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Gender and Sexuality: Shame and Safety in the Psychiatric Encounter 

Gender and Sexuality: Shame and Safety in the Psychiatric Encounter
Chapter:
Gender and Sexuality: Shame and Safety in the Psychiatric Encounter
Author(s):

Andrew Cruz

, Julianne Torrence

, and Christopher M. Palmer

DOI:
10.1093/med/9780190849986.003.0010
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date: 04 July 2020

The psychiatric encounter provides an opportunity to discuss sexuality and sexual behaviors with patients. Often patients are reluctant to discuss sexual matters with clinicians, as shame can often be associated with sexual behaviors and fantasies. Clinicians, therefore, need to be aware of both common and uncommon fantasies and behaviors and be willing to initiate conversations with patients in a safe and respectful manner. Sexual behaviors can be associated with some psychiatric disorders and can sometimes be a psychiatric disorder unto themselves. Therefore, a sexual history and assessment is often a required portion of a complete psychiatric evaluation. However, there is tremendous variability in what is considered normal and abnormal, posing challenges for clinicians. This chapter sets out to provide a framework for approaching some of these challenging situations.

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