A British medical journal published research confirming that sexual issues likely signal other health risks. According to The Lancet, healthcare providers who ignore reports of sexual dysfunction may be missing early indicators for heart failure, depression and other serious ailments. While this groundbreaking connection represents how many factors impact health, it poses a potential ethical dilemma for massage therapists.

The Lancet

In the research paper, doctors are encouraged to discuss sex with their patients. Dr. Rosemary Basson, the study’s lead author, states, “Sex is a legitimate part of medicine, but it has largely been kept separate from the rest of medicine.” As a result of Basson’s research, physicians are being increasingly advised to take initiative in asking details about patients’ sex lives, including questions about interest, who they have sex with, how frequently, and if they engage in potentially risky behavior. Although not involved in the study, Dr. Jonathan Zenilman, chief of the infectious diseases division at Johns Hopkins Bayview Medical Center says, “People aren’t going to volunteer that kind of information unless they’re specifically asked.” Because people typically fail to realize that sexual dysfunctions can be a symptom of something more serious, they tend to keep this kind of potentially embarrassing information to themselves.

Early identification of sexual issues can alert physicians to further investigate their patients’ health. Those with erectile dysfunction, the most common sexual disorder in older men, are at an increased risk of heart disease.

  • In a study of 132 men who had heart surgery, nearly half had a history of erectile dysfunction.
  • The diagnosis of erectile dysfunction preceded heart surgery in nearly 60 percent of the men.

However, picking up on sex clues can be more difficult in women.

  • A woman’s lack of sexual desire reveals an underlying depression in up to 26 percent of cases.
  •  When considered together with other symptoms, sexual abnormalities in women could point to hormone imbalances, kidney failure, diabetes or other chronic diseases.

Clinicians aware of the connection between sexual issues and systemic health problems are at an advantage of diagnosing a potentially risky illness early enough to stop its progression.

The Danger

While the connection between sexual dysfunction and disease may not be a surprise, it does pose an ethical dilemma for bodyworkers hoping to provide the most effective care. Disclosure about sexual dysfunction raises two red flags for bodyworkers:

  1. Scope of Practice
  2. Sexual Misconduct

Scope of Practice

The clinical application of massage therapy often approaches the limitations of a bodyworker’s scope of practice. Accompanied by the significant amount of research demonstrating massage’s capability in reversing a variety of health ailments, bodyworkers are becoming more respected members of the healthcare community. As massage therapists’ credibility rises, people are turning to them for guidance and advice for a majority of their healthcare needs. Adhering to the following valuable steps and skills will assist in handling those items that are within a massage therapist’s scope of practice:

  • A thorough intake and assessment
  • Awareness of the conditions and medications contraindicated with massage
  • The ability to communicate with Western medical doctors
  • Having a working knowledge of pathology

While these components of a massage therapist’s repertoire enhance therapeutic outcome and assure safety, there is a clear distinction between enhancing one’s knowledge and making a medical diagnosis. Massage therapists who are voluntarily offered information about a client’s sexual issues can make informed decisions or referrals if aware of related signs of illness. However, it is beyond a massage therapist’s scope of practice to make any medical conclusions based on anything other than a doctor’s diagnosis.

Sexual Misconduct

As professionals working in the most intimate setting imaginable with clients, maintaining sexual boundaries is mandatory. A nude client receiving massage in an enclosed, softly lit room is likely to be alarmed if the massage therapist asks about their sexual health. The possibility of a client construing a therapist’s intentions as inappropriate are extremely high even if questioning about sex is done in a clinical intake room, with the client fully dressed. Between client and bodywork practitioner, the subject of sex can easily elicit feelings of extreme vulnerability, transference, counter-transference and inferiority. Physicians and psychiatric practitioners are specifically instructed on how to approach sexual topics, and if misinterpretation by a patient does occur, they carry extensive malpractice insurance.

According to the code of ethics set forth by the National Certification Board for Therapeutic Massage and Bodywork, massage therapists shall “Refrain, under all circumstances, from initiating or engaging in any sexual conduct, sexual activities, or sexualizing behavior involving a client, even if the client attempts to sexualize the relationship.” This description is merely a framework, and requires some interpretation. Depending on the situation, initiating a discussion about sex could be interpreted as an attempt by the practitioner to sexualize the therapeutic relationship.

Even though seeking information from a client about their sexual health could help a bodyworker create a more effective treatment plan and help initiate a referral to a physician to check for a certain health condition, it is inappropriate. Regardless of how careful a massage therapist is in evading diagnosing and making it clear they are not sexualizing the relationship, talking about sex is too big a risk to take. Unless you are also a physician or psychologist, mixing sex talk – no matter how well intentioned – with the restrictions and intimacy of massage is best avoided. If you do suspect a client needs to discuss their sexual health or could use a medical evaluation, rely on the power of a referral network. Doing so could save your client from missing out on a medical diagnosis, and it could save you from a lawsuit.

Recommended Study:
Ethics: Therapeutic Relationships
Advanced Anatomy and Pathology
Pharmacology for Massage