Sexuality and Disability Flashcards
Sexual feelings are _______; Sexual expression is a ________ behaviour.
Natural; Learned
Sex is _____ of sexuality.
Part
Sexuality is a _______ issue.
Health
Sexual health involves both ____________ and _____________.
Competence; Relationships
A person may need more than ________________ to find the best answers to sexual concerns.
His/her personal experiences or private opinions
An individual’s ability to solve sexual concerns is frequently handicapped by ________ ____________, ______, __________, and ______________ ___ _______ ____________.
Personal experiences; Biases; Prejudices; Over-reactions to sexual information
We are not responsible for having feelings, but we are responsible for _____ ___ ___ _______ ______.
What we do with them
Each person has _________ to their own beliefs.
A right
___________ is an integral part of one’s total ___________ and is expressed in _____________.
Sexuality; Personality; All that they do
What are the factors involved in one’s sexuality?
Beliefs and values Communication Personality Body image Self-image Physical expression Socialization Gender
Sexuality is mostly a ________ phenomena, and it has _________, __________, and _________ aspects.
Learned
Physical; emotional; spiritual
What are the five aspects of sexuality (Dailey, 1984)?
Sensuality (Connection and comfort with own body)
Intimacy (with partner)
Sexual identity
Reproduction
Sexualization (Use of self to influence, control, and manipulate others)
We all have _____________ bias regarding sexuality.
Reproductive
What are moral values?
Our conduct with and treatment of other people, more than just right or wrong. Looks at the whole picture.
What are sexual moral values?
Rightness and wrongness of sexual conduct and when and how sexuality should be expressed.
What are the sources of sexual moral values?
Social environment (parents, friends, media, religion, etc.)
Who are the sexually elite?
Those whose activity does not violate reproductive bias and could lead to socially sanctioned conception and pregnancy (e.g. heterosexual married couple).
Who are the sexually oppressed?
Those who are perceived as not conforming to the reproductive bias and who tend to be systematically asexualized.
Who are the sexually unusual?
Those who society views as deviant, weird, sick, or criminal (e.g. pedophiles, exhibitionists, etc.)
What is sexual health (WHO definition)?
A state of physical, emotional, mental, and social well-being related to sexuality.
What kind of attitude does sexual health require?
A positive and respectful approach to sexuality and sexual relationships, and possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination and violence.
What are the interventions from a medical vs. a sex-positive approach?
Medical: Harm reduction, prevention, protection, accident-based
Sex-positive: Quality of life, enhancement
What does it mean to be sex-positive?
Having a comprehensive definition of sexuality
Viewing sexual health as a basic human right
Being non-judgmental and challenging narrow social constructs
Using inclusive language
In terms of sexual health, what should a health professional bring to the table?
Positive attitudes towards sexuality
Objectivity in counselling
Knowledge of biological psychological aspects of human reproduction, sexual behaviours, sexual dysfunction, and sexual diseases
Describe the embryonic development of the reproductive organs.
5-6 weeks: Primitive gonads, ducts, and external genitals form.
7 weeks: Differentiation to male/female organs
The basic blueprint for reproductive organs is ______ (female/male).
Female
What is the role of hormones in the embryonic development of the reproductive organs?
Androgens (e.g. testosterone) produced in testes lead to male development. Lack of androgens leads to female development. Female hormones (e.g. estrogen) is important for changes during puberty
Where do testes and ovaries start at the start of development – High or low in the abdomen?
Testes and ovaries start high in abdomen then descend to their respective places.
What is mons veneris?
The fatty tissue that covers the joints of the pubic bones, below the abdomen and above the clitoris
What condition on the mons veneris can develop in women with spinal injuries and why?
Pressure sores on mons veneris. Women with spinal injuries can have their fat redistributed, and the fat on top of the mons veneris (which protects from repetitive force) can be displaced. This could be life-threatening if not looked after.
What are the muscles that encircle the entrance to the vagina?
Pubococcygeus muscle
What are Kegel exercises?
Exercises that strengthen the pubic floor
What are the basic movements associated with Kegel exercises?
- Tighten - Pull tail bone and pubic bone together
- Feel a lift inside (Lower stomach may tighten)
- Let contraction go and let pelvic floor open like a flower.
- Repeat.
What are some reasons why having a strong pelvic floor can be helpful?
- Help with incontinence during pregnancy, the birting process, and recovery after birth.
- Help with incontinence in general
- Increase sex/orgasm intensity (women can have a more active role) and help with pre-ejaculation
- Strengthen the whole core
What location might be the best for Kegel exercises, expecially for elderly patients or patients with incontinence?
Over the toilet, to prevent any accidents
Describe the distribution of sensation throughout the vagina.
The outer 1/3 of the vagina has the most sensitive sensations, and the deeper 2/3s only have deep pressure sensations.
Describe the typical process of hysterectomy.
Tools (camera, etc.) are inserted through the belly button and brought near the fallopian tubes. The fallopian tubes can be tied or cauterized.
Why is it better for the man to have vasectomy than the woman in the couple to have hysterectomy?
There are more risks and complications associated with hysterectomy than vasectomy. Vasectomy can be also be reversed (with some risks for complications), while hysterectomy cannot be reversed.
What is the labia majora?
Large folds of skin that run downward from the mons veneris along the sides of the vulva
What is the function of the labia majora?
Respond to stimulation (amply supplied with nerve endings). Shield the inner portions of the female genitals.
What is the labia minora?
Two hairless, light-coloured membranes located between the major lips. They surround the urethral and vaginal openings, and join at the prepuce (hood) of the clitoris at the top.
What is the function of the labia minora?
Highly sensitive to sexual stimulation (lots of blood vessels and nerve endings). They darken and swell when stimulated.
What is the clitoris?
A female sex organ consisting of a shaft and glans located above the urethra opening.
What is the function of the clitoris?
Sexual pleasure
What is the prepuce of the clitoris?
The “hood” covering the clitoral shaft
What is the introitus?
Another name for vagina
What is the hymen?
A fold of tissue across the vaginal opening that is usually present at birth and remain at least partially intact until engagement in intercourse
How long is the vagina at rest?
3 to 5 inches
What is the cervix?
The lower end of the uterus that produces secretions that contribute to the chemical balance of the vagina
What is the “os”?
The opening in the middle of the cervix
How large is the “os” usually?
About the width of a straw
What is the usual/unusual position of the uterus within the abdomen?
The uterus slants forward/antroverted in 90% of women, and 10% of women have uteruses that tip backward.
What is the fundus of the uterus?
The upper-most portion of the uterus
What is endometriosis?
When endometrial tissue grows in the abdominal cavity or elsewhere in the reproductive system. Most common symptom is menstrual pain. Can lead to infertility if left utnreated.
What is the myometrium of the uterus?
The well-muscled second layer of the uterus which create powerful contractions and flexibility
What is the perimetrium of the uterus?
The fibrous third or outermost layer which provides an external cover.
What are the four parts of the fallopian tubes, from the nearest to the farthest from the uterus?
Isthmus, ampulla, infundibulum, fimbriae
How large are ovaries?
1.5 inches long
Which hormones do ovaries produce?
Progesterone and estrogen
Which organs are removed in a complete hysterectomy?
The ovaries, fallopian tubes, cervix, and uterus
When are complete hysterectomies usually done?
When spreading of cancer throughout the reproductive system is to be prevented
What is the areola?
The dark skin area around the nipple
What lubricates the nipples during breast-feeding?
Oil-producing glands in the areola
What is the rooting reflex?
Newborns’ reflex to turn towards a stimulus that is applied on its cheek
What is the sucking reflex?
Newborn’s reflex to start sucking on anything that is placed in their mouth
When a mother and a baby are having trouble with feeding, what are some things that should be assessed?
- The mother: Inverted nipple, small nipple, etc.
- The baby: Tongue-thrust reflex, being tongue-tied, etc.
What is the G spot or the Grafenberg spot?
The region about 1-1.5 inches into the vagina with the most sensitivity
What is the function of the G spot or the Grafenberg spot?
- During birth, the back of the head of the baby presses the most on the G spot area, which may help with the pain
- May produce the most intense orgasm, which facilitates fertility
How can the G spot or the Grafenberg spot be used for women with sensory loss?
They may still be able to experience orgasm if you put pressure there.
What is the corpus cavernosum?
Cylinders of spongy tissue in the penis that become congested with blood and stiffen during sexual arousal
What is the corpus spongiosum?
The spongy body that runs along the bottom of the penis, contains the penile urethra, and enlarges at the tip of the penis to form the glans
What is the corona?
The ridge that separates the glans from the body of the penis
What is the frenulum?
The sensitive strip of tissue that connects the underside of the penile glans to the shaft
Stimulation of what area can cause a reflexive erection in men?
The corpus spongiosum just behind the scrotum and near the rectum
How long does it take to mature sperm?
Up to 72 days
What is circumcision?
Removal of the foreskin
What is the smegma?
An oil-producing region on the shaft below the foreskin
What four structures does the scrotum hold?
- Spermatic cord
- Vas deferens
- Cremaster muscle
- Dartos muscle
Does the prostate gland produce an acidic or a basic substance? What is the role of this substance?
Basic, to protect the semen in women’s acidic vagina
What should be considered when assessing the fertility compatibility between a man and a woman?
The pH compatibility
What is semen made up of and by how much?
- Sperm (0.05%)
- Seminal fluid (80%)
- Prostate fluid (15%)
- Cowper’s gland (~2%)
Does vasectomy influence erection?
No; As sperm is only a small percentage of semen, the amount of semen will be the same after vasectomy.
What secretes testosterone?
Interstitial cells or Leydig’s cells
What is the most important androgen?
Testosterone
What are the roles of testosterone in men?
- Stimulate prenatal differentiation of male sex changes
- Stimulate sperm production
- Development of secondary sex characteristics
What are seminal vesicles?
Small glands about 2 inches long behind the bladder, which secrete fluids that combine with sperm
What is the function of the seminal vesical fluid?
Nourishment of sperm (high in fructose) to help them become active/motile
What is the prostate gland?
A gland about the size of a chestnut that lie beneath the bladder
What is the function of the prostatic fluid?
- Provide the characteristic texture and odour of the seminal fluid
- Provide the alkalinity that neutralizes the acidity of the vaginal tract and prolong the life span of sperm through the female reproductive system
What are the Cowper’s or bulbourethral glands?
Two glands that lie below the prostate and produce a drop or so of clear, slippery fluid during sexual arousal
What is the role of the 5 senses in sexuality?
Increase desire
What are the 4 steps of the sexual response cycle suggested by Masters & Johnson?
Excitement
Plateau
Orgasm
Resolution
What are the 5 phases of the sexual response cycle suggested by Kaplan?
Desire Excitement Plateau Orgasm Resolution
What are the 3 patterns of the sexual response cycle in women?
A: Arousal level increases through excitement and reaches plateau. After a while, reaches orgasm(s) and arousal decreases to resolution.
B: Similar to A, arousal level increases through excitement and reaches plateau but never reaches orgasm.
C: Arousal steeply increases through excitement and barely stops at plateau before reaching orgasm. May drop off steeply to resolution.
True or False: Women have refractory periods between orgasms.
False. Orgasms increase the chances of fertility, so women evolutionarily do not have refractory periods between orgasms.
True or False: Women can have multiple orgasms at once.
True. However, it depends on many factors, e.g. desire.
What are the changes that occur to the external female sexual organs during excitement?
Clitoris elongates and widens.
Labia minora expand and extend outward.
Labia majora flatten out and spread away from vaginal opening.
What are the changes that occur to the external female sexual organs during plateau?
Clitoris retracts under hood.
Labia minora turn bright red and increase in size.
What are the changes that occur to the external female sexual organs during orgasm?
Clitoris retracts under hood.
What are the changes that occur to the external female sexual organs during resolution?
Clitoris slowly returns to normal size.
Labia majora return to normal size and position.
Labia minora return slowly to normal size and position.
What are the changes that occur to the internal female sexual organs during excitement?
Uterus pulls up and away from vagina.
Vagina begins to lubricate.
Nipple erection/breast enlargement.
What are the changes that occur to the internal female sexual organs during plateau?
Uterus fully elevated and rises into false pelvis.
Vaginal barrel increases slightly, creating a small posterior dip.
The vaginal opening contracts to produce a grasping effect on the penis.
What are the changes that occur to the internal female sexual organs during orgasm?
Strong contractions of the vaginal orgasmic platform – 3 to 5 in a mild orgasm and eight to twelve contractions in an intense orgasm.
Uterus undergoes contractions similar to those of labor.
Rectal sphincter contracts.
What are the changes that occur to the internal female sexual organs during resolution?
Uterus drops back to normal position.
Cervix drops into and sucks up from the semial pool collected in the vaginal barrel.
Outer third of vagina (orgasmic platform) returns quickly to normal; Inner two-thirds of vagina returns to normal more slowly.
Ideally, should the man or the woman orgasm first?
The man should orgasm first.
Describe the sexual response cycle of men?
The arousal level rises through excitement and reaches plateau. After some time, orgasm is reached and arousal goes down during the refractory period. Either the man orgasms again, or he relaxes into resolution.
What two factors does the refractory period depend on?
Age – The refractory period becomes longer as the man ages.
Sexual activity – More sexual activity throughout life leads to shorter refractory periods.
How often should a couple have intercourse in order to get pregnant?
It’s best to intercourse only once a day or a few days after the last intercourse, right when the woman starts ovulating.
What are the changes that occur to the male genitals during excitement?
Vasocongestion of penis resulting in erection.
Testes begin elevating.
Scrotal skin tenses and thickens.
What are the changes that occur to the male genitals during plateau?
The coronal ridge of the glans increase in diameter and turns a deeper reddish-purple.
The Cowper’s glands may release fluid (i.e. pre-ejaculate, for lubrication).
The testes become completely elevated and engorged when orgasm is imminent.
What are the changes that occur to the male genitals during orgasm?
Contractions of vas deferens and seminal vesicles expel sperm and semen into urethra.
Prostate expels fluid into the urethra.
Sperm and semen are expelled by rhythmic contractions of urethra.
Rectal sphincter contracts.
What are the changes that occur to the male genitals during resolution?
Erection subsides.
Testes descend.
Scrotum thins and the folds return.
What is masturbation?
Touching and stimulating own genitals.
Viable and healthy throughout lifespan.
What is self-pleasure?
Pleasuring of body in a sensual way
What is the key hormone for desire level in both men and women?
Testosterone
What are the 2 stages of male orgasm?
- Emission stage: Contraction of the prostate, seminal vesicles, and the upper part of the vas deferens (i.e. the ampulla). Semen is pushed into the prostatic part of the urethral tract (i.e. urethral bulb).
- Expulsion stage: Propulsion of the seminal fluid through the urethra and out of the urethral opening at the tip of the penis. Accompanied by the highly pleasurable sensations of orgasm.
What is retrograde ejaculation?
The ejaculate empties into the bladder instead of being expelled from the body.
Describe the Kinsey orientation scale?
0-6 scale with 0 being completely heterosexual and 6 being completely homosexual. Defined based on behaviour, feelings, and fantasy.
What are sexual vs. gender identities?
Sexual identity: What a person self-identifies as
Gender identity: How one psychologically perceives oneself as either male or female?
What are sexual behaviour vs. orientation?
Sexual behaviour: What sexual activities the person engages in
Sexual orientation: Sexual attraction to one’s own or the other sex
What does the word “transvestite” mean?
People who derive sexual arousal from wearing clothing of the other gender. Derogatory for trans people.
Who are Two-Spirited individuals?
North American Aboriginal people who is bisexual or transgender
How should same-sex advances handled?
The same way that opposite-sex advances are treated – Set professional boundaries.
A disabled person has the right to all information about sexuality that _______________. It includes the right to ____ range of sexual expression.
That they can understand; Full range
What does sexual adjustment mean?
Resuming or initiating sexual behaviour after an incident or with a condition
How does sexual adjustment in people with congenital vs. acquired conditions differ?
Congenital: Less opportunities for exploring sexuality and less education.
Acquired: Going through grief/loss, tend to compare to before
How does sexual adjustment in people with mild/localized vs. severe/systemic conditions differ?
Depends on the client; A mild/localized condition might have more effect on the person’s sexuality than a severe/systemic condition.
How does sexual adjustment in people with stable vs. progressive conditions differ?
Stable: Often a short period of time for adjustments that last a long time.
Progressive: Multiple adjustments have to be made over a period of time.
How does sexual adjustment in people with visible vs. invisible conditions differ?
Visible: Difficult to initiate relationship due to stigma and the belief that they’re asexual
Invisible: Might be easier to initiate relationships but tend to systematically self-isolate and limit their interaction (i.e. hiding the condition)
What are some factors that affect sexual adjustment?
Degree and constancy of pain, and medication Degree of control and/or management of bladder and bowel function In relationship (can resume sexual activity) vs. looking for relationship (tendency to avoid relationships) Attitudes/acceptance of significant others
What are some general factors that may be affected by disease or injury, which may affect sexuality?
Body image
Self esteem
Public attitudes
What is the recommendation for people who have incontinence when resuming sexual activity?
Empty bowel and bladder before sexual intercourse to avoid accidents
How does SCI impact women vs. men in terms of fertility?
Women: Ovulation can stop immediately after the trauma but will start up again after a while
Men: No immediate effect on fertility, but may become infertile later on due to lack of temperature regulation
How does SCI affect the birthing process for women?
Can make the birthing process easier due to no pain sensation, but there is a risk of autonomous asphyxation due to the stress. As such, still need to treat as if they’re in pain.
What are some factors around reproduction and response that may be affected by disease or injury, which may affect sexuality?
Fertility
Pregnancy & delivery
Arousal
Orgasm & ejaculation
What are some behavioural factors that may be affected by disease or injury, which may affect sexuality?
Self-pleasure & Masturbation
Choices of sexual activities
Positioning for sexual intercourse
True or False: Sexual dysfunctions will always be of concern to an individual or couple.
False. Individuals or couples may be satisfied of their sex life even with these dysfunctions.
What is paraphilia?
Arousal and response are dependent on unusual objects or behaviours, but physiological response is intact.
True or False: Sexual dysfunctions do not include paraphilia.
True. Sexual dysfunction refers to any dysfunction to physiological response, while physiological response is intact in paraphilia.
What are the 3 main causes of sexual dysfunctions? Which one should be explored first?
- Organic – Should be explored first
- Psychogenic
- Cultural/interpersonal
What are the 4 layers of the course of sexual dysfunctions that should be considered?
- Duration – Life long vs. Acquired
- Onset – Sudden onset vs. Gradual onset
- Context – Generalized vs. Situational
- Cause – Organic vs. Psychogenic vs. Cultural/Interpersonal
What are the 4 main treatment strategies for sexual dysfunction?
- Freud’s psychoanalytic model
- Masters and Johnson’s behavioural approach
- Kaplan’s psychosexual therapy - Combination of psychoanalytic and behavioural
- Eclectic approach - Flexible
What are the 4 outcomes that sexual health intervention should focus on?
- Changing attitudes
- Providing information/Education
- Giving permission (for alternatives)
- Reducing intensity
What are the potential causes of low or inhibited sexual desire?
Hormonal deficiencies or illnesses
Deperssion and anxiety
Relationship dissatisfaction
History of assault or abuse
What are the treatment options for low or inhibited sexual desire?
Relationship counseling and sex education
Therapy for psychological illnesses and abuse
Behavioural exercises, e.g. sensate focus
What are the potential causes of compulsive sexual behaviour?
Organic, e.g. brain disease or injury
Strong need for love for inability to relate
What are the treatment options for compulsive sexual behaviour?
Lifestyle counseling or therapy
Medications
What are the potential causes of sexual aversion?
Shame, fear, and anxiety
History of abuse or assault
What are the treatment options for sexual aversion?
Medications
Psychological counseling
What is dyspareunia?
Painful intercourse, more often for women.
What are some causes of arousal disorders in females?
Diabetes Reduced estrogen levels Neurological disorders, e.g. SCI Anxiety or stress Narcotics, alcohol, medications Negative experiences such as abuse Most often psychological cause
What are the treatment options for arousal disorders in females?
Medical intervention for physical causes
Sexual conseling to reduce performance anxiety
Relationship counseling
What are anorgasmic vs. pre-orgasmic disorders?
Anorgasmic: Complete inability to have orgasm
Pre-orgasmic: Reaches right before orgasm but does not actual continue to orgasm
What are potential causes of orgasmic disorders in females?
Guilt or anxiety
Insufficient clitoral stimulation
What are the treatment options for orgasmic disorders in females?
Counseling and education to counteract negative attitude toward sex
Self-exploration and massage
Couple education on female sexual response
Education adn counseling on alternative sexual activities and use of devices such as vibrators
What is vulvadynia?
Abnormal sensation in the vulva. Not a sexual dysfunction by definition.
What are potential causes of dyspareunia in females?
Most often inadequate vaginal lubrication
Vaginal infection of STI’s
PID, endometriosis, other diseases
What are the treatment options for dyspareunia in females?
Medical intervention for physical causes
Use of artificial lubricants
Counseling or psychological causes
Education on sexual techniques, e.g. increased foreplay
What is vaginismus?
Involuntary contractions of the pelvic muscles surrounding the outer third of the vaginal barrel, which prevents penetration
What are potential causes of vaginismus?
Most commonly fear of vaginal penetration often related to history of assult or abuse
Brain disease or injury
What are treatment options for vaginismus?
Use of graduated plastic vaginal dilators
Counseling regarding prior abuse
Dominating positions
What are the 5 main factors that contribute to male sexual dysfunction?
Desire Arousal Penetration Erection maintenance Orgasm and ejaculation
What are potential causes of erectile dysfunction?
Diabetes (50-90% of diabetics) Stress and fatigue Low testosterone Vascular problems General illness Use of abuse of narcotics, alcohol, and meds Anxiety about sexual performance
What are the treatment options for erectile dysfunction?
Psychological therapy aimed at decreasing anxiety, e.g. sensate focus
Medical intervention for physical causes, e.g. Viagra, vacuum pump, penile injections, penile prosthesis
Do testosterone supplements help treat erectile dysfunction?
No, not by itself. Testosterone returns the desire but not the function.
What is the gold standard treatment for erectile dysfunction?
Penile injections
What are some complications of penile prosthesis?
Infection Erosion Deformities Mechanical malfunction Patient dissatisfaction
What is the average time from penetration to ejaculation?
4-4.5 minutes
What are potential causes of premature/rapid ejaculation?
Mostly psychological causes – Anxiety
First sexual experience in less than ideal situations
What are the two primary treatments for premature/rapid ejaculation?
- Stop-go technique – Stimulating the penis until just before orgasm and then stopping until the urge to ejaculate goes away
- Squeeze techniques – Pressing in the coronal region
What is ejaculatory incompetence?
Inability to ejaculate after penetration despite firm erection and sufficient arousal
What are potential causes of ejaculatory incompetence?
Primarily psychological – Anxiety associated with penetration and ejaculation
Medication-induced – Newer antidepressants
What are the treatment options for ejaculatory incompetence?
Psychological causes, e.g. sensate focus
Behavioural approach
Changing the timing of the medication (take them in the morning)
What is Peyronie’s Disease?
Curvature of penis caused by sclerotic/fibrous plaques on the penis
What are the treatment options for Peyronie’s Disease?
Oral: Vitamin E and cochicine
Ultrasound
Surgery
Older individuals are _____ sexually active than early/middle-aged adults and are _____ likely to get STI’s.
More; More
What are the normal age-related physiological changes for women?
- Decrease in rate and amount of vaginal lubrication
- Orgasmic changes – Decrease in the number of involuntary contractions, acceleration of post-orgasmic decreascendo or clitoral retraction
- Structural changes – Atrophy of the labia and uterus, reduction in the expansion of the vagina width
- Thinning of the vaginal lining
What are the normal age-related physiological changes for men?
- Erection is slower, less full, and disappears quickly after orgasm. Longer refractory period (12-24 hours)
- Decrease in muscle tone
- Testicles do not achieve full elevation and do not increase in size
- Decreased volume of spearm – Decreased fertility level
- Increased ejaculatory control
- Ejaculation is less powerful and orgasm is often less intense
- Decrease in ejaculatory testosterone
What are the possible consequences of normal age-related physiological changes for women?
Irritation and/or painful intercourse
Reduced penetrative intercourse
What are the three main social and psychological issues affecting sexuality of older individuals?
- Values/attributes of the older generation
- Societal values
- Lack of available sexual partners
Why is giving estrogen as hormone replacement therapy (HRT) harmful?
Increases chance of uterine cancer
What is estrogen now given with as hormone replacement therapy (HRT)?
Progestin
What is the maximum amount of time that an individual should be on hormone replacement therapy (HRT)?
5 years
What is child sexual abuse?
An older person using authority over a child to engage the child in sexual activity, ranging from exhibitionism to fondling to penetration
What are some strategies that sex offenders use to groom children?
Tricks
Bribes
Threats
Physical force
What is grooming in sexual abuse?
Ensuring the child/victim keeps the secret and does not speak out.
When a child asks about sex, what should we do?
We have a professional responsibility to provide factual information to answer any questions about birth control, protection, etc.
What do we do if parents say up front that they do not want you to talk to their child about sex?
- Document
2. Use professional judgment
Individuals with severe mental illnesses are sexually _______.
Active
What is the main hindrance to sexuality in individuals with severe mental illnesses?
Medication side effects
Most individuals with severe mental illnesses practice [safe/unsafe] sex, and [have/lack] knowledge about STI’s.
Unsafe; Lack
Individuals with severe mental illnesses have [high/low] prevalence of history of sexual abuse.
High
What are the 4 interrelated psychosexual factors that must be considered for individuals with mental illnesses?
- Sexual identity
- Gender identity
- Sexual orientation
- Sexual behaviour
What is the main concern when it comes to sexual activity in individuals with psychotic disorders?
Their symptoms include poor judgment, impulsivity, and vulnerability, which increases their risk of unsafe sex and drug use.
What is the Information-Motivation-Behaviour model of education?
- Provide information
- Motivate them to use the information – Put the information in a meaninful context
- Give them skills on how to do it
What are some adverse sexual effects of antipsychotic drugs?
Impaired erection and ejaculation
“Dry ejaculation”
Reduced vaginal lubrication and readiness
What are the most common issues with sexual activity that individuals with affective disorders experience?
Decreased libido
Anhedonia
Varying levels of sexual dysfunction ranging all phases of the response cycle
What are the most common side effects of antidepressants and anti-anxiety agents in regards to sexual dysfunction?
Interference of erection and delayed ejaculation
What is the difference between older vs. newer antidepressants and anxiolytic drugs in terms of side effects?
Newer drugs have fewer side effects, including weight gain.
What are some general suggestions with regards to medication if an individual with depression or anxiety is experiencing sexual dysfunction?
- Take drugs earlier in the day
- For prolonged issues in ejaculation, orgasm, or desire, take occasional “drug holidays” of 2-3 days to allow desire to return
- Suggest newer drugs: Pristiq, Wellbutrin or serzone, and Tradazone
- Education for client and their partners
What is the key sexual issue for individuals with anorexia and bulimia nervosa?
Body image
What are the two kinds of common social mistakes for sexual behaviour?
- Public-private errors
2. Stranger-friend errors
What are some possible focuses of education and treatment programs for sexual behaviour?
Education – Information on safe sex, skill building
Techniques for recognizing and managing high risk situations
Communication and assertiveness training
What are the 3 main presentations of gender dysphoria?
- Discontent with biological sex
- Desire to possess body of opposite sex
- Desire to be regarded by others as the opposite sex
What can be used as intervention for those with driven hypersexuality?
Medroxyprogesterone acetate
Why are there more programs and research for individuals with cognitive impairments vs. individuals with physical impairments?
There is a lot of demands from caregivers to control sexual behaviour and program it out of individuals with cognitive impairments.
What are the two extreme categories that children, adolescents, and adults with intellectual disability are often classified into?
Asexual beings vs. Sexual deviants
What are some reasons why sexual dysfunction is experienced by individuals with cognitive disabilities?
Internalized societal disapproval of their sexuality
Loneliness and dissatisfaction with social life – Inappropriate sexual behaviour
Lacking privacy in institutions
What are the concerns about sexuality specific to women with cognitive disability?
High rates of childhood and adult physical, sexual, and emotional abuse
Often targeted by predators
Lack of control and choice
Poor self-esteem
What are the features of individuals with cognitive disability that make them vulnerable to sexual abuse and exploitation?
Culture of obedience and compliance
Many different caregivers
Need for help with body care
Inability to defend and speak up for themselves
Lack of sex education and knowledge of normal social and sexual limits
Loneliness
Inappropriate sexual behaviours are determined by ________.
Society
What are the most frequently mentioned inapproriate sexual behaviour in children?
Exposing and inappropriate sexual touching
What are the most frequently mentioned inappropriate sexual behaviours in adolescents?
Promiscuity and inappropriate sexual advances
How do the rates of inappropriate sexual behaviour compare between males and females with cognitive disabilities?
They’re similar.
What do the inappropriate sexual behaviour for females tend to be?
Boundaries and promiscuity; Tend to be victims of sexual abuse
What do the inappropriate sexual behaviour for males tend to be?
Coercive and nonconsensual activities with absence of malice; Tend to be perpetrators of sexual abuse
Being a victim of sexual, physical abuse, or violence [increases/decreases] the odds for inappropriate sexual behaviour.
Increases
What is the most influential protective factor for the risk of inappropriate sexual behaviour?
A stable/nurturing home
What is the main issue in regards to consent and individuals with intellectual disabilities?
Once a person is deemed incapable of consenting, their opportunities for sexual expression become very limited.
What does consensual ability mean?
Capability to give informed consent to sexual contact.
What 3 factors should inform evaluation of an individual’s consensual ability?
- Knowledge of the nature of the sexual contact
- The possible consequences of the sexual contact
- The social and moral context in which it occurs
What is situational or graduated consent?
Capability to consent to some forms of sexual contact but not others with the same or other individuals in other settings.
How should individuals with intellectual disabilities be educated about sexuality, based on their chronological and intellectual ages?
Topics and forms of physical affection should be tailored to the chronological age.
The teaching methods/tools should be tailored to their intellectual abilities.
What should always be clarified when educating about appropriate sexual behaviour?
Context
What are some strategies to control high libido in individuals with intellectual disabilities?
Masturbation schedule
Add productivity role to reduce loneliness and boredom
Educate in the context of social stories and scenarios
Journaling about fake relationship, so that it can be guided toward a more appropriate expression
When is the societally acceptable age to have intercourse?
18 years old
When is it appropriate for adults to use children sexually?
Never
What is the P-LI-SS-IT model?
A model to describe your involvement in sexual health with the client and what you should do at each level
Describe the 4 steps of the P-LI-SS-IT model.
- Permission
- Limited Information
- Specific Suggestions
- Intensive Therapy
What is the key consideration when addressing sexuality in the initial stage of a condition when first diagnosed?
Acknowledge and bring up the topic of sexuality, and wait for the individual to ask further questions. Wait until they give you permission and indicate their readiness.
What is the key consideration when addressing sexuality in the middle stage of a condition when they have been discharged from acute care?
They have now realized or come to terms with their new sexuality. Provide a supportive, sex positive environment that allows for sexual expression – Provide resources or refer to someone else.
What is the key consideration when addressing sexuality in the later stage of a condition when adjusting to the reality of their situation?
Listen first. Help them brainstorm solutions and/or provide resources. Make sexuality part of the intervention plan.
How should self-disclosure about sexual topics be done?
Make professional judgments about the context and your relationship with the client.
Tell the client whether you will share and why.
Be selective and focused with what you share.
Do not burden the client with your disclosure.
What is the goal of using toys to enhance sexual function?
Increase stimulation and function with minimal effort.
Which toy should be considered to enhance sexual function?
Versatile toys, unless you’re looking for a very specific function.
What is the main function of vibrators in sexual function?
Increase blood flow and stimulation in individuals with fatigue, altered sensation, circulatory problems, and arousal dysfunction.
What is the main function of lubricants in sexual function?
Combat dryness in individuals with altered sensation, arousal disorder, or pain
What equipment can be used to enhance sexual function for individuals with limited mobility/ROM/strength, fatigue, sensation, or spasticity?
Pillow, wedges, slings, straps
What equipment can be used for individuals with erectile dysfunction?
Vacuum pumps, rings, prosthetic penis attachments
What are primary vs. secondary vs. tertiary sexual dysfunctions?
Primary: Functional problem specific to sexual activity
Secondary: General problem that affects other parts of life
Tertiary: Psychological, e.g. body image, self-esteem, sexual/gender identity
What is the main goal of sexual health counseling?
Increasing personal definition of sexuality – Make it real and livable for the client and their partner
