“If we can show that we are helping adolescents to understand themselves, their feelings and their needs, then we are doing [a] valuable job”: counselling young people on sexual health in the Brook Advisory Centre (1965–1985)

First opened in 1964 in London, the Brook Advisory Centres (BAC) were the first centres to provide contraceptive advice and sexual counselling to unmarried people in postwar Britain. Drawing on archival materials, medical articles published by BAC members and oral history interviews with former counsellors, this paper looks at tensions present in sexual health counselling work between progressive views on young people’s sexuality and moral conservatism. In so doing, this paper makes two inter-related arguments. First, I argue that BAC doctors, counsellors and social workers simultaneously tried to adopt a non-judgmental listening approach to young people’s sexual needs and encouraged a model of heteronormative sexual behaviours that was class-based and racialised. Second, I argue that emotional labour was central in BAC staff’s attempt to navigate and smooth these tensions. This emotional labour and the tensions within it is best illustrated by BAC’s pyschosexual counselling services, which on the one hand tried to encourage youth sexual pleasure and on the other taught distinctive gendered sexual roles that contributed to pathologising teenage sexual behaviours and desire.In all, I contend that, in resorting to an emotionally orientated counselling, BAC members reconfigured for the young the new form of sexual subjectivity that had been in the making since the interwar years, that is, the fact that individuals regarded themselves as sexual beings and expressed feelings and anxieties about sex. BAC’s counselling work was as much a rupture with the interwar contraceptive counselling tradition—since it operated in a new climate, stressed a non-judgmental listening approach and catered for the young—as it was a continuity of some of the values of the earlier movement.

One Thing at a Time… Timeliness of Rehabilitation for Sexual Problems in Men With Prostate Cancer

ObjectiveThe randomised clinical trial ProCaRe (Prostate Cancer Rehabilitation) aimed to test the effect of sexual pre-habilitation in prostate cancer patients treated with radiotherapy concomitant with androgen deprivation therapy.We planned recruitment of 92 participants. The complex intervention designed with previously treated patients and partners included sexual counselling, penile rehabilitation and supervised exercise in groups. The primary outcome was sexual functioning measured by the International Index of Erectile Function Score (IIEF-5). The secondary outcomes included a reduction in irritative urinary problems and improvement in quality of life.ResultsWe identified eight eligible patients among nine screened between January 22th and June 1st, 2018. Among these patients, three accepted study enrollment but one withdrew because of a lack of energy. The study was closed because of slow recruitment, i.e. a low number of eligible patients and low participation rate (38%) according to the timeframe and intervention planned. The study had a strong design but was not sufficiently pilot-tested because the study site had too few eligible patients. Furthermore, at this early time of the disease trajectory, sexual rehabilitation was not perceived relevant to the patients or prioritised. Future studies should be co-designed with patients more representative for the target group.

Acceptance of the disease and sexual functions of patients with heart failure

Background: Sexual activity is an important element of quality of life for many individuals suffering from heart failure. Aims: The study investigated the influence of disease acceptance on sexual function in a population of male patients with chronic heart failure. Methods: The study included 80 patients with chronic heart failure (mean age 63.3±9.2 years) who filled in the Mell–Krat Scale questionnaire to evaluate sexual needs and reactions. We also used the International Index of Erection Function (IIEF-5) inventory and the Acceptance of Illness Scale (AIS). Results: The study showed that the acceptance of the illness was positively associated with all of the Mell–Krat components such as sexual need, F = (3.27), frequency of intercourse, F = (2.46), position and technique, F = (1.88). Also, according to the IIEF-5 questionnaire, 84.42% of respondents had erectile dysfunction. Taken together these indicated that psychological adjustments such as acceptance of disease increase quality of all aspects of sexual functions in heart failure patients, including their erectile functions. Conclusions: Our findings suggest that psychological adjustments to feelings of loss associated with the onset of heart failure disease is the important determinant of quality of sexual life among male adults. Our research implicates that effects of AIS on sexual functioning give reasonable information to tailor sexual counselling for males suffering from heart failure.

Discussing Sexual Health in the Medical Oncologist’s Practice: Exploring Current Practice and Challenges

Sexuality is a significant quality-of-life concern for many cancer patients. Patients may be disadvantaged if they are not informed and not offered sexual health care. We sought to reveal oncologists’ current practice and opinions concerning sexual counselling. The aim of this study was to explore the knowledge, attitude and practice patterns of Dutch medical oncologists regarding treatment-related sexual dysfunction. Questionnaires were sent to 433 members of the Dutch Society of Medical Oncology. The majority (81.5%) of the 120 responding medical oncologists (response rate 30.6%) stated they discussed sexual function with fewer than half of their patients. At the same time, 75.8% of the participating oncologists agreed that addressing sexual function is their responsibility. Sexual function was discussed more often with younger patients and patients with a curative treatment intent. Barriers for avoiding discussing sexual function were lack of time (56.1%), training (49.5%) and advanced age of the patient (50.4%). More than half (64.6%) stated they had little knowledge about the subject and the majority (72.9%) wanted to acquire additional training in sexual function counselling. Medical oncologists accept that sexual function counselling falls within their profession, yet they admit to not counselling patients routinely concerning sexual function. Only in a minority of cases do medical oncologists inform their patients about sexual side effects of treatment. Whether they counsel patients is related to how they view patient’s prognosis, patient’s age, and self-reported knowledge. Findings indicate there is a role for developing education and practical training.

‘You Can’t Dismiss that as Being Less Happy, You See it is Different’. Sexual Counselling in 1950s England

This article uses the audio recordings of sexual counselling sessions carried out by Dr Joan Malleson, a birth control activist and committed family planning doctor in the early 1950s, which are held at the Wellcome Library in London as a case study to explore the ways Malleson and the patients mobilised emotions for respectively managing sexual problems and expressing what they understood as constituting a ‘good sexuality’ in postwar Britain. The article contains two interrelated arguments. First, it argues that Malleson used a psychological framework to inform her clinical work. She resorted to an emotion-based therapy that linked sexual difficulties with unconscious, repressed feelings rooted in past events. In so doing, Malleson actively helped to produce a new form of sexual subjectivity where individuals were encouraged to express their feelings and emotions, breaking with the traditional culture of emotional control and restraint that characterized British society up until the fifties. Second, I argue that not only Malleson but also her patients relied on emotions. The performance of mainly negative emotions reveals what they perceived as the ‘normal’ and sexual ‘ideal’. Sexual therapy sessions reflected the seemingly changing nature of the self towards a more emotionally aware and open one that adopted both the language of emotions and that of popular psychology to articulate his or her sexual difficulties.