The intimacy of health

Sally Lehr

by Dana Goldman

Sally Lehr dares you: just try and question the need for her course on sexuality, officially named Human Sexuality in Health and Illness.



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Emory Nursing Magazine


For the past 24 years, Lehr has taught the elective, a rarity for health professionals nationwide, at the School of Nursing. Through it, she's determined to help her students feel more comfortable raising issues around sex and sexuality with patients and their families.

That's a skill that perhaps has never been more needed. For example, many medications to treat everything from high blood pressure to depression can impact patients' sex drive or sexual function. But that's information they often find out only after months or years of frustration and anxiety. "A lot of times those side effects aren't addressed at all," says Lehr, 65N, 76MN. "They may not know that it's the medication that’s causing the problem."

If patients are too uncomfortable to talk with their doctors about changing medications, they often take another route. "They may figure out why their sex drive has changed and quit taking the medicine," Lehr says. That might help their sex life in the short term, but it comes at the long-term cost of any benefits the prescription drug was providing.

At the heart of the problem, says Lehr, is discomfort among patients and medical professionals when it comes to talking about sex. "Physicians don't get any more training in sexuality than anyone else," she says. Lehr tells of an obstetrics-gynecology resident she met at a conference three years ago who told her he'd gone through 18,000 hours of medical training—but only 45 minutes of that had been on human sexuality. "But people expect doctors to be comfortable talking about sex," says Lehr. "A lot of people expect their physicians to answer questions if they're brave enough to ask them."

To be ready to have those conversations about sex, Lehr says nurses and other medical professionals first need to feel comfortable thinking and talking about sexuality themselves. That's a journey she herself began at Emory, years after her mom handed her a medical book so she could learn about sex. "Those were the days when you didn'’t talk about it," Lehr says.

Indeed, Lehr had no intention of talking about sexuality until she began studying for her master's in nursing in 1974. In the process of being educated as an advanced practice psychiatric nurse, she became intrigued with sexuality's connection to health when she met a faculty member, Frances Nagata, who also worked as a sex therapist. "She was the first person in my life who ever talked openly about it," Lehr says. "Feeling like it was okay to talk about sexuality—having permission to do that—was just great." When Nagata started the sexuality class in the nursing school, Lehr was happy to serve as her assistant, helping others become more comfortable with the topic. When her mentor left in 1984, it was a natural fit for Lehr to take on full responsibility for the class.

Human Sexuality

Since then, the course has changed to address current issues and new information. Transgendered sexuality and homosexuality have become major topics in class discussions, along with a range of other sex-related topics that often connect to both patients and nurses: sexuality and disability, rape, and sexuality and spirituality.

While students become more comfortable talking about sexuality, they also gain empathy and information, as in when talking to a guest speaker in a wheelchair about his sex life. "I think that's really important for the students to hear," says Lehr. "Then when they see other people in wheelchairs, they know there may be some very similar concerns and issues for them."

As a result of the guest speakers and discussions, the course often makes students realize and reassess their own beliefs about sex. "“A lot of what happens in sexuality—a lot of the values we have—maybe came from something somebody said back when we were young that stays with us forever," says Lehr. "So I tell people this is a class that's not necessarily meant to change your values, but to explore your values and see if they’re values that are still meaningful for you."

Nurse midwife Jennifer Smith took the class in 2003 and now comes back each semester to teach a session on sexuality and pregnancy. For her, the course is a reminder of how open and helpful she wants to be with her patients and of how far medical professionals still have to go. "I am sometimes amazed how little women, even future nurses, know about their bodies' sexual responses," she says.

Smith doesn't wait for her pregnant patients to bring up the subject of sex. "I make a habit of discussing sexuality at the first obstetric visit, then at around 24 weeks—because women feel so much better during the second trimester and might enjoy intercourse—and then in the hospital post-partum and at the postpartum visit in the office." It's her way of ensuring that her patients can share concerns.

For nursing school senior Rob Wuthenow, his experience with the class this past spring already has been helpful. This past summer, he was working at a hospital when a middle-aged patient who had been admitted because of emphysema also showed signs of rectal bleeding. While doctors and nurses talked to one another, trying to figure out the connection between the two, Rob felt comfortable enough to approach the patient directly. "This person told me something he wouldn't have admitted without my asking directly," Rob says. "As a result we were able to identify what was going on with him."

That's a conversation Rob probably wouldn’t have been comfortable having a year ago. "Without the sexuality class, I wouldn't have the courage to speak to people about things like that," he says. "But being a nurse you have to look at sexuality because it's part of the human condition. You have to address all aspects of patient care. Sexuality does come up."

Now, Rob Wuthenow and Jennifer Smith—along with the hundreds of other Emory nursing students who have taken the class—are ready when sexuality does come up with their patients. They are ready to decode what a patient really means when he says, "I won’t be a man anymore" or "I'm not going to be any good," and are not so shocked when they see the signs of alternative lifestyles or female circumcision. They're at ease initiating a post-op conversation about when a patient can be sexually active again and straightforwardly tell patients with new medication to come back if they notice any changes in their sexual functioning.

For Lehr, those are all parts of what makes this class so special to her. "Generally I get good feedback that the course has been meaningful for people," she says. "It's really nice after the fact to hear that it's made some difference."