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What does a caregiver do?

Make a diagnosis
An important first step is making the diagnosis. The caregiver will discuss the situation with you in order to identify what the problem is. That discussion can give you more insight into your own situation and can often help you on your way towards finding a solution. In many cases it will be unnecessary, but the caregiver might propose that you undergo a physical examination or blood tests. If the caregiver gives you a physical examination, you can assume that he or she will give you control over the situation and will respect your boundaries. To be able to make a proper diagnosis, the caregiver could also ask you to fill in a questionnaire. And he or she might ask you to examine your body yourself at home. That self-examination can also help make you feel more familiar with your body.

 

Investigate possible connections with other conditions
If sexual problems are somehow related to a physical or psychological condition, the caregiver will look at what the cause is and what the consequences are. Especially if you have been having your problems for some time already, that distinction is not always entirely clear. Then he or she will determine which of the symptoms to treat first or whether various treatments can be given at the same time.

Provide information
Once the diagnosis has been made, it is often essential that you receive relevant information. With many sexual problems, psychological aspects play a role. If you know what your problem is, you may be able to break through certain patterns.

Recommend medications
The caregiver can advise you to use medications that you can buy without a prescription, such as creams and lube in the case of vaginal pain. In other cases, the caregiver will give you a prescription, for example for erection pills, or for tablets or an ointment to prevent premature ejaculation (when a man comes too quickly).

Give homework assignments
The treatment will often also consist of ‘homework’ assignments. You can find information in Dutch about a number of different exercises on www.seksueledisfuncties.nl.

Decrease your anxiety: ‘ban on fucking’
Anxiety often plays a role in sexual problems. That can include a fear of pain or a fear of passing your HIV on to others. That anxiety can cause you to avoid having sex. Often that will only heighten your anxiety, since the avoidance will prevent you from experiencing that you can also leave your fears behind. If that is the case for you, you may well receive advice aimed at decreasing your anxiety, for example by means of a ‘ban on fucking’. If you promise yourself that you will look for physical intimacy but without fucking, you can experience what will happen to you if you expose yourself step by step to the thing you are afraid of. In that way, you can lower your anxiety by adjusting your behaviour.

Insurance cover
The exact coverage scheme can change each year, but often your health insurance will cover the cost of the treatment by a psychologist or sexologist. It is a good idea to ask the sexologist and/or your health insurance company about this in advance.

  • Whether or not the care will be covered can depend on the professional qualifications and registration of the psychologist or sexologist.
  • Your health insurance company might only cover the cost of care given by those psychologists or sexologists with whom it already has a contract.
  • Your health insurance might be limited to a certain maximum number of sessions or a maximum amount.
  • You might need to pay part of the cost of each session yourself (i.e. make a co-payment).
  • If the care is not covered by the compulsory basic insurance, it might be covered by a supplemental insurance policy. Do you have such supplemental insurance?

How would you rate your sex life?
I’m often the one who brings up the topic of sexuality, but sometimes a patient will bring it up him or herself. I think it’s my job to figure out how a patient has arranged his or her sex life and whether he or she needs any support in that regard. I often ask my patients how they rate their sex life. Over the years, it has become easier and easier for me to talk about sexuality. If you are doing a check-up for sexually transmitted infections, you will need to know what to test. Has the person had anal contact, for example? I notice fairly often that a patient may have difficulty talking about sexuality in the beginning, but then also once they start, they get used to talking about it fairly quickly. In some cases I will notice that a patient is uncomfortable with it. I really pay attention to that because you don’t want the other person to think: ‘I’m never going back to that nurse.’ In a few cases I will refer someone to a sexologist who can discuss the problem in more depth and who can apply a number of different techniques. A sexologist will invite people to play and to try out new things. It can make you inhibited if you are constantly being distracted by your thoughts while you are having sex. Among other things, that can lead to less pleasure or to problems getting and/or maintaining an erection. A sexologist is good at challenging people and encouraging them: try this or that in that particular situation.
Loek Elsenburg, HIV nurse

 

 

 

 

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