Abstract

Although most clinicians believe that discussing sexuality is important clinically, most clinicians do not initiate these discussions. Further, for therapists working with transgender, nonbinary, and gender expansive (TNBGE) clients, discussing sexuality may feel challenging when therapists fear inadvertently stigmatizing or mischaracterizing their clients and their concerns. We propose a sexual wellbeing framework as an adjunctive to traditional feminist therapy, in which discussions about sexuality is comfortable and appropriate to the goals of therapy. We review existing evidence that suggests sexual wellbeing of TNBGE clients may be enhanced by (a) attending to the client’s larger sociocultural context in which sexual wellbeing emerges, (b) understanding that sexual wellbeing is multiply determined, the contributing factors to sexual wellbeing are unique for each person, and sexual wellbeing changes over time and across situations, (c) challenging assumptions that genitals, hormones, and sexual functioning are the most important aspects of sexual wellbeing, (d) emphasizing sexual comfort and pleasure by enhancing immersive attention and facilitating gender affirming sexual experiences, and (e) conceptualizing consent as a means to ensure safe and pleasurable experiences. We conclude by offering clinical scenarios that present practical considerations when applying the sexual wellbeing framework to illustrate the ways in which conversations with TNBGE clients about sexuality can enhance sexual wellbeing.

摘要

尽管大多数临床医生认为讨论性在临床上很重要，但大多数临床医生不会发起这些讨论。此外，对于与跨性别、非二元性别和性别扩张（TNBGE）客户一起工作的治疗师来说，当治疗师担心无意中侮辱或错误描述他们的客户及其担忧时，讨论性行为可能会感到具有挑战性。我们提出了一个性健康框架作为传统女权主义治疗的辅助手段，其中关于性的讨论是舒适且适合治疗目标的。我们回顾了现有证据，表明 TNBGE 客户的性健康可以通过以下方式得到增强：(a) 关注客户出现性健康的更大社会文化背景，(b) 了解性健康是由多种因素决定的，性健康的影响因素对每个人来说都是独特的，性健康会随着时间和情况的不同而变化，(c) 挑战生殖器、激素和性功能是性健康最重要方面的假设，(d) 强调性舒适通过增强沉浸式注意力和促进性别肯定性体验来获得愉悦感，以及 (e) 将同意概念化为确保安全和愉悦体验的一种手段。最后，我们提供了在应用性健康框架时提出实际考虑因素的临床场景，以说明与 TNBGE 客户有关性的对话可以增强性健康的方式。和性功能是性福祉最重要的方面，(d) 通过增强沉浸式注意力和促进性别肯定性体验来强调性舒适和愉悦，以及 (e) 将同意概念化为确保安全和愉快体验的一种手段。最后，我们提供了在应用性健康框架时提出实际考虑因素的临床场景，以说明与 TNBGE 客户有关性的对话可以增强性健康的方式。和性功能是性福祉最重要的方面，(d) 通过增强沉浸式注意力和促进性别肯定性体验来强调性舒适和愉悦，以及 (e) 将同意概念化为确保安全和愉快体验的一种手段。最后，我们提供了在应用性健康框架时提出实际考虑因素的临床场景，以说明与 TNBGE 客户有关性的对话可以增强性健康的方式。