24 Psychosexual Adjustment Flashcards
Why do we care about the sex lives of ill people?
- Impacts QOL (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
How do we define sexuality
Sexual activity, loving relationships and intimacy, physical appearance
- Gender, socialisation, body image, physical expression, personality, communication, values etc
- Sexual health
- Sexual dysfunction
What is sexual dysfunction?
are 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 misconceptions of sexuality after cancer regarding relationships?
- The cost of survival
- Relationship Impact
- Being sexual for him -> feeling like it is a duty
- Perception of femininity
- Partners response to changes in sexual functioning
What are the misconceptions of sexuality after cancer regarding coping mechanisms?
Coping with the unknown/information provision
- Physical alterations -> “new anatomy” don’t know how it looks like
- Not sure of partner’s opinions on the new body -> not sure how to address it, not sure if can continue like old ways or if it hurts now etc
What are some of the factors to psychosexual assessment?
Match the service to the specific needs of the patient
- A taboo subject, doctors not really addressing the side effects on sexuality, confidence loss, coping with the unknown without help
What are the communication factors to psychosexual assessment?
Communication about sexual activity and intimacy after a heart attack
(Lack of) communication about sexual issues
Explain what patients and clinicians want in terms of communication about sexual issues
Patients want to know about post-treatment sexual issues and clinicians to raise the topic
Clinicians reluctant to initiate the discussion and wait for the patient to voice their concern
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 appropriate
- Lack of knowledge/skills
- Lack of resources
- Perception of patients
What are some perceptions of patients that create a barrier to discussing sexual issues in a consultation?
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 e.g. hormonal/body changes
- Physical domain e.g. emotions: anxiety, depression. Cognition: body image, negative thinking. Motivation: self-efficacy
- Relationship domain e.g. relationship discord, fear of intimacy, lack of communication
- Cultural domain e.g. religious beliefs, social norms cultural values
What is in need when sex is discussed by health professionals?
A need for an integrated bio-psycho-social model to assess and manage sexual difficulties
What are the limitations to sexual assessment tools?
Most measures assess/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’s health)
Subjective quality of sex life is a better outcome measure to assess overall sexual satisfaction
What is needed for low scores in the limitations for sexual assessment tools?
A need to move the measure of sexual wellbeing beyond physical function and sexual function
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/functional abilities
- Gender and sexual preference neutral
- Appropriate for use across cancer types
What are the important questions to ask in the PROMIS scale?
- How satisfied have you been with your sex life?
2. How satisfied have you been with your sexual relationship with a partner
Describe the PLISSIT Model for sexual functioning assessment
Most commonly used model for discussing sexual issues in a medical setting
Permission
Limited Information
Specific Suggesstions
Intensive Therapy
Explain what is meant by the P in the PLISSIT model?
Permission: to raise the topic of sexuality so that patients feel that they have permission to discuss it (100%)
Explain what is meant by the LI in the PLISSIT Model?
Limited Information: provide information on common sexual changes common to their treatments; correct understandings/myths; provide resources (100%)
Explain what is meant by the SS in the PLISSIT Model?
Specific Suggestions: taking into account sexual history and relationship status; provide specific strategies for dealing with problems (50%)
Explain what is meant by the IT in the PLISSIT Model?
Intensive Therapy: refer patients who have premorbid sexual concerns/mental health problems/complex sexual issues to a specialist (10%)
