Assessment and Treatment of Sexual Dysfunctions Flashcards
Mind the Gap! There is limited training across healthcare disciplines… such as?
- Medicine
- Nursing
- Occupational Therapy
- Psychiatry
- Psychology
- Social Work
Many of these professions have very limited training in sexual health.
What does UBC Medical Education do to address the gap in sexual health?
- Sensitive Interviewing for Sexual Dysfunctions
- All second-year medical students
- Two sessions based on cases
- Standardized patients (someone will lived experience, volunteering to interact with the trainees)
Clinical Interview for Sexual Dysfunction?(9)
- Demographic information
- Presenting problem(s)
- Personal distress
- Symptom onset and duration (specifiers)
- Biopsychosocial factors
- Sexual technique (sufficient stimulation)
- Sexual response (what part of the sexual response cycle is affected)
- Partner’s response (interpersonal)
- Treatments to date
PLISSIT Model? (Annon, 1976)
P: Obtaining Permission from the individual to initiate sexual discussion. Giving individual Permission to raise sexual issues.
Li: Providing the Limited Information needed to support sexual function.
SS: Giving Specific Suggestions for the individual to proceed with sexual activity.
IT: Providing Intensive Therapy surrounding the issues of sexuality for the individual
PLISST Model? (Annon, 1976) Example?
P: “Is there anything about your sexual health you would like to discuss today?”
Li: “Some people with depression experience difficulties with obtaining or maintaining erections”
SS: “You may benefit from engaging in non-penetrative sexual activities with your partner.”
IT: “Your sexual health is important. I’d like to refer you to someone with expertise in treating erectile disorder”
Multidisciplinary Care?
Vulvar Pain Assessment Clinic, who is involved and what do they contribute? (3)
- Gynaecologist
- Diagnosis of vulvodynia
- Treatment planning - Registered Psychologist
- Assess contributing facotrs
- Provide pain psychoeducation (research) - Physiotherapist
- Assess pelvic floor muscles
- Teach PFM exercises
Biomedical Treatments - Pharmacotherapy for Erectile Disorder?
- PDE-5 inhibitors increase blood flow, but only if paired with sexual stimulation.
- Most people who receive a prescription do not fill it
- Those who fill it, only about 50% refill it… why?
(Stimga around picking it up and using it, having to plan the sexual encounter, having positive experiences and boosting confidence and no longer needing it, it is expensive and sometimes not covered by insurance)
Biomedical Treatments - Pharmacotherapy for Low Sexual Desire? What medication?
Flibanserin (Addyi) is approved by US FDA and Health Canada for use in women with low desire. A pill you have to take every day/
Flibanserin (Addyi) - Clinical trials and polarising?
Clinical trials
- Daily use = 0.5 “satisfying sexual events” per month vs. placebo (very small change)
- Side effects: drowsiness, dizziness, nausea, fatigue
Two Polarizing sources:
- Even the Score, promoting more access to pharmacological sexual interventions. Equlity framework.
- The New View Campain, we shouldn’t pathologize low sexual drive and should instead consider societal and contextual factors.
Low uptake by both prescribers and patients.
Biomedical Treatments - Pharmacotherapy for GPPPD?
Lidocane
- Topical (numbing) cream applied before sex
- OR Applied nightly on a cotton swab
- Applied vuvlarvesibule and not on the clitoris
- May cause burning
- Not very effective, still many doctors prescribe it
Biomedical Treatments - Pelvic Floor Physiotherapy?
- First line treatment for GPPD
- Vaginal inserts
- Practice in clinic and at home
Psychological Treatments - Cognitive-behavioural therapies (CBT)?
-> Emotions -> Thoughts -> Behaviours ->
These three concepts intersect, meaning that if we change our thoughts it’ll affect our emotions and behaviours.
It is easiest to act on our thoughts and behaviour, but not our emotions.
Psychological Treatments - Mindfullness-based therapies (MBT)?
-> Awareness -> Present moment -> Acceptance ->
Evidence-based Psychological Treatments + Effect size?
- Support for group, couple, and individual CBT (All female sexual dysfunctions, erectile dysfunction)
- Lack of studies for PE and DE, expert opinion supports CBT
- Mindfulness-based sex therapy (low desire, pain)
- Directed masturbation training (orgasmic disorder)
Effect sizes:
d = .57 (symptom severity) moderate effect
d = .47 (sexual satisfaction) moderate effect
Treatment for PE
- Stop-start-squeeze techniques
- Practise building control
- High success rates (over 95%)
