW); she was a nurse, and the book is a fictional autobiography of a nurse, synthesised from her own experiences and those of friends/colleagues.
    Prostitution is still illegal in some of Australia (as far as I know), but was legalised in Victoria in the early 1980's in response to the first AIDS cases here. The government, in an unprecedentedly (is that a word?) enlightened move, sought advice from prostitutes, who came up with this as part of an overall plan to minimise transmission of the virus, and the Victorian Prostitutes' Collective is now a standard participant in any State policy-making on the topic.
    Part of the legalisation was strict regulation of the industry - street prostitution is still illegal, and there are regulations about OH&S issues, pay and conditions etc.
    Unfortunately I don't know anything about the details of provision of sex services - I only knew it was an option because the mother of an acquired brain injury patient (who hung himself in a juvenile detention centre) demanded we provide it for him. I was a student then, and not involved in any of the finer details, and in this case I hand-balled it to SW. However, I'll start a thread on the Aussie/NZ nurses board and see if anyone else knows. If there aren't any bites, there are a couple of people associated with the PCV at uni who might know more about it.
    I'll keep you posted,
  2. by   DavidFR
    I don't believe anywhere on this thread said that they wouldn't be willing to counsel a patients about his/her sexual frustrations, or refuse to discuss it with them. You specifically asked in your OP if a nurse would help, or "do" it for a patient. BIG difference. .[/QUOTE]

    Re-read the posts. Many have said they can't believe this is up for discussion, it has made them laugh, they thought it was a joke, they would simply tell the patient it's not their job. Many have made it clear that they simply ignore issues they are not comfortable with.

    I'm sorry, WHO'S being immature? I think that statement alone completely discredits you..[/QUOTE]

    Your post was also edited. The mods on this forum are very vigilant, over vigilant in my view. I make no judgement about your edited post as I didn't see what was cut out, but evidently you have sixth sense.

    Well, in the majority of the USA any paid sex worker is illegal, so that's just not an option. Like others have said, no one has died from lack of orgasm or sexual release. Yes, I feel for them. Yes, I would discuss their feelings with them. I'd get SS and possibly their family involved with the pts consent. Anything more than that is not "humane" as you like to call it, it's inappropriate and would likely result in an immediate termination or suspension of one's nursing liscence, if reported. And as for your last comment.....most prostitutes aren't doing it for their own sexual desires, either. That's irrelevant...[/QUOTE]

    So we address the issue of sex work and legalize prostitution.
    Nobody died from lying three hours in a wet bed, but I prefer to clean up the incontinent patient as soon as possible. Your argument is facile.


    For crying out loud, PLEASE don't start with that "free speech" whine! People laughed because it was so ridiculous to even consider doing that for a patient.[/QUOTE]

    And this is sad. I never even came down one way or the other in my initial post, yet people choose to laugh because I posed the question? This is a fundamental difference between this forum and other (European or Asian dominated) forums that I go on. Eleswhere if somebody doesn't like a question that's been posed or disagrees with a point of view, they'll argue vehemently, often heatedly (with less censorship than this forum) but to laugh and call somebody's question ridiculous is very impolite. I would suggest if people laugh it's becuase they are uncomfortable with this topic, have never been faced with issue and don't wish to think of the sexual needs of the disabled/handicapped/paralysed. I have never faced this issue personally, and in my current job am unlikely to, but having read about it elsewhere I was prepared to consider the issues. It saddens me that nurses wish to simply dismiss the issue or "laugh" as opposed to engaging in inetlligent disussion. Whatever your viewpoint, discussing these things helps formulate the best poicies in patients' interests. Simply laughing at the issue discredits the patients' problem.
  3. by   Marie_LPN, RN
    "Providing" for what the pt. needs is this: A door with a lock, a DND sign. The REST is for the PT. or family to take care of. If i were in such a situation as the pt., now way would i even CONSIDER it even the nurse's BUSINESS, let alone concern, of whether i 'get some'.

    And (assuming by then that i am a nurse) if the laws would change to where it's legal for the nurse to 'relieve' her pt. and/or it was part of my job description, you'd see this nurse hanging her hat on the rusty wall nail and getting the heck out of Dodge. I didn't go to school for THAT kind of pt. care.

    (and hear a week later "Welcome to Mal-Wart, would you like a shopping cart today?......")
  4. by   Roland
    LPN2BE, how would "locking the door" help the patient that doesn't have use of their hands (or even have hands). Why do we worry about other issues of ADL such as grooming, range of motion ect? Using your logic we should perhaps relegate these issues to the patient and family. Also, you don't seem to be responding to the notion that almost NO ONE (including the original poster) is advocating these things being done by nurses or doctors. You haven't explained why this shouldn't be considered as an option when done by "professionals". Also, you haven't addressed why my proposals of using "technology" or "volunteers" shouldn't be considered. Don't take offense at something that hasn't been advocated (that is to say nurses providing this "service").

    Thanks for the info talaxandra. Also whatever happened to the notion that there wasn't such a thing as a "stupid" question anyway? Personally, I have deep respect for the fact that you dared express such a controversial question. The concept of free speech is not designed to protect "easy and uncontroversial" thoughts, but those which cause controversy. Of course this doesn't entitle someone to "yell fire in a crowded theatre" or engage in obscenity in the name of discussion. However, at no time have you been anything, but respectful, intellectual, and professional in the presentation of your ideas.
    Last edit by Roland on Apr 7, '04
  5. by   caroladybelle
    Quote from Roland
    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).

    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.
    It still does not lead to the idea that everyone that wants sex is "entitled" to have sex with a partner.

    So, is everyone to be entitled to sex, for a healthy life. It leads to a slippery slope. Who are we to say that other conditions might not lead to our insurance/funding for medicare money may not lead to sexual gratification of someone who is just too unpleasant to have a partner, and qualifies as "disabled? It is not where I want my money to go.

    Frequent sex for men may have have a reduced risk of prostate cancer. Perhaps, but it has increased: sexually transmitted diseases, including AIDs, and Pregnancy (wanted and unwanted). Several recent surveys have also documented a sharp rise in Syphilis infection and have seen a correlation with use of Viagra. So, when do we ban viagra or at least stop insurance payment for it?

    What happens when "sex therapist" gets or causes unwanted pregnancy, HIV, Disease? Or the"patient" develops an unreciprocated affection on the "therapist? I have a feeling that the liability that a facility would face for any of those issues, is much higher than getting sued on the basis of "poor prostate health" practices or lawsuits over parenthood.

    Another issue is the patients with money to pay for the services and are "pleasant" to deal with will either usually have a partner to assist or easily acquire a "pro" and there are "pros" out there fairly easily available for that service. The internet, the newspaper, or NYC's channel 35 for example.

    Those that are not "pleasant" patients and will be most in need of it, well, who will want to provide that service.

    When I cared for quads/paras in the South (country) virtually all had families, friends, spouses. The majority had become injured hunting (falls from deer stands), swimming/diving, car accidents, or spousal abuse.

    When I cared for quads/paras in the Northern innercities, EVERY SINGLE quad/para that I met (and I had lots of quads/paras as patients, about 20 - 30 times the amount as in rural areas) was injured by gunshot wounds, generally related to drug dealing, gang warfare, or other illegal activities. EVERY ONE!! Many had served time in jail for violent crime and/or been "compassionately" released from serving time/being the State would not have to foot the bill for care. The majority had serious infections, or were cross infected with HepB/HepC/HepD. There was also a lot of incidences of "poor impulse control" or control issues that involved being abusive to staff. And they were the ones that lacked a support network.

    How many people are going to want to have "contact" with the later group?

    How will you address infection control and unwanted pregnancy?

    Are you going to bias the gender of the "provider" of services to the desires of the patient? After all, if it is merely just sex or "release", then the gender of the provider should not matter in the least? It would provide the same "health benefits" for the prostate.
  6. by   Roland
    First of all as health professionals we don't make judgements about who is deserving of beneficial interventions based upon the CAUSE of their condition. The man who gets AIDS from multiple sexual partners is JUST as entitled to the best available treatment, as the little girl who gets HIV from her infected mother (the exception would be organ transplants, but even this is an issue of medical viability and NOT who deserves it more). In addition, we are by definition talking about people NOT capable of self stimulation (no use of hands ect.). Furthermore, we are talking about manual, external, stimulation for the most part rather than intercourse (maybe in Austrialia we are talking about intercourse, I'm not quite certain). Also, the disease STATUS (HIV/Hep B,C and otherwise) would obviously be information relevent to both the sexual "professional" and the patient and would be integrated into any such decision made. As a CNA/student BSN nurse, I have to get "knee deep" into the excrement, urine, and body fluids of several HIV patients at the LTC facility where I work for ten dollars an hour!

    As for who would want to take this sort of risk to "help" people, the life of Mother Theresa comes to mind. I watched a video of her life's work at the hospice where my mother died (I think it was called Into the Arms of Love by Ann Ryder). I was STRUCK by how her mission emphasized hands on care for the dying (many of whom had diseases like Tuberculosis, and Aids). Furthermore, there were several, volunteers from AMERICA one of whom had just got out of the armed forces. Now I am someone who is by my own admission going into nursing, primarily for the money, and the opportunity that income may afford to my family. However, I have OFTEN dreamed of going to India or elsewhere to participate in her MISSION if only for a few months. That is because I remember Christs admonishion of "that which you do for the least of your fellow man, you do for ME", and also his advice to "care not for your physical body which will rot away, but for your eternal soul" (and I am a borderline AGNOSTIC who believes in Jesus for what he stood for rather than NECESSARILY who he was). The point is that if a money, grubbing, Rush Limbaugh listening, Donald Trump respecting, CAPITALIST PIG like myself will seriously consider moving to India to live amongst and serve the poor, then I have no doubt but that OTHERS far more spiritually enlightened than I would be willing to help people in these sorts of situations.
    Last edit by Roland on Apr 7, '04
  7. by   caroladybelle

    I am not talking about "entitlement" for services.

    I am talk about how are you going to get a supply of "providers".

    You can prattle on about how everyone is equally entitled to sex all you want.

    But finding someone to spend time in school/training to work with a population with those issues, and maintain some degree of ethical behavior (drug testing, licensing, health checkups, legal requirements of a "health care provider") and will want to work with such patients.

    As a nurse that works with alot of HIV+, it is hard enough to get nurses to work with those patients. It is difficult to get MDs to work with those patients. It is nearly impossible to find Nursing Homes that will take those patients. Their own parents will not visit them, because their behavioral issues are so bad.

    How many therapists that fulfill health care requirements will want to have sex - of any type - with them, when their own families will not touch them with a ten foot pole?

    (And many do obtain prostitutes for services, but would any of those be able to pass a drug/alcohol screen or licensable - highly doubtful)

    You can talk entitlement all you want, but unless there is a "supply" that fulfills the requirements, well you're out of luck.

    PS Would you encourage your SO to perform these activities....with these a profession?
  8. by   caroladybelle
    And would YOU be willing to make it your livelyhood to provide these services ...for both part of encouraging good health....on a professional or volunteer basis?
  9. by   critcarenurse16
    My stomach hurts from laughing so hard-- I think I wet myself too...LOL. I'd also like to know where this has been 'hotly' bebated--besides here of course. Of course this is completely inappropriate. Any sexual contact with a patient is way out of context of nursing professionalism and should be grounds for termination. Think of this as well; patients in the hospital setting are acutely ill and are on medication that can affect orientation, LOC, decision making ability and so on. Therefore sexual contact with a patient may be seen as assult. Let someone else take care of his sexual needs at HOME. I for one don't want my ICU or ED contaminated.
  10. by   Marie_LPN, RN
    For the record, a couple of other boards that i visit every so often, this is an issue that has been debated, so it's not just this one.
  11. by   Palpitations
    I'll tell you what. I was told that paraplegic patients are unable to "feel" anything below the area of the injury to the spine. Therefore, if he is disabled from chest down, he cannot "feel" the erection and he therefore would not "feel" the orgasm, nor would he know if he were in pain. There in lies the problem.

    I once had a patient that had a prosthesis. All of the aides were telling the RN's about this man. Me and another nurse becamed concerned because we were wondering if this man was in pain or at risk of losing his penis from a prolonged injection. We called a urology floor and asked them what to do. Man, these nurses had no clue and talked to us as if we were sadistic freaks instead of concerned nurses. We ended up calling the doctor that put it in. He said that there was a valve in place in his scrotal sac that would release the air in the prothesis. You would have to pinch it to get it to release the air. Well me and this other RN goes in there and tries to pinch this valve. It had to be a trick to it because we couldn't get it to release, and we were afraid of doing more damage than good. We called the doctor again, he said not to worry, that he would come in the morning to release the valve, that the patient would not be in any danger.

    So that being said, we need to look up priapism in a paraplegic patient and how to treat it, and you should notify his physician. I sure would document that the patient had a sustained erection and that the physician was notified.

  12. by   Palpitations

    Priapism related to administration of
    intracorporeal vaso-active drugs can cause retention of urine and occasionally
    dysreflexia. Aspiration of blood from the corpora together with injection of vaso-
    constrictors such as phenyl ephedrine would be of value.

    I will look up some other sites to see what they would advise.

  13. by   renerian
    David I agree it would be a horrible thing to have to deal with or think about if you had to face it. Maybe since I have had a patient approach me on this I have a viewpoint established.

    Not everyone is laughing. I guess if someone posts any topic I always prepare myself for all sorts of viewpoints.