24 Psychosexual Adjustment

Question 1

Why do we care about the sex lives of ill people?

Answer 1

• 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

Question 2

What is sexual health?

Answer 2

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

Question 3

How do we define sexuality

Answer 3

Sexual activity, loving relationships and intimacy, physical appearance

• Gender, socialisation, body image, physical expression, personality, communication, values etc
• Sexual health
• Sexual dysfunction

Question 4

What is sexual dysfunction?

Answer 4

are the “various ways in which an individual is unable to participate in a sexual relationship… he/she would wish”

Question 5

What are the four main phases of the sexual response cycle?

Answer 5

Desire/Excitement
Arousal
Orgasm
Resolution

Question 6

What are the misconceptions of sexuality after cancer regarding relationships?

Answer 6

• 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

Question 7

What are the misconceptions of sexuality after cancer regarding coping mechanisms?

Answer 7

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

Question 8

What are some of the factors to psychosexual assessment?

Answer 8

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

Question 9

What are the communication factors to psychosexual assessment?

Answer 9

Communication about sexual activity and intimacy after a heart attack

(Lack of) communication about sexual issues

Question 10

Explain what patients and clinicians want in terms of communication about sexual issues

Answer 10

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

Question 11

Why is there a lack of communication about sexual issues?

Answer 11

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

Question 12

What are some system/clinician barriers to discussing sexual issues in a consultation?

Answer 12

• Embarrassment
• Low Priority
• Not appropriate
• Lack of knowledge/skills
• Lack of resources
• Perception of patients

Question 13

What are some perceptions of patients that create a barrier to discussing sexual issues in a consultation?

Answer 13

Too old, too ill, too single, everyone is heterosexual, it just happens

Question 14

When sex is discussed by health professionals what needs to be talked about?

Answer 14

• 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

Question 15

What is in need when sex is discussed by health professionals?

Answer 15

A need for an integrated bio-psycho-social model to assess and manage sexual difficulties

Question 16

What are the limitations to sexual assessment tools?

Answer 16

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

Question 17

What is needed for low scores in the limitations for sexual assessment tools?

Answer 17

A need to move the measure of sexual wellbeing beyond physical function and sexual function

Question 18

What is the PROMIS Global Satisfaction with Sex Life Scale?

Answer 18

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

Question 19

What are the important questions to ask in the PROMIS scale?

Answer 19

1. How satisfied have you been with your sex life?

2. How satisfied have you been with your sexual relationship with a partner

Question 20

Describe the PLISSIT Model for sexual functioning assessment

Answer 20

Most commonly used model for discussing sexual issues in a medical setting

Permission
Limited Information
Specific Suggesstions
Intensive Therapy

Question 21

Explain what is meant by the P in the PLISSIT model?

Answer 21

Permission: to raise the topic of sexuality so that patients feel that they have permission to discuss it (100%)

Question 22

Explain what is meant by the LI in the PLISSIT Model?

Answer 22

Limited Information: provide information on common sexual changes common to their treatments; correct understandings/myths; provide resources (100%)

Question 23

Explain what is meant by the SS in the PLISSIT Model?

Answer 23

Specific Suggestions: taking into account sexual history and relationship status; provide specific strategies for dealing with problems (50%)

Question 24

Explain what is meant by the IT in the PLISSIT Model?

Answer 24

Intensive Therapy: refer patients who have premorbid sexual concerns/mental health problems/complex sexual issues to a specialist (10%)