task 3

Question 1

mansexuality after prosatate cancer treatment

Answer 1

often results in loss of erectile function Despite the high prevalence, patients often report being poorly prepared to cope with ED after PCa treatment and commonly report a lack of knowledge about sexual health and ED treatments.
current sexual rehabilitation programs
overlook psychosocial factors and focus on biologicals aspects

Question 2

The discrepancy between the effectiveness of ED treatments and the low rate of long-term use suggests that

Answer 2

The discrepancy between the effectiveness of ED treatments and the low rate of long-term use suggests that physiological erectile response is an insufficient indicator of successful ED treatment

Question 3

barriers to successful use of Ed treatments

Answer 3

• The length of tume a couple waits before seeking treatment,
• The patient’s and partner’s attitudes, expectations, and readiness to begin a treatment protocol,
• The meaning of using a medical intervention to restore sexual acidity, the quality of the couple’s relationship outside of the seuxla context
• The presence of sexual dysfunction in the partner
• Lack of desire for sexual intercourse in the patient or partner,
• Lack fo opportunity.
Additionally, only half of patients are willing to try an ED treatment after PCa treatment

Patients should be offered treatment alternatives to those aimed exclusively at restoring erections.

Question 4

With increasing demands, physicians relay heavily on nurses to spend more time on patient education and counseling for ED

Answer 4

There are many barriers of nurses addressing patients’ sexual needs:
• Inadequate training, resulting in insufficient knowledge base or experience,
• Low confidence, embarrassment, or discomfort of the health care provider,
• Perceived patient embarrassment or discomfort,
• The assumption that inquiring about sexuality is an invasion of patient privacy,
• Concerns over uncertainty regarding patients’ cultural or religious beliefs about sexuality,
• Assuming that it is the responsibility of other health care providers on the team to address sexuality
 Continuing education is an important tool for increasing nurses’ competence and confidence in addressing the sexual health concerns of oncology patients.

Question 5

Sex &Autism

Answer 5

Difficulties with social contact, communication and imagination

Interpret everything literally and do not understand the meaning of non-
verbal or implicit messages

Insufficient social skills to maintain a relationship

Have sexual feelings, but these are ignored

Inappropriate sexual behavior in public and fascination for sensations that have a sexual connotation (fetisjism)
=> good sex education (concrete)

Question 6

psyvchopharma &sexuality

Answer 6

Dopamine: attention and concentration, innitiate and stop (sexual) behavior, reward and punishment, emotion and orgasm

Serotonine: regulation of mood, anxiety, sleep, appetite and sexuality (ejaculation)

Noradrenaline: influences arousal (erectionn and lubricationn) and ejaculation

have direct as well as indirect effects

Question 7

strategies to deal with sexual side effects

Answer 7

Acknowledge and discuss dysfunction.

Indicate that it is a side-effect.

Sexual dysfunctioon disappears when medication stops

Wait for spontaneous remission

Lower the dose

Medication-interval (weekend drug holiday). A1er a medication stop of 76h, sexual function is recovered for 50%

Use another type of medication with less side-effects

Add stimulating medication (eg viagra)

Sexuological counseling: seeking new sexual scenario’s

Question 8

sexuality in psichiatria patients

Answer 8

considered as asexual or hypersexual -> ignore or inhibit sexuality

Right to sexuality, right to privacy, right to experiment with sex and relationships

Vurnerable to sexual abuse: difficulties to judge how reliable the other is, to deal with the agression and intense sexual impulses of others (and themselves) => importance of good sexual education

Vulnerable to transgressing behavior of the therapist. Therapists can become confused and aroused by the sexual and seductive behavior of their patients

Question 9

sexualizy in psychiatric patient

Answer 9

Positive effects of sex: Agression regulation, anxiety reduction, comfort, self- esteem, less loneliness, less sexual incriminating public behavior, practice with making contact

Negative effects of sex: disappointment and lovesickness are experienced more intensively, higher risk of STD’s and unplanned pregnancy

Question 10

sex and disease

Answer 10

Cancer: radiation => loss of sexual function, less energy, feeling less attractive

Breast cancer §Prostate cancer

Loss of urine: shame

Mastectomy, hysterectomy: feeling less feminine

Heart and blood vessels (diabetes)

Physical examinations in intimate areas: anxiety, insecurity, shame

Disturbance of psychological and relational balance in the relationship
Finding a new balance in the relationship

Change the meaning and function of sex (comfort, intimacy)

Question 11

depression

Answer 11

Intereferes with level of serotonine and dopamine => reduces level of pleasure (and sexual pleasure)

Lower sexual desire and more arousal problems

Direct link: anhedonia
Indirect link: low self-esteem, feelings of guilt, feeling tired, neurophysiological changes

Role of testosterone: 2 x more depression in women

Sexual problem can be the cause of a depression: low self-esteem < not feeling
good enough as a sexual partner

Question 12

anxiety & sex

Answer 12

Hypervigilant, difficul9es to relax, difficul9es to enjoy without worrying

Less sexual interest vs. sex as a mood regulator (masturba9on as coping)

Panic disorder: Avoid sex because they fear an aLack

Social phobia: difficul9es with social contact

OCD: mysophobia (fear of stains) => sex is dirty

PTSD: sexual abuse => higher risk of sexual dysfunc9ons

Question 13

impact of disease on sex in daily life

Answer 13

Diseases have high comorbidity with sexual dysfunctions (50-70&)=> sexual dysfunctions, sexual adjustment problems

Influence of and on psychosocial factors
– Disturbance of psychological balance
– Disturbance of partner relationship
– Existential issues (mortality, interferes with sexual iden9ty)
– Changes in daily life

you might need to learn sex once again => explore body again, what do I like ? there from of sex then penetration

Question 14

effects of progressing disease

Answer 14

Fear of relapse

Confrontation with mortality

Imbalance

Needs time

No sexuality during first year after diagnosis

Low energy

What do I need to cope with the disease?

Anger, sadness, worries, frustration, ask for help

in most cases disire comes back after 2 years

Question 15

sexuality with mental disability

Answer 15

“Normal” sexual behavior requires autonomy and self-determina9on -> people with MD do not meet these standardsNo financial independece
– Dependent on others and cannot make their own decisions
=> do not ques9on the decisions of the health care providers
– They are seldom alone, have little privacy

Question 16

attitude supervisors and social worker

Answer 16

Ambivalence: let sleeping dogs lie + function mentally as children + fear of unplanned pregnancy and STD

Intrusion of the privacy of the client

Feeling shy and insecure to talk about sexuality

Ethical and legal issues
– No clear rules about offering sexual services -> social workers are discouraged to
talk about and facilitate sexual interactions
Acknowledge the right to sexuality and intimacy, but do not talk about it and thus don’t know the knowledge and needs of their clients

Too little attention for positive aspects of sexuality (pleasure, desire), too much prevention

 Absolute repression (protection discours) versus idealized permisiveness (normalisation discourse)
=> Do not ignore sexuality in MD, but also not the same

Question 17

People with (mild) mental disability

Answer 17

Have desires for and expectations about sexuality

Do not all want the same => Tune to their needs

Differences in understanding (eg What is sex? Holding hands or intercourse?) => avoid transgressions

Anticonception

Parenthood

Socio-sexual consciousness increases with age (≠ between <18 en >18)
Þ Are aware that their peers and siblings have more autonomy regarding sex and
relationships and they feel not satisfied about this inequality
Þ Are aware of secrecy and deception

Can understand mutual consent and trust in relationship, want to marry and have children, know about masturbation and need more privacy

Internalize negative sexual attitudes of healtcare providers and family -> develop negative attitudes regarding own sexuality

Question 18

sexual abuse and mental disabilities

Answer 18

60 % of people with disability are confronted with sexual abuse once or more in their life
=> Less autonomy and more dependent on others

=> Show difficult to interpret behavior (environment does not believe them)

=> Low resilience

=> Boundless life

=> No or incorrect sexual education

=> Lack of judgement

=> Many intimate contacts (less control over their own body)

=>Disturbance of physical boundaries

Question 19

how to deal with sexual abuse

Answer 19

Acknowledging possible signals

Talk about suspicions

Open attitude

Become aware of own attitudes and experiences with sexuality and sexual abuse

Good observation skills (body language!) and being alert

Alerts: physical damaging, difficulty to talk about sex, sleeping & eating problems , over sexualised bahevour , physiological/ emotional complaints

Question 20

difficulties when discovering abuse

Answer 20

Changes in behavior are aLributed to the disability

Environment denies the abuse

No witnesses

Police has difficul9es to find out the truth
– Justition ≠ Healthcare
(Obligation to report: Signals vs. proof)
– Complementary

Question 21

effects of abuse on md

Answer 21

Traumatic experiences are more difficult to process

Takes longer

Abuse can exacerbate the disability

Behavioral problems

Learn wrong ideas about sexuality -> Cross the sexual borders themselves and become abusers

Question 22

preventing abuse

Answer 22

Adequate sex education (Sex can be learned!)

Learn about norms, values, boundaries (what is ok!)

Optimize communication skills

Train resilience

Pay attention to environment!
– Dependency, (socially) isolated, and live in context with power inequality

Importance of policy about sexual abuse!

Question 23

sex education

Answer 23

Adequate sex educa9on, adjusted to
– Developmental stage (physical, mental, social-emo9onal)

Body-image

body experiences

sexual experineces

norms and values
-what is good & wrong ?

relationship devolpment

resilience
How can I set my boundaries?
– Acknowledging emotions and differentiate between pleasant and unpleasant emotions

Tailored sex education
– Has a direct and measurable effect on their capacity to make decisions about
rela9onships
– Increases their understanding of consensual versus abusive rela9onships
– Increase their autonomy and self-determina9on

Only half of people with MD get sex educa9on

Higher risk of STD, unplanned pregnancy and abuse

Question 24

Frequently reported disturbances to sexual functioning after diagnosis and treatment of breast cancer in Western women (and non-Western women) include:

Answer 24

• Dyspareunia
• Fatigue
• Vaginal dryness
• Decreased sexual interest or desire
• Decreased sexual arousal
• Numbness in previously sensitive breasts
• Difficulty reaching orgasm
• Lack of sexual pleasure
• Coital pain
• Sexual dissatisfaction
• Deterioration of the sexual relationship
• Loss of interest in their partner

woman who undergo Chema are at higher risk

Question 25

breast cancer & relationship

Answer 25

The quality of a woman’s relationship is a stronger predict of sexual satisfaction, sexual functioning and sexual desire after breast cancer than the physical and chemical damage to the body.

Question 26

Begin preparing couples for sexual recovery in advance of PCa treatment

Answer 26

The role of the health care provider is essential in encouraging patients and partners to develop positive, but also realistic expectations about sexual recovery
they should be informed that it might take some months

Question 27

consequences of a prostate treatemnt

Answer 27

While men may still experience sexual arousal, most men attain errections insufficiently firm for intercourse, and some don’t attain errection at all.

loss of sponatnety

Question 28

raesons for nonadherance

Answer 28

Men do not readily seek treatment for erectile dysfunction, even though there are many treatments available.
• When they do seek treatment, they are often not satisfied with the results and don’t continue with it.
• Even fairly successful treatments of ED don’t always result in a return to sexuality men knew before treatment.

Interventions to increase adherence to erectile dysfunction treatment include offering treatment choices for erectile dysfunction and mounting a nationwide written information campaign.

Frequently reported reason for former nonadherence were inhibition to talk about the problem and being afraid of a medical examination.
• Psychosexual counseling along with the offer of ED treatment resulted in greater use of intracavernosal injections.

Question 29

the psychological work

Answer 29

• At each state, men must do a small intentional piece of the psychological work of grieving in order to maintain focus and complete the sexual act.
• When men relax into the refractory phase of the sexual act, sharing grief with a partner can reinforce bonding, which then may reinforce desire for more sexual activity.

Question 30

bassom as a partial solution to mens loss of spanatnity

Answer 30

• Sexual receptivity – a deliberate decision based on context and self-awareness – is a new skill that men may need to develop after the losses associated with prostate cancer treatment.
• As they cannot rely on the spontaneity of erections, they must make a series of adaptations that will enable them to have a satisfying sexual experience  for this they have to work through feelings that are posed to derail them at several stages until those feelings are no longer powerful because of their unfamiliarity of influential because grief had not been addressed

Question 31

why men need to work trough grief

Answer 31

• By disallowing the pain of grief, men may, inadvertently, suppress sexual desire as well.

If men do allow themselves to feel grief, they will move through those feelings during each sexual encounter

Question 32

Strategies for preventing and treating sexual dysfunction during antidepressant therapy

Answer 32

The simplest strategy is to wait for a reduction in SD-associated side effects with the respective agent.
• However, this only occurs in only 5%-10% of patients and can take 4-6 months to develop.

Antidepressant dose may be decreased but this strategy may lead to a relapse in depression.

A drug holiday is an alternative to discontinuing an antidepressant but while a drug holiday can result in the discontinuation of symptoms as in the case of short-acting SSRIS, and patients may not resume taking the medication, leading to relapse.

A more effective strategy may be to switch to an antidepressant that is less likely to cause SD relative to other antidepressants.
• Reasonable approach, but changing medication needs to be done carefully by monitoring the effectiveness of antidepressant treatment as well as possible adverse effects.
• It is preferable to start treatment with a medication not associated with SD development, especially if SD is a significant patient concern or pre-existing condition, which is a known risk factor for treatment-related SD.

The initial medication may also be augmented with another drug to maintain effective treatment for depression but counteract SD.
• 66% patients of a study reported improvement in their sexual function when SSRI- or SNRI-induced SD was augmented with bupropion treatment.

Close monitoring of the patient, including questioning about sexual function at intervals after any change in therapy, is essential for optimal care to support treatment adherence.
• To detect drug effects, it is also important to question the patient about sexual function before beginning antidepres- sant treatment and to establish the patient’s level of concern about sexual function.

Question 33

women with disabiliteis feel like tehy cant talk about sex because

Answer 33

overprotective parents, who do not encourage, emphasise or normalise sexual relationship

caregivers who do not speak because they lack knowledge and are afraid of attracting attention to sexuality

Question 34

solutions that favour mastrubation in disabled women

Answer 34

discussion groups , sex education that meet their needs

Question 35

autism Sex ed implciation

Answer 35

• Individualized sex education led to a direct and measurable improvement in their abilities to make independent decisions in their sexual relationships.
right now topics are biological => should involve more personal sexuality & relationship

group work can facilitate discussiion

still need for focussing on individual needs ( simplified language)
riecht now lack of

computers=> beneficial for shy, social anxiety

Question 36

problems with sexual assistance

Answer 36

one of them might becone emotionally attached . social stigma, unlawfulness, disapproval of family, risk of emotional vulnerability

Question 37

trainings programms for employees that deal with ID-patients should include

Answer 37

• Awareness about employees’ attitudes to persons with ID and how they differ
• Adaptive ways of supporting individuals with ID to allow them make decision about who they want to share time with or who they want to establish relationships with
• What needs to be done if a client can be exploited or abused
• What should employees do if they think that other employees are too restrictive or unfair towards a client or clients
• Rights of persons with ID, specific principles and rules of a specific residence establishment

Sexual diversity might be an important topic to address, since caretakers aren’t always aware of the needs of homosexual people with ID.