Together Integrating Sexology

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Together Integrating Sexology

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Dr Anita Taylor andDebbie Davies-SouthPorterbro
ok Clinic andRoyal Hallamshire
Hospital,Sheffield
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(No Transcript)
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Integration in Sex Therapy

• Historical conference due to integration of
  multiple aspects of sex therapy
• There is a paradigm shift occurring
• Integrative treatments in sexual therapies need a
  sound theoretical base from which to work from
• Thought through formulations are very helpful in
  patient management

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Integrated medical and psychological treatments

• Female genital pain is common and may take years
  to diagnose. It should not be dismissed as all
  in the mind
• Gynaecologists must be attuned to psychological
  issues
• Need for medical gynaecologists who dont
  operate but diagnose and treat

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Integration

• Multiple aspects of functioning need to be taken
  into account and a multidimensional viewpoint
  adopted
• Study of the doctor / patient relationship and
  the psychosomatic genital examination are a
  useful psychodynamic way of working with
  psychodynamic problems

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Male Sexuality

• Must diagnose and treat priapism quickly.
• Low flow (ischaemic/veno-occlusive) priapism
  needs urgent intervention.
• Regular sex is good for cardiac function and
  longevity.

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Male sexuality

• SIS/SES scale is a validated instrument to
  measure sexual inhibition and sexual excitation
  proneness
• SES is a good predictor of arousal proneness
• SIS represents inhibition
• The balance between SIS and SES is crucial

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Male sexuality and Sexual medicine

• The importance of combining the effects of a
  variety of treatment possibilities to meet the
  needs of individual men presenting with erectile
  dysfunction
• Need to raise awareness of the incidence of
  sexual dysfunction and help educate sufferers and
  their partners

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Orgasm and Ejaculation

• Dont use term premature ejaculation rather
  early orgasm
• Pleasuring the partner first reduces performance
  anxiety in the male
• The purpose of psychotherapy should not be to
  delay ejaculation but to help the patient cope
  with early orgasm

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Pharmacology

• When assessing erectogenic drugs we must take a
  more holistic approach not focussing only on
  erectile function but also desire, ejaculation,
  mood and relationship

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Couple Therapies

• Child development research to extend
  understanding of interactions between family
  members is significant when considering the
  interaction between care-seekers and therapists
• Attunement is a mental, emotional and physical
  process
• Sexual functioning and emotional/bodily
  attunement are linked

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Female Sexuality

• Gonadal steroids exert extensive effects on the
  Central Nervous System to modulate sexual
  behaviour and emotions
• Also exerts effects on the genito-urinary tract
• Disturbances in the amount of gonadal steroid
  production, both in relative or absolute terms
  may result in morbidities such as pre-menstrual
  syndrome or the menopause

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Female sexuality

• Women are complex therefore it is better to
  consider sexual disorders or dissatisfaction
  rather than sexual dysfunction
• Lack of desire is common for many couples
• Many medications can affect sexual responses in
  females

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Female sexuality

• The mind and body are connected in sexual
  medicine
• Various forms of sensory stimuli can lead to
  orgasm
• Orgasm is a total body experience
• Orgasm can eliminate pain eg arthritic in some
  women

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Female Sexuality

• There are numerous reasons for a woman to engage
  in sexual activity with her partner, many of
  which are not desire per se
• Physiological data contradicts this
• Multidimensional view of arousal/desire and
  dyspareunia needs to be adopted

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Desire/arousal/desire

• Spontaneous/initial desire subjective arousal
  responsive desire and responsive arousal orgasm

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Reflections of a service user

• A normal female with a pain after investigation
  becomes an abnormal female with a diagnosis
• Healing doesnt equal cure
• 1 year without sex plus another year without sex,
  does not equate to 2 years without sex but a
  breakdown of a relationship

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Further reflections

• Suffering cannot be controlled but stigma can
• Patients need empathy, compassion, listening and
  permission to speak

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Sexual dysfunction

• Organisations offering support via websites,
  helplines and press, giving confidential advice
  via telephone, e-mail and letters
• Health care professionals must accept the
  responsibility of enquiring about clients sexual
  health
• Despite the increased availability of treatments,
  most people with sexual dysfunction, still do not
  seek help

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Sexual dysfunction (cont)

• Sexual dysfunctions may not always be significant
  predictors of the distress found in men and women
• Education of the general population essential

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Sexual Health

• Sexual health is a viable concept
• Sexual health requires an understanding of
• sexualityas a construction of human culture
  and
• sexual rightsas a minimum standing to be
  achieved by any human being

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Sexual health in young people

• Self esteem is key to young peoples sexual health
  and programmes should be developed to address
  this
• Services eg. GUM, FP, Psychosexual, GPs, need to
  be sensitive to the needs of young people and to
  make positive efforts to attract them
• A holistic model of sexual health is appropriate
  to developing effective interventions

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HIV and Sexual Health

• Self worth essential for optimal sexual health
• Services must be attractive to users
• Providers need to be sensitive to the needs of
  users
• Effective interventions should use a holistic
  model of sexual health
• Development of local guidelines needed for
  clarification regarding disclosure

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Sexual health in Mental health

• Sex therapists have to care for each other and
  for themselves basis of sexual health
• Depression is one of the reasons for sexual
  dysfunction

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Sexual health in General practice

• More realistic training is required to
  effectively manage sexual health problems in
  non-heterosexual patients
• There are barriers in discussing sexual health
  with patients
• Limited time resources
• Erectile dysfunction and matters of the heart
• Opening a can of worms

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Cancer and Sexuality

• Patients suffering from cancer have the right to
  have sex
• Effects of treatment on their sex lives should be
  discussed so they can make informed choices
• The use of HRT soon after surgery helps reduce
  side effects, esp. after radiotherapy and
  preserves sexual function
• Cosmetic refashioning post surgery is essential
  for sufferers sexual wellbeing

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Fertility

• Sexual health can be damaged by sub-fertility
  and its management
• What is a normal semen and sex-life?
• Doctors and politicians concentrate on the
  acute and the cure at the expense of the
  chronic and healing

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Fertility (cont)

• The legal and ethical considerations of frozen
  or donated sperm use in the cases of-
• Teenage cancer victims
• Assisted conception after the donors death and,
• Donor selection by lesbian couples

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Cultural Aspects

• A culturally successful sexual health programme,
  relies on complex planning and implementation, by
  a team including outside experts and cultural
  insiders
• Important to be aware of historical and cultural
  factors
• Main focus should be on gender, social and
  educational inequities

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Cultural aspects (continued)

• Educational freedom, separation of church and
  state are important.
• There is a need to emphasise human rights in
  sexual health
• Understanding gender issues in diverse cultures
  is a challenge

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Therapist/Client relationship

• We as therapists need to remove our fig leaves
  before expecting our clients to reveal and look
  at themselves

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Age and Sex

• Sexual expression changes with age.
• Older people need education to find ways of
  managing their continued sexual urges and partner
  responses.
• Carers must be aware of problems facing the
  elderly especially in nursing homes e.g.lack of
  privacy, lack of staff training and family
  disapproval.

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Sexology Training

• Wide range of training but overall paucity and
  lack of uniformity
• Attempt underway to introduce a European
  certificate and Accreditation in Sexual Medicine
• Limited regional certification available in
  psychotherapy and sexology

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Visual Aids

• Visual messages are sometimes more effective than
  verbal ones
• Films can help reduce prejudice about minority
  groups

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Tool Box

• Using market place contacts to source best toys
  or playthings is a simple and practical
  solution for health professionals treating sexual
  problems
• Increased knowledge of products available is an
  important aspect of treatment

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Electronic Education

• Website available offering free on-line sex
  education for all
• Already used by 2,000,000 a month
• Huge potential in benefiting trainers and
  training organisations

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Cybersex

• Cybersex is seen as a betrayal equal to actual
  sex or infidelity
• Cybersex impacts on relationships
• Cybersex allows boundaries within the usual
  relationship to be crossed on-line
• Cybersex is not in the future its already here

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Sexual Addiction

• Cybersex is changing the nature of inter-personal
  relationships
• Polygraphy (use of lie detector) can be a useful
  contribution to treatment
• The large problem of child pornography can be
  solved if we all work together to pressurise the
  industry to come up with improved technical
  solutions

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Gender Identity Disorders

• If Gender Identity Disorder presents at an early
  age allow the child to experience him/herself in
  the post-pubertal phase of their biological sex
  before intervention.
• The Gender Recognition Bill provides full legal
  recognition of the new gender for all purposes.

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Gender identity disorder (cont)

• Is real life experience, in gender dysphoria
  assessment, necessary?
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• New operative techniques being developed for
  gender reassignment surgery

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Research

• The more we know, the more we know we dont know!
• Research in many scientific fields impinge on
  sexuality and sexual health

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Ongoing research
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Together Integrating Sexology

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