DOCTOR OF MEDICINE DOCTOR OF HUMAN SEXUALITY DOCTOR

DOCTOR OF MEDICINE DOCTOR OF HUMAN SEXUALITY DOCTOR OF PHILOSOPHY (IN HUMAN SEXUALITY) IASHS (Institute for Advanced Study of Human Sexuality), San Francisco, USA Royal Thai College of Obstetricians and Gynecologists Board Certified Sexologist, American College of Sexologists Degrees Certified Members ATIWUT KAMUDHAMAS

Division of Clinical Sexology and Sexual Medicine Department of Obstetrics and Gycecology Faculty of Medicine Thammasat University Thammasat Universit �������������� ���

Female sexual dysfunction Anatomy and physiology of women’s sexual function Sexuality in certain conditions FEMALE SEXUAL MEDICINE core curriculum Effects of certain situations on sexual function Sex education Women’s sexual health issues

Anatomy and physiology of women’s sexual function • Anatomy and physiology of female reproductive organs • Physiology of women’s sexual function and female sexual response cycle • Arousal spots and sensate focuses of women Sexuality in certain condition • Sexuality in pregnancy and puerperium • Sexuality in adolescent and the elderly • Sexuality in certainly ill patients : cancer / mental illness / disability Effects of certain situations on sexual function • Effects of drugs / illness / contraceptives on sexual function Women’s sexual health issues • STIs / HIV • Sexual healthcare for women • Sexual factors and infertility • Rape and sexual violence Sex education • Comprehensive sexuality education • Safer sex education • Sex education for public and schools • Sex coaching

Female sexual dysfunction • • • Sexual desire disorders Sexual aversion disorders Sexual arousal disorders Orgasmic disorders Sexual pain disorders Iatrogenic and post-traumatic female sexual disorder

Appetitive phase Hypoactive sexual desire disorder /Sexual aversion disorder Hypoactive sexual desire disorder due to a general medical condition Substance-induced sexual dysfunction with impaired desire Excitement phase Female sexual arousal disorder / Male erectile disorder Vaginismus Male erectile disorder due to a general medical condition Dyspareunia due to a general medical condition Substance-induced sexual dysfunction with impaired arousal Orgasmic phase Female orgasmic disorder / Male orgasmic disorder Premature ejaculation Orgasmic anhedonia Other sexual dysfunction due to a general medical condition Resolution Substance-induced sexual dysfunction with impaired orgasm Postcoital dysphoria / Postcoital headache

Prevalence of Female Sexual Dysfunction Prevalence and incidence studies of FSD are confounded by a lack of consistent methodology. Variability in levels of normal sexual function and the importance of sexual function to individuals and cultural beliefs also complicate the classification and determination of FSDs. Community studies indicate that the prevalence of female sexual dysfunction ranges from 25 to 63%. An important population-based study, a 63% substudy of the National Health and Social Life Survey, was conducted in 1992. It provides a probability sample among 1749 women and 1410 men living in the USA, aged 18 -59 years. Sarit O. Aschkenazi, Roger P. Goldberg Expert Rev of Obstet Gynecol. 2009; 4(2): 165 -178.

� Lack of interest in sex: 27 -32% � Unable to achieve orgasm: 22 -28% � Pain during sex: 8 -21% � Sex not pleasurable: 17 -27% ปญหาทพบบอยในเพศหญงไดแก low sexual interest ��� difficulty with orgasm The study found that sexual dysfunction is more prevalent in women than men (43 vs 31%). Lack of interest was the most frequently reported female sexual complaint.

Causative factors of female sexual dysfunction

3. FSFI (Female Sexual Function Index) Ø (link to PDF file) Ø 19 questions for assessment of female sexual dysfunction Ø FSFI scoring (PDF file) Ø Rosen, R. , Brown, C. , Heiman, J. , Leiblum, S. , Meston, C. , Shabsigh, R. , Ferguson, D. , D’Agostino, R Jr. (2000). The Female Sexual Function Index (FSFI): a multidimensional self-report instrument for the assessment of female sexual function. Journal of Sex & Marital Therapy, 26, 191– 208.

Physical examination 1. 2. Ø Ø Ø General PE เพอพยายามหาสาเหตทางกาย Genital examination เพอพยายามหาสาเหตทางกายภาพของอวยวะเพศ NIUB/MIUB : pubic hair / perineum / introitus / hymen / clitoris / urethra / Bartholin’s gland Vaginal : discharge / rogue / atrophic / infection Cervix : inflammation / ulcer Uterus : retroflexion / tenderness Adnexa : tenderness / cystic lesion Cul de sac : tender nodules

3. Sexological examination Ø Pelvic floor assessment : strength, painful contraction, relaxation Ø Personal sexual enrichment assessment Ø Specific sexological examination

Laboratory investigation � Urine analysis � STIs investigation � Pap smear � Urogynecologic study

Comprehensive assessment � Severity of problem � Intention to be treated � Patient’s adherence / compliance � Holistic approach / Bio-psycho-social

8. Tantra’s yoga for sex 9. Sexological hypnotherary

11. Sex therapy P : Permission LI : Limited Information SS : Specific suggestions IT : Intensive Therapy PLISSIT model : Annon 1976

International society in sexual medicine ISSM : International Society for Sexual Medicine � SMSNA : Sexual Medicine Society of North America � ESSM : The European Society for Sexual Medicine � APSSM : Asia Pacific Society for Sexual Medicine � ACS : American College of Sexologists � SSSS : Society for the Scientific Study of Sexuality �

International journal in sexual medicine � JSM : The Journal of Sexual Medicine � EJHS : Electronic Journal of Human Sexuality � IJSH : International Journal of Sexual Health � JSR : Journal of Sex Research

Sexual Health Clinic Thammasat University Hospital ลกษณะของผรบบรการ › Female Sexual Disorders ไดแก Orgasmic dysfunction, Frigidity, Dyspareunia › Male Sexual Disorders ไดแก Premature ejaculation, Erectile dysfunction, Retarded ejaculation › Male and Female Sexual Concerns ไดแก ขอสงสย ขอกงวลใจ ตางๆเกยวกบเพศ ลกษณะทางเพศ การรวมเพศ ของตนทตองการคำปรกษาจากผเชยวชาญ › Male and Female Sexual Variances ไดแก Homosexuality, Pedophilia, Gerontophilia, Necrophilia, Scatology, Sadistic and Masochistic, Fetishism › Marriage and Family Therapy ไดแก การทำครอบครวบำบดในกรณครอบครวมปญหาทพจารณาเบองต นแลวนาจะเกดจาก Sex, Love, Lust, and Intimacy › Psychosexual test ไดแก การทดสอบสขภาพจตสำหรบผปวยตองการเปลยนเพศ › Sexually transmitted infections ไดแก การรกษาโรคตดตอทางเพศสมพนธ (ทงผหญงและผชาย )