How to use the PLISSIT model to care for the sexual health needs of arthritic patients

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Panush, Mihailescu, Gornisiewicz and Sutaria adapted the PLISSIT model (permission, limited information, specific strategies and intensive therapy) for use with arthritis patients.¹ This method includes the following:

• Permission consists of questioning the patient about his/her sexual dysfunction, taking the liberty and showing openness to dialogue. The doctor must show the patient that his/her sexual problems can be mitigated. Furthermore, it is essential that the doctor encourages the dialogue with the patient’s partner, due to his/her need to be aware of the difficulties of the couple.

• The second step is to search and provide information about sexual dysfunction. At this stage, one should establish the cause of the problem – lack of libido, pain, fatigue, vaginal dryness, anxiety, fear of not having a good performance or not satisfying the partner are possible causes.

• The third phase is to develop specific strategies for each problem. Low sexual desire can be circumvented by replacing medications, psychotherapy and stress reduction. Transdermal testosterone may be used in women with low levels of this hormone or in those undergoing surgical menopause. As to vaginal dryness, lubricating oils or intravaginal estrogen creams may be used. With regard to pain and fatigue, the practice of different sexual positions, resting before intercourse and the use of muscle relaxants or painkillers are recommended. The use of supports in the joints helps in maintaining the sexual positions; on the other hand, heat in the form of compresses reduces joint stiffness. It is recommended, though, to take a warm bath before intercourse, to achieve muscular relaxation.²

For more information on helping patients with arthritis: Addressing the sexual health needs of patients with arthritis  

References:

• Panush, S.R., Mihailescu, G.D., Gornisiewicz, M.T., Sutaria, H.S. (2000). Sex and arthritis. Bulletin of Rheumatic Disease, 49, p. 1-6

• De Almeida, P.H., Castro Ferreira, C., Kurizky, P.S., Muniz, L.F., & Da Mota, L.M. (2015). How the rheumatologist can guide the patient with rheumatoid arthritis on sexual function. Revista Brasileira De Reumatologia (English Edition),55(5), p. 458-463.