24 - Psychosexual Adjustment Flashcards
Why do we care about the sex lives of ill people?
Impacts quality of life
Survivorship more common
Sexuality is an important and legitimate aspect of all our lives
Media message -> sex is for the young, beautiful and healthy
What is sexual health?
is a state of physical, emotional, mental and social well-being relating to sexuality. It’s not merely the absence of disease, dysfunction or infirmity
What is sexual dysfunction?
is the “various ways in which an individual is unable to participate in a sexual relationship… he/she would wish”
What are the four main phases of the sexual response cycle?
Desire/Excitement
Arousal
Orgasm
Resolution
What are the impact of illnesses/treatment on the desire phase of the sexual response cycle?
- Altered masculinity/femininity
- Body image changes
- Anxiety
- Depression
- Fatigue
- Hormone imbalance
- Alopecia
- Nausea
- Diarrhoea
What are the impact of illnesses/treatment on the arousal phase of the sexual response cycle?
- Anxiety/depression
- Hormone imbalance
- Nerve injury
- Penile artery damage
- Peripheral neuropathy
- Erectile dysfunction
- Vaginal changes
- Dyspareunia (pain)
What are the impact of illnesses/treatment on the orgasm phase of the sexual response cycle?
- Anxiety
- Reduced semen volume
- Ejaculation disorders
- Altered orgasmic sensation
- Delayed orgasm
What are the impact of illnesses/treatment on the resolution phase of the sexual response cycle?
- Post coital bleeding
- Post coital pain
- Reduced sexual enjoyment
What key issues to do with sexuality were revealed after interviews with women during early stage gynecological cancer?
- Cost of survival (happy to live without sex, just happy alive)
- relationship impact
- being ‘sexual’ for him
- fear of resuming intercourse
- changes in perception of femininity
- coping with unknown information (“hole inside)
- partner’s response to change in sexual functioning
What do patients with gynecological cancer report about discussions about sex with their health professionals?
- Only half of the women report having a discussion with a health professional
Observed consultations; only 25% of the post-radiotherapy consultations were sexual side effects were discussed. Vaginal changes were discussed but not sexual issues.
Why is there a lack of communication about sexual issues?
Conspiracy of silence; patients want to know and don’t ask, wait, vice versa
The greatest barriers to good sexual life in cancer patients/couples are ANXIETY, MISINFORMATION and IGNORANCE
What are some system/clinician barriers to discussing sexual issues in a consultation?
- Embarrassment
- low priority
- not my role
- not appropriate
- lack of time
- lack of knowledge
What are some perceptions of patients that create a barrier to discussing sexual issues in a consultation?
Perceptions of patients
- Too old
- Too ill
- Too single
- Everyone is heterosexual
- It just happens
When sex is discussed by health professionals what needs to be talked about?
Physical domain
- Hormonal/body changes, pain, fatigue, lack of sensation
Psychological domain
- Emotions; anxiety, depression
- Cognition; body image, negative thinking
- Motivation; self-efficacy
Relationship domain
- Relationship discord, fear of intimacy, lack of communication
Cultural domain
- Religious beliefs, social norms, cultural values
A need for an INTEGRATED bio-psycho-social MODEL to assess and manage sexual difficulties
What are the wrong types of questions to ask in regards to sexuality?
Sex includes sensuality
Isn’t just coital intercourse
And sexual satisfaction is not just preserved functionality
Acknowledging but not over emphasising the gender divide
What did experiments with gynecological patients reveal about the importance of intimacy in sexual relations?
Quality vs quantity; Predictors of sexual adjustment
- Quality (rather than quantity) of sexual interaction was the best predictor of overall sexual life
- A small change in perceived quality -> a large impact an overall sexual life/function -> a predictor of quality of life
Important to assess satisfaction/’qualitative’ aspects of sexual life
- Most clinicians ask, “are you sexually active”, not “how satisfied you are”
What are the limitations to sexual assessment tools?
Most measures rely on:
- Physical/functional aspects; coital intercourse, arousal, orgasm
- Some level of recent sexual activity and having ready access to a sexual partner
Low scores may be misinterpreted and may be attributable to other factors (e.g. a poor or no relationship or partner health)
Medical treatments can impede sexual responses/physiology -> a need to move the measure of sexual wellbeing beyond physical function and sexual responses
- Subjective quality of sex life is a better outcome measure to assess overall sexual satisfaction
What is the PROMIS Global Satisfaction with Sex Life Scale?
- Allows for a subjective assessment of overall satisfaction with sex life beyond any explicit definitions of sex, relationship status or functional abilities.
- Gender and sexual preference neutral
- Appropriate for use across cancer types
What are the two sexual functioning models for strategies and assessment?
BETTER Model - Strategies
PLISSIT Model - Assessment
Describe the BETTER Model for sexual functioning strategies
Bring up the issue
Explain sexuality a part of life, and they should discuss
Tell the patient that resources will be found to address concerns
Timing may not be appropriate, they can askant anytime
Educate patients of sexual side effects
Record the discussion
Describe the PLISSIT Model for sexual functioning assessment
Most commonly used model for discussing sexual issues in medical setting
Permission; raise topic
Limited Information; provide info and correct myths, provide resources
Specific Suggestions; considering sexual history and relationship, provide strategies for problems
Intensive Therapy; refer to specialist with premorbid sexual concerns, mental health or more complex
What are some specific suggestions for female genital pain or erectile dysfunction?
Vaginal moisturisers, lubricants or dilators
Oral medications, injection therapy, vacuum erection devices
Penile implants
What did the study on the effectiveness of a psycho-educational booklet about sexual problems demonstrate?
In women undergoing radiotherapy for gynaecological and anorectal cancer.
Booklet to improve communication about psychosexual adjustment
Study booklet led to greater knowledge about radiation-induced side effects and sexual rehabilitation option/self-care strategies. and Higher Adherence with dilator use 3, 6 and 12 months follow up
What are the typical contents of psychological interventions for sexual health problems?
Focus on intimacy and physical connection, not necessarily sexual intercourse.
Use of biomedical treatments for sexual dysfunction (e.g. vaginal dilators, moisturisers/lubricants, pumps)
Communication skills training to talk to partners and providers
What are some typical barriers to uptake and retention of sex education?
Patients are unaware of available resources; lack of referral
Embarrassment (patients and/or providers)
Lack of engagement (either or both partners)
Minimal attention to partners (not included or assessed)
What are the main principles for intervention of sexual issues after illness?
- Introduce routine clinical assessment for sexual morbidity (especially in ‘high impact’ disease groups)
- Include partners
- Intervene early
- Consider ‘prehabilitation’
- Encourage sex despite low libido
- Combine rehabilitation aids
- Promote renegotiation/flexibility of sexual practices
- Foster realistic expectations: extent of and timeline for recovery
- Prepare patients to manage failures
- Normalise grieving process
- Establish sexual rehabilitation pathways/referral network
