The injured body is still a sexual body. But for pain patients, sex often goes unaddressed by their physicians. Shari Steiner, long-time Kaiser Nurse and self-designated sex coach, has taken it upon herself to fill this need. And it gets her in trouble.
Shari fell into sex coaching as a transplant nurse. Through her “jobby-job” as Shari calls it, she discusses the logistics and safety of sex with her patients, and assesses them to insure they aren’t at risk for infection.
“The anti-rejection drugs undermine the immune system, so sexy time is a big topic,” Shari tells me. But another concern around the execution of sex arises right after surgery, when the body must be treated differently. There is a new normal to grapple with and patients are left with the question of, now, how do I do it?
THE QUESTION OF SEX IS ALWAYS THERE, BUT THERE ISN’T USUALLY A CHANCE TO ASK IT OUT LOUD.
The most common scenario is someone who has undergone open-heart surgery. The question of sex is always there, but there isn’t usually a chance to ask it out loud. For three months following surgery, the patient is not supposed to use their arms: no pushing, no pulling, and no lifting.
“You really have to give yourself a hug for three months to make sure you don’t pop that open,” Shari emphasized, telling me she once asked a patient to practice getting in and out of bed without using his arms. “There’s a look… I asked what he was thinking about, and he was like, ‘Oh it’s nothing.’ And I said, ‘You’re thinking about sex.’ And he was like, ‘Well yeah, but my mom is sitting right there!’” Shari ushered his mother out of the room, so he felt freer to voice his question: how do you have sex if you can’t put any weight on your arms? By talking to him about how he normally has sex, Shari offered him other positions like woman on top with the caveat that his partners not press on his chest. He started brainstorming his own solutions and tested positions like lying on his side, but without, (as Shari instructed), holding onto anything like a bed frame. I asked Shari how he’s doing now. “He met a girl, and they’re having good sexy times.”
“It’s there. The question is always there,” Shari says. “There just aren’t enough nurses out there who feel comfortable with it. Even my boss, when I first started this job, wasn’t happy with me, ‘That’s not your role,’ she said, ‘that’s the social worker’s job.’”
So Shari went to ask the social worker, a “woman who was nearing retirement”, if it was her role to speak to patients about sex, and was she comfortable with that? Would she have the talk with them? “F— no,” the social worker replied, and so Shari began conducting these conversations “under the table.”
As she began to take on this role, Shari taught herself different tactics to approach the subject, including humor. She suggested to one older couple that the wife would have to get on top. “She looked at me like—what, that’s never happened before! And I said, ‘There’s no time like the present! Try something out that’s new and fun!’” If they could laugh about it, they were able to hear her.
One young woman was angry at the prospect of not being able to have sex with her boyfriend, who had broken his leg. There was panic and frustration in the air. Whatever information Shari gave them wasn’t going to stick in their heightened state, and the only way they’d retain anything was if they came up with a solution on their own. “I made them get in the stretcher and figure out what worked.” Shari gathered a bunch of pillows, helped them find the most comfortable position for the patient, and then found how the girlfriend would fit.
A patient with Asperger’s started asking Shari questions about sex during an intake. “It’s not like I was prying. I was just asking the usual: are you doing the drugs, are you smoking cigarettes, are you having sex? He really opened up to me and wanted to call me and have me help him ask girls out on dates.” The patient seemed to believe that the first person he has sex with would become his wife, so he didn’t understand why Shari was so insistent about condoms. “I looked at his mom and said, ‘Did you marry the first man you had sex with?’ And I knew in that moment, here’s where I get written up.” The patient’s mother responded honestly that no, his father was not her first sex partner; the patient was shocked. “[His mom] had this look: holy shit my son is talking about sex. I think with that population it’s hard because you’ve been dealing with this child and all of a sudden they’re masturbating.” Perhaps, Shari’s boss suggested, Shari was the first person to speak to this patient like an adult. Shari’s hope is that this interaction spawned further, open discussion at home, but she wasn’t sure if the mother would let the patient call about talking to girls. “It’s not my job. But he’s my patient.”
I asked how she sets boundaries. “I don’t. I get in trouble.” She calls parents prior to meeting with a pediatric patient to tell them that sex may come up in the conversation. The parents often say that they’ve already covered it and to talk about what she wants. “And then I get in the room, and that hasn’t happened. And then I get complaints.”
To qualify for a transplant, questions about healthy sexual practices inevitably come up. “I had one guy, years ago, and he had so many kids! I can’t even remember how many. Usually you get one or two family members to show up at an education session. But every single one of them filled this room. And not one of them had the same mom. Not one.” She asked their dad if he was in a relationship currently, and he said, “I’m in a lot of relationships!” Giggles rippled across the room—the kids knew their dad well. Shari explained that when you receive a transplant, you’re put on anti-rejection meds, which “put your immune system in the toilet.” Unsafe sex would put him at a much greater risk for infection. She gave him the basic rundown: eat fully cooked food, avoid unvaccinated children, and don’t get an STD. “He was like, ‘You’re telling me I gotta wear a condom?!’ And I said, ‘I’m telling you, you gotta wear a condom!’ He struggled with that. He died before his transplant. Not necessarily because of that, but he had never worn one. Even his kids were like, ‘You’re asking the world of our dad.’”
There are strides being taken toward making the topic of sex more prevalent and acceptable in the medical world through training courses like Sex Coach U, which Shari is currently taking, though these programs are not accredited. One aspect of the course is a “Sexual Attitude Reassessment and Restructuring”—a weekend-long conference. “It was horrible. And it was awesome,” Shari says. “Three days of nothing but sexy time [dialogue], which was a little overwhelming for me.” The weekend is structured around types of sexuality, including homosexuality, transgender sex, senior citizen sex, and S&M. “You watch porn because you can’t teach about sex unless you watch sex. That’s why these programs aren’t accredited.”
Participants are instructed to track their reactions to each type of sexuality: what turns them on, what repels them, and everything in between. Representatives from each population speak at the conference and participants ask questions. “After you watch [porn] you have to ask, ‘How did this make you feel,’ and I hate that touchy feely stuff,” Shari says. But she appreciated how it forced each individual to acknowledge personal biases. “And if you do have a bias, you don’t work with that population.”
Most of her classmates will go on to start their own practice. But Shari wants to stay at Kaiser. “I want all the physicians to know who I am, and I want them to refer their patients to me.” She says this line of questioning is becoming more acceptable among the younger generation of doctors, but that she gets a lot of raised eyebrows. There aren’t many practitioners like Shari in facilities like her medical center. “I know there’s a need out there, but I don’t know where I fit yet.”
Shari has seen the need for people like her, and the repercussions of this lack of resources, in her own family’s experience. Her mother has fibromyalgia. “I ask my mom if she talks with her doctors about sex, and she says, ‘Heavens no!’ And I wonder what would happen if Doctor Kevin said, ‘How is this affecting your sex life?’ I know she would talk his ear off. But doctors only have a fifteen-minute window. That’s not a conversation any doctor in their right mind is going to start because they’re not going to be able to finish it. That’s just the way of the medical world and insurance right now.”
I DON’T THINK SEX COACHING IS ABOUT SEX. I THINK IT’S ABOUT LISTENING TO PEOPLE’S WANTS AND HELPING THEM FIGURE IT OUT. ESPECIALLY WITH CHRONIC PAINERS—THERE’S A WHOLE WEB GOING INTO THAT WITH ONLY ONE TINY PIECE OF IT BEING SEX. ALL OF IT HAS TO BE KIND OF CHIPPED AWAY AT.
Her mother’s health also speaks to a larger issue that Shari is moved by: the importance of story and that practitioners in the field take the time to listen to their patients. “When fibromyalgia first came on the market it was a catchall [and doctors said] here, take all the oxycodone. So my mom has been taking oxycodone since she was thirty years old.” Shari says that her mother never had a physician look into her history or ask about her adolescent trauma, which was extreme. When she was diagnosed, only the physical pain was addressed, not the emotional, “solely based on the fact that she’s sixty-nine and it just wasn’t part of the medical culture.” She has asked her mother if she and her father have sex. They don’t, and Shari believes that getting off oxycodone could be the first step toward healing that aspect of their relationship.
But there’s no instant gratification when it comes to sex coaching. Patients have to define their goals with language and tools they can gain with a coach’s help. “I don’t think sex coaching is about sex. I think it’s about listening to people’s wants and helping them figure it out. Especially with chronic painers—there’s a whole web going into that with only one tiny piece of it being sex. All of it has to be kind of chipped away at. It’s hard.” And the spouse or partner, “who has been with a crazy pain person for the last however-many years,” is equally a patient or client in this scenario.
What’s most important and will make all the difference, according to Shari, is listening to people. Shari’s goal is to work inside the medical center and have the time to talk and listen to patients where that approach is less common.
Shari’s work with sexuality has led her toward the theme of love and connection. She is starting her own matchmaking service called “Friends with Shari.” I can’t help but draw the connection between her job as a heart transplant matchmaker and this metaphorical heart matchmaking. Love stories help her navigate the medical world. “You can always calm a person down by asking them about their love story. If you’re ever in a room where the world is just falling apart around you, put your eye on somebody and ask them how they met. And you’ll just watch their breathing slow, and the problems of the world wash away.” This tactic has aided her older patients who have lost their spark. “You just have to take them back to the beginning,” she says. Shari is less into new fangled toys and novel sex positions than she is into learning her patients’ stories and starting from wherever they are. “I think people just need to find the love again, and they’ll get there.”