Health - Psychosexual Adjustment Flashcards
By the end of the session students should be able to:
§ Identify dimensions of sexuality
§ Understand common misconceptions and barriers to communication
about sexuality in a medical setting
§ Outline models for undertaking psychosexual assessment
§ Discuss key principles of sexual intervention / rehabilitation
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Sexuality incorporates a multitude of dimensions:
- personality
- values
- body image
- communication
- gender
Sexual Health is the state of physical, ______, mental and ______ well-being relating to sexuality. It is NOT the absence of _______ and dysfunction
Sexual dysfunction is the various ways in which an individual is ______ to _______ in a sexual relationship to the extent they would wish.
This is a REAL problem and whilst things might return to normal after a while…sexual function sometimes does not…and lingers for a long time…
emotional social disease unable participate
Impact of illness and/or treatment of sexuality can occur at different stages of the sexual response cycle.
Name these phases and some examples
Desire
- altered masculinity and femininity
- body image
- depression
- fatigue
- nausea
- hormone imbalance
Arousal
- erectile dysfunction
- dyspareunia (painful intercourse)
- nerve injury
- anxiety/depression
- hormone imbalance
Orgasm
- ejaculation disorders
- altered orgasmic sensations
- delayed orgasm
Resolution
- post-coital bleeding or pain
- reduced enjoyment
Despite the very real problem of changes in sexual functioning, only _____ of women said doctors discussed post-treatment sexual changes with them (self-report data), another study (observed consults) found that it was discussed ____% of the time.
Further, most doctors think that sexual activity is important to discuss after a heart attack, yet only ____% actually do it. ____% of doctors don’t feel comfortable discussing it. Other barriers include ____, confidence, and lack of _______ in regular care.
half
25
24
50
time
protocols
What is the conspiracy of silence?
- clinicians wait for patients to voice their concerns
- patients wait for doctors to bring it up
- clinicians and patients want the topic to be brought up
The greatest barriers to good sexual life are ______, ________ and _________.
Other barriers for doctors include:
- low priority
- embarrassment
- not my responsibility
- lack of knowledge/skills
- lack of resources/interventions
barriers for patients
- too old
- too sick
- too single
anxiety
misinformation
ignorance
When sex is discussed, it is important to consider it’s various domains…what are these 4 domains?
What does this mean when creating a model for sexual health?
- Physical
- Psychological
- Relationship
- Cultural
–> need for an integrated bio-psycho-social model to assess and manage sexual difficulties
PROMIS Global Satisfaction with Sex Life scale allows for a ________ assessment of overall satisfaction with sex life, _______ status, or functional abilities.
It is appropriate for use across _____ types.
It is quick and _____ to administer
In the past 30 days... 1. How satisfied? 2. How much pleasure? 3. Hoe enjoyable? Etc
subjective
relationship
cancer
easy
BETTER model
This is an acronym for a strategy for doctors to use in their consults
Bring up the issue
Explain that sexuality is part of QoL
Tell the patient that there are resources to address their concerns
Timing might not be right at the moment, but they can talk about it anytime
Educate patients on sexual side effects
Record that the conversation has taken place
The PLISSIT Model for assessment
–> most commonly used model
Permission (100%)
- sex is something you can talk about
Limited
Information (100%)
- provide information on sexual changes during treatment - resource booklets, etc
Specific
Suggestions (50%)
- provide strategies to deal with changes
eg: vaginal moisturisers, lubricants, dilators
eg: oral meds, injection therapy, vacuum erection devices, penile implants
Intensive
Therapy (10%)
- referral to a specialist if required
Breaking the cycle of silence involves
…addressing some of the barriers
eg: providing training to clinicians, and resources to offer patients
Clinicians need to bring it up so the patient knows about the issue(s) and what to expect, and specific suggestions have to be made regarding possible interventions
Whilst it is not a mandatory part of training, clinicians can becomes skilled through…
Psycho education resources - an example given…
module a part of their professional development
For example, RCT conducted of an educational booklet to improve communication about psychosexual changes in women undergoing radiotherapy for gynaecological and anorectal cancer
–> women with the booklet had greater knowledge of the side effects and higher adherence of the use of a dilator (important for sexual functioning and for future doctor examinations)
Principles for intervention:
§ Introduce routine clinical assessment for sexual morbidity (_____ up the conversation)
§ Include _______ (if possible/desired)
§ Intervene _____ (when medically safe)
§ Consider _________ (the techniques that are recommended - do them before!)
§ Encourage sex despite low ______ (plan specific times and stick to them, the desire will come)
§ Establish sexual rehabilitation _______ and ______ network
§Promote renegotiation / _______ of sexual practices (satisfaction is possible)
§ Foster _______ expectations: extent of & timeline for recovery (it takes a while!)
§ Prepare patients to manage _______ (important to start with the most effective, least invasive treatment)
§ Normalise _______ process (fertility, erection, etc)
§ take into account _______ and individual differences
open partners early prehabilitation libido pathways referral flexibility realistic failures grieving cultural
Sex is just another form of…
All individuals have the right to…
All health professionals can support patients/couples…
Post-treatment sexual function and satisfaction…
Intimacy is…
sexual rehabilitation is an…
…communication
…experience good sexual health (according to their needs and preferences)
…in their psychsexual recovery…
…can be improved, but it might take a long time…
…always possible
…essential component of health care
