Lucy Snider Sexual Health Adviser - PowerPoint Presentation

Slide1

Lucy Snider

Sexual Health Adviser

Psychosexual Therapist

“One normal sex life please”

Slide2

Who Am I??

Psychology background

Post-graduate counselling & psychotherapy

Psychosexual training

Working for THT

HIV& Sexual Health training

Healthcare Assistant

Health Adviser

Slide3

What is Psychosexual Therapy?

Sex counsellor

S

exuality counsellor

Psychosexual psychotherapist

Sexologist

Sexual therapist

Sex therapist

Sex worker?!

Slide4

What is Psychosexual Therapy?

“Psychosexual therapy

is talking therapy that specialises in helping individuals and couples who experience sexual

difficulties”

http

://

www.chelwest.nhs.uk/services/hiv-sexual-health/clinics/56-dean-street/psychosexual-therapy

“

The sexual dysfunctions are characterised by a disturbance in sexual desire and in the psycho-physiological changes that characterise the sexual response cycle and cause marked distress and interpersonal difficulty

for at least six months

”

Sexual Dysfunction DSM-V

Slide5

Fun Facts!

What do you think is the average length of time between

penetration

and

ejaculation

for men?

8-12

minutes

What %

of women can orgasm from

vaginal penetration

alone?

Only 20% -

approx

80

% women

cannot orgasm

during penetrative sex alone

Slide6

Types of Sexual Difficulties

Erectile

difficulties

Rapid or delayed ejaculation

Difficulty to orgasm

Arousal issues

Low sexual desire

Painful intercourse

Compulsive

sexual behaviour(s)

Issues around

gender and/or sexuality

Sexual

risk taking

behaviour

Slide7

Types of Sexual Difficulties

Slide8

Problems Health Advisers Might See

Mental Health:

effects of depression/anxiety on sexual

function, effects

of mental health on safer

sex, disclosure of abuse

Younger Patients:

impact of mental health on sexuality and

relationships, sexuality issues, consent

Older Patients:

issues of ageing and

sexuality

Intellectual

Disabilities

:

issues of consent for sexual

relationships, stigma

and beliefs around sexuality and learning

difficulties

Physical

Health

:

effects of medication/illness on sexual functioning,

effects of HIV/STIs on sexuality

Chem

Sex:

effects of drug use on safer sex, consent, relationships, sexual function

Slide9

Medical Causes of Sexual Dysfunction

These should be ruled out first

!

D

iabetes

Heart

disease

Surgery, injury

or trauma

Neurological

disorders

Medication

side effects

Hormonal changes

Fatigue!

Slide10

Other Causes

of Sexual Dysfunction

Performance anxiety

Unrealistic expectations

Depression/anxiety

Unresolved sexual orientation issues

Trauma

Conflicts in the relationship

Lack of education

Religious, personal, or family values

Low self-esteem

Slide11

Not For Psychosexual Therapy

T

here

is no

sexual problem (expectations)

Organic

cause

D

epression

or other mental health problems

A

lcohol

abuse/drug dependence

Domestic violence

Relationship

difficulties

S

exual assault/PTSD/trauma

Slide12

The Sexual Response Cycle

Masters and Johnson “

Human Sexual Response”

(1966) – linear

model, has limitations

Helen Singer

Kaplan (1979)

-

added

psychological, emotional, and cognitive factors

Many more models

since

Slide13

Break in the Cycle

Slide14

How

Does

It Work?

Individuals

or

couples

Psycho-education

Focus on the behavioural aspect of

sexual

dysfunction

C

ounselling/psychotherapy

to

address any underlying

issues

Sex positive,

non-judgemental, open

space

B

roader

issues

may include:

relationship therapysexual orientation and identity

gender diversity

puberty and adolescent sexuality

older people and sexuality

sexuality

and disability

sexual and reproductive health issues (

STI/HIV/IVF)

a

ddictions

Slide15

Practical Exercises

Masturbation/self-exploration

Positive body-image reinforcement

Mutual masturbation

Sensate focus

Mindfulness/relaxation techniques

Vaginal trainers

Toys/condoms/lube etc.

Reading/education

Slide16

Medications & Tools

Slide17

Medications & Tools

Slide18

Medications & Tools

Slide19

Medications & Tools

Slide20

Role Play

Turn to the person next you and discuss the last time you had difficulty having sex and how that made you feel

JUST KIDDING!!!!

Slide21

Case Study 1

Su Yin

is a19 year old student. She has

asked her GP for a referral

to psychosexual therapy after

reading an article about ‘sex addiction’ in a magazine. She reports spending most of her time thinking about

sex and says she has

had

lots of sex with

men and women she

meets out in clubs or via

the

internet. She often takes

cocaine

during sex.

Su Yin

says

she is

“never satisfied”

and wonders if she has a “hormonal problem”. She says she would like to “stop being a

slut” and

settle down with

someone but

quickly gets bored whenever she has a regular sexual partner.

Slide22

Case Study 2

Jeremy is 32 years old and identifies as MSM. He comes to the clinic complaining of erectile dysfunction. He tells you he can’t last as long as he used to and is asking about Viagra. He says this is really upsetting him and he wants to “get back to normal”. After further discussion, Jeremy tells you he was using Crystal Meth for the past year, but he is now sober and has a new regular boyfriend.

Slide23

Case Study 3

Melanie is a 26 year old heterosexual female. 2 years ago she was diagnosed with HSV 2. Her first outbreak was very painful and

t

raumatic but she has not had any recurrent outbreaks since. Melanie states its very painful in her vagina when she tries to have penetrative sex. The last time she tried was 18 months ago with a casual male partner.

Slide24

Merging My Two Roles

Idea

There is already

a psychosexual clinic in

place

I already have the qualifications

I have protected time to see patients

Can I see psychosexual patients?

Implementation

Discussion with manager and psychosexual service

Agree time off floor for supervision etc.

Secure place for notes

Appointments added to system etc.

Secretarial

assistance/running

my own

clinic

Maintenance

Supervision

CPD training

Slide25

Benefits - Me

Maintain my skills

CPD

Variety to my role

Cross-directorate working

Increased job satisfaction

Access to resources

Work in an NHS setting

Wide range of patients

Experience

Slide26

Benefits - Patients

“Sexual health”

does not simply mean free from sexual infections, it involves obtaining emotional and physical pleasure from

sex

All

treatment

options/services available at their

local

clinic - not

be referred to somewhere

else (anxiety, lost to follow-up, immediate access)

Sex positive environment, non-judgemental service

Space to be open -

helps to show that we prioritise emotional as well as physical

issues

I’m used to talking about all sexual problems

Able to “dig a bit deeper”

Wide range of knowledge

Access to onward referrals

Offer of an additional service – in high demand, complete “sexual health” service

Slide27

Benefits – My Team

We begin to be considered as a specialised team

I can share psychosexual/counselling

expertise within the

team - experience

, knowledge, training, links with other psychosexual

counsellors/services etc.

Boosts the professional standing of the JHC HA Team within the wider MDT

Provides a link between JHC and the

trust’s

p

sychosexual

s

ervice

(run from 56

Dean Street)

Slide28

Benefits – Health Advising

Broaden Health Adviser role

More specialised clinics & services

Scope for further training and qualifications - “Health Adviser” becomes a recognised and qualified role

Improves the professional standing of

HA’s

in sexual

health

HA’s

providing a psychosexual service provide a focussed and supported (via

supervision

) expert service for patients

Meets

a demand from patients

Slide29

In Conclusion

Sex

is more exciting on the screen and between the pages than between the

sheets

-

Andy

Warhol

Slide30

Resources

www.cosrt.org.uk

www.psychosexualtraining.org.uk

www.tccr.org.uk

The New Male

Sexuality

-

B.

Zilbergeld

Becoming

Orgasmic: A

Sexual

and

Personal Growth

P

rogramme

for

Women

-

Julia

R.

Heiman, Joseph

& Leslie Lo Piccolo

Ending Female Pain

– Isa

Herrera

How To Overcome Premature Ejaculation

-

Helen

Singer

Kaplan

Human Sexuality and its

Problems

-

John

Bancroft

Slide31

Questions

Thank you for listening, I am happy to receive any questions

Contact me:

l

ucy.snider@chelwest.nhs.uk

0203 315 6155