Lucy Snider Sexual Health Adviser Psychosexual Therapist One

Lucy Snider Sexual Health Adviser Psychosexual Therapist “One normal sex life please”

Who Am I? ? Psychology background � Post-graduate counselling & psychotherapy � Psychosexual training � Working for THT � HIV& Sexual Health training � Healthcare Assistant � Health Adviser �

What is Psychosexual Therapy? Sex counsellor � Sexuality counsellor � Psychosexual psychotherapist � Sexologist � Sexual therapist � Sex worker? ! �

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

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

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 �

Types of Sexual Difficulties Penile HIV/STI Related Anxiety Vaginal Addictions/ Hypersexual Anal Arousal

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

Medical Causes of Sexual Dysfunction � These should be ruled out first! › Diabetes › Heart disease › Surgery, injury or trauma › Neurological disorders › Medication side effects › Hormonal changes › Fatigue!

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 �

Not For Psychosexual Therapy There is no sexual problem (expectations) � Organic cause � Depression or other mental health problems � Alcohol abuse/drug dependence � Domestic violence � Relationship difficulties � Sexual assault/PTSD/trauma �

The Sexual Response Cycle Orgasm Plateau Resolutio n Excitement 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 �

Break in the Cycle Avoids sex, low selfesteem, depression Worries and anticipates won’t get an erection Reinforces idea “I have erectile dysfunction” Anxiety & Adrenalin Can’t get an erection

How Does It Work? � � � Individuals or couples Psycho-education Focus on the behavioural aspect of sexual dysfunction Counselling/psychotherapy to address any underlying issues Sex positive, non-judgemental, open space Broader issues may include: › › › › relationship therapy sexual orientation and identity gender diversity puberty and adolescent sexuality older people and sexuality and disability sexual and reproductive health issues (STI/HIV/IVF) addictions

Practical Exercises Masturbation/self-exploration � Positive body-image reinforcement � Mutual masturbation � Sensate focus � Mindfulness/relaxation techniques � Vaginal trainers � Toys/condoms/lube etc. � Reading/education �

Medications & Tools

Medications & Tools

Medications & Tools

Medications & Tools

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!!!!

Case Study 1 � Su Yin is a 19 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.

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.

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 traumatic 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.

Merging My Two Roles � Idea › › � Implementation › › › � 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? 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

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 �

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

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 psychosexual service (run from 56 Dean Street) �

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 � � �

In Conclusion Sex is more exciting on the screen and between the pages than between the sheets - Andy Warhol

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 Programme 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 � �

Questions � Thank you for listening, I am happy to receive any questions � Contact me: › lucy. snider@chelwest. nhs. uk › 0203 315 6155