Treating Sexual Complaints in a Community Acupuncture Clinic

In a discussion with POCA Tech students about boundaries in the clinic, a student brought up the issue of treating sexual complaints, particularly erectile dysfunction. The student had heard that a number of female-identified community acupuncturists simply wouldn’t treat that particular complaint because they’d had so many bad experiences with male-identified patients who’d used it as a pretext for sexual harassment of their practitioner. The student wanted to know, isn’t this also an issue about access? Like, erectile dysfunction is a common problem that can cause a great deal of emotional and social distress, is it really the best solution to just not treat it in your clinic?

Hmm, I said, that’s a good question.

It is a good question, and it’s also a good example of why discussions about safety could use more nuance than they generally get.

Before I go any further I want to say that, having been an acupuncturist for almost 27 years, I have heard lots and lots of stories about practitioners (and student interns) being sexually harassed by patients, to the point that I understand completely why practitioners might set all sorts of boundaries simply to avoid repeating those experiences. When I first started writing about the community acupuncture model and started hearing back from acupuncturists who were relieved to hear that there might be another way to structure their practices, some of those relieved acupuncturists were people who never wanted to be alone in a cubicle with a partially undressed patient again, and a big part of their interest in this model was that they wouldn’t have to be. I don’t know that anyone has ever collected any data about how many acupuncturists feel that they’ve been sexually harassed by patients at work, but I’d bet it’s a bigger problem than we think.

So for anybody who has decided that erectile dysfunction is something they simply won’t treat, I’m absolutely not arguing with you. I do want to unpack the question more, particularly for students who are just starting their careers. This seems like an example of why imagining safety as a deck of cards could be helpful. If you’ve chosen cards from the suits of “self care” and “boundaries”, that’s a valid choice and if you don’t want to hear any more about it, I wholeheartedly support your choice to stop reading right here. I’d like to use this post to take a look at the other suits in the deck, particularly “communication” — but you certainly don’t have to.

I’ve treated quite a few male-identified patients for erectile dysfunction, and I’ve also treated quite a few patients of different genders for low libido (another common sexual complaint). None of these patients sexually harassed me and some of them got good results, which helped their emotional and social well-being. And so my take on treating sexual complaints is that it’s a risk; it’s one that happened to turn out well for me and my patients so I’m glad I took it. For POCA Tech students, I’d like to cultivate a a neutral, analytical, non judgmental, safety-positive relationship to this particular risk (as well as to risk in general). Which means that everyone has to assess their own risk tolerance, and also it’s useful to talk about ways to manage the risk.

So let’s get into communication. (This topic is in a sense a subset of the safety/risk continuum of talking to patients.)

A book that I think provides tremendously useful background information for treating the kind of sexual complaints you tend to see in a community acupuncture clinic is Come As You Are, Revised & Updated: The Surprising New Science That Will Transform Your Sex Life, by
Emily Nagoski. It’s both very scientific and very accessible, and it’s potentially a book to recommend to patients. However, what’s REALLY interesting, is that after writing the first version of Come As You Are, Emily Nagoski went on to write another book with her sister Amy called Burnout: the Secret to Unlocking the Stress Cycle. I think this is also a very useful book for community acupuncturists about the science of stress, but the reason I’m bringing it up here is to note that a human sexuality educator like Nagoski decided that what the world really needed was a whole book about the physiology of stress -- because the topic of stress comes up so often, in such key ways, in the context of human sexuality.

And that happens to be one way to manage the risk of treating patients for sexual complaints.

If I saw on a new patient’s health history that their chief complaint was erectile dysfunction or low libido, I usually did their intake without ever uttering those words. I would say something like, “So, yes, acupuncture can be effective for this” -- tapping the line on the form where they’d written it -- “and in our experience, the place to start in terms of treatment is by addressing your stress in a global way. Because stress is potentially such a big component, what we like to do is to address your stress first and see how you respond, before we try anything else. Okay?” Most people would say immediately, “Yeah, that makes sense”. (New parents with low libido — a not uncommon demographic in my clinic — would audibly sigh with relief.) I would still go ahead and ask the usual questions of, how long have you been dealing with this, on a scale of 1-10 how much is it bothering you -- but I think because I had set the expectation that we could address a sexual complaint without using any sexual words, the conversation felt easy and neutral.

In follow up conversations, we’d either talk about stress -- any complaint that brings people to a community acupuncture clinic almost always leads to talking about stress -- or my patients would say something like, “So, the problem I came in for? I think it’s getting better” and I’d say something like, “That’s good to hear, I’m so glad” in the exact same way I’d say it if they’d told me their arthritis was responding to acupuncture. I remember one young male-identified patient who managed to tell me tactfully that he wouldn’t be coming in for treatment anymore because everything was great and he and his girlfriend were very happy.

Once the patient and I figured out how to communicate, treating sexual complaints in the clinic was pretty much like treating every other kind of complaint. It didn’t get weird.

On the opposite end of the spectrum, if I had a patient who wanted to have conversations including specific details that I didn’t want to have, I felt fine about saying something like, “So in terms of treating you in this clinic, mostly I need to check in with you in a very general way about how you’re doing. I’m not a urologist -- I’m just your acupuncturist -- and so I’m not qualified to have detailed discussions about um, anatomy. If you did want to have those kinds of discussions, I’d need to refer you out. So I’d like to focus on reducing your stress overall and see how you respond, okay?”

A patient who insists on talking about their anatomy after that is either unable to follow social cues in general or a sexual harasser, and they can’t be safely treated in a community acupuncture clinic. Similarly for patients who can't keep their clothes on, which is not a problem I ever had in relationship to treating sexual complaints but I know that it occurs, unfortunately. A community acupuncture clinic functions like a collaboration between the patients and the acupuncturist. Everybody has to help make a safe-enough environment for treatment to happen.

I think that treating sexual complaints in a community acupuncture clinic requires an active, intentional approach to creating social safety. There’s no one right way to do that, and doing it doesn’t mean you’ll be able to treat everyone. I do believe it’s worth trying, though. Let’s be safety-positive!