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Female Sexual Dysfunction: Couples Who Need a Helping Hand

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Female Sexual Dysfunction: Couples Who Need a Helping Hand

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Presented by Clinical Sexologist Dr. Martha Tara Lee of Eros Coaching as part of Certificate of Andrology by Society of Men's Health, Singapore at Amara Hotel on 9 April 2016.

Dr Martha Tara Lee is Founder and Clinical Sexologist of Eros Coaching since 2009. She is a certified sexologist with ACS (American College of Sexologists), as well as a certified sexuality educator with AASECT (American Association of Sexuality Educators, Counselors, and Therapists). Martha holds a Doctorate in Human Sexuality as well as Certificates in Sex Therapy, Practical Counselling and Life Coaching. She was recognised as one of ‘Top 50 Inspiring Women under 40′ by Her World Singapore in July 2010 and ‘Top 100 Inspiring Women by CozyCot Singapore in March 2011. Website: http://www.eroscoaching.com.

Presented by Clinical Sexologist Dr. Martha Tara Lee of Eros Coaching as part of Certificate of Andrology by Society of Men's Health, Singapore at Amara Hotel on 9 April 2016.

Dr Martha Tara Lee is Founder and Clinical Sexologist of Eros Coaching since 2009. She is a certified sexologist with ACS (American College of Sexologists), as well as a certified sexuality educator with AASECT (American Association of Sexuality Educators, Counselors, and Therapists). Martha holds a Doctorate in Human Sexuality as well as Certificates in Sex Therapy, Practical Counselling and Life Coaching. She was recognised as one of ‘Top 50 Inspiring Women under 40′ by Her World Singapore in July 2010 and ‘Top 100 Inspiring Women by CozyCot Singapore in March 2011. Website: http://www.eroscoaching.com.

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Female Sexual Dysfunction: Couples Who Need a Helping Hand

  1. 1. Female Sexual Dysfunction: Couples Who Need a Helping Hand Certificate of Andrology for Society of Men’s Health 9 April 2016
  2. 2. Dr. Martha Tara Lee Clinical Sexologist • Doctorate in Human Sexuality • Masters in Public Policy and Management • Bachelor of Arts (Comm) • Certificate in Sex Therapy • Certitificate in Practical Counselling • Cert in Life Coaching
  3. 3. Agenda 1. Sexology 2. Sexual Dysfunctions 3. Treatments 4. Let’s Talk about Sex 5. Quiz
  4. 4. What is Sexology? Study of sexual interests, behavior, and function which combines: Biology Physiology Medicine Psychology Statistics Epidemiology Criminology Religion Philosophy Zoology Anthropology Sociology
  5. 5. Sexologists study: Sexual development Sexual orientation Sexual relationships Sexual activity Sexualities of special group
  6. 6. Common Sexological Issues • Body image and sex- negative conditioning • Sexual desire • Courtship concerns • Obstacles to Intimacy • Sexual development, maturation and aging • Sexual communication and negotiation • Medical considerations affecting sexuality • Atypical sexual behaviours • Sexual trauma • Gender identity • Sexual orientation • Sexual education for parents • Women’s concerns • Men’s concerns
  7. 7. • Hypoactive Sexual Desire Disorder • Sexual Arousal Disorder • Sexual Aversion Disorder • Female Orgasm Disorder • Sexual Pain Disorder Dyspareunia Vaginismus Female sexual interest/ arousal disorder Genito-pelvic pain/penetration disorder DSM-5 Female Sexual Dysfunctions
  8. 8. Frigidity Inhibited Sexual Desire Disorder - DSM-3 Hypoactive sexual desire disorder - DSM-3-R Female sexual interest/ arousal disorder - DSM-5 A Name is Just a Name?
  9. 9. • Sexual dysfunctions (except substance-/medication- induced sexual dysfunction) now o Require a duration of approximately 6 months and o More exact severity criteria • Subtypes for all disorders include only o “Lifelong vs. acquired" and o “Generalized vs. situational” • Two subtypes were deleted: o “Sexual dysfunction due to a general medical condition" and o “Due to psychological versus combined factors" More on DSM-5
  10. 10. Sexual Response
  11. 11. Factors Influencing Sexual Response • Vascular (Blood Vessels) • Neurological (Brain) • Hormonal • Psychological (Mental mind) • Relational • Psychosexual skills
  12. 12. Sexual Desire • Begins in the brain. • The experience of sexual fantasies, thoughts, and wanting to engage in or be involved in sexual activity. • Includes being responsive or receptive to sexual advances by a partner and of wanting to continue the activity once physical contact begins.
  13. 13. Responsive Desire Spontaneous Desire
  14. 14. NightMorning
  15. 15. My Observations 1. Before Pregnancy • Female: Fears/ anger/ dismissive – just sperm • Male: Sexual performance anxiety 2. During Pregnancy • Female: Mood swings • Male: May not have any sex 3. After Baby • Female: Tired • Male: When are things going to get better?
  16. 16. Madonna/ Whore Syndrome
  17. 17. 1. Guilt – much to be grateful for 2. Dismissed – I’d just go away/ withdraw 3. Rationalized - she’s a good person/ wife/ mother 4. Frustrated – why am I always last on the list? 5. Anger – towards wife/ child For Men - Persistent lack of sex
  18. 18. 6. Rejected – no longer a priority 7. Self-esteem - No longer attractive to their partner – own self-perceived lack of attractiveness 8. Used – to procreate only 9. Internalize things – must have done something wrong For Men - Persistent lack of sex
  19. 19. Psychosocial Issues • Lifelong or acquired • Symptom or situational • Unresolved history of sexual abuse or trauma • Body image/ Self-esteem issues • Psychiatric history • Stress, anxiety, sadness • Relationship conflict • Partner’s sexual dysfunction
  20. 20. Relationship Problems • Anger • Poor Communication • Criticism • Neurotic Interactions • Incompatible Sexual fantasies • Alcoholism & Sexual Abuse • Phobic Avoidance of Sexual Intercourse • Unconscious Conflict about Sex, Commitment, Pregnancy • Sexual Abuse Issues
  21. 21. The Orgasmic Diet 1. Take supplements (especially fish oil); a multivitamin; calcium, magnesium, and zinc; and extra iron and vitamin C. 2. Balance of 40 percent carbs, 30 percent protein, and 30 percent fats at every meal. • Avoid trans fats and polyunsaturated fats, including vegetable oils such as corn oil, soybean oil, and safflower oil, that counteract the benefits of the omega-3 fatty acids • Eat monounsaturated fats like olive or canola oil or moderate amounts • Eat a half-ounce of quality dark chocolate every day. 3. Avoid things that interfere with sexual function, including caffeine, cigarettes and other stimulants; hormonal birth control; and drinking alcohol to excess. 4. Exercise the PC muscles Lindberg, M (2008) The Orgasmic Diet: A Revolutionary Plan to Lift Your Libido and Bring You to Orgasm, Harmony
  22. 22. The Low Down on Low Libido • Increase sea vegetables • Increase beans • Increase root vegetables • Increase water • Increase spicy foods • Increase chocolate • Reduce alcohol Source: Vitti, A. (2013) Woman Code, HarperOne, p. 298
  23. 23. Lack of Sexual Drive 1.Communicate 2.Get Tested 3.Arms on Deck 4.Schedule Sex 5.Prepare for sex 6.Self care a. Exercise b. Quit smoking c. Food
  24. 24. 7. Expand your ways of having sex a. Masturbation witnessing b. Mutual masturbation c. One-way sex d. Sex toys 8. Recruit a Taskforce 9. Give it some time Lack of Sexual Drive
  25. 25. What is Vaginismus? Involunatry contraction of vaginal muscles making penetrative sex difficult or impossible
  26. 26. Kegels
  27. 27. • 28 lessons + transcripts • Affordable • 24 x 7 Online Access • Multiple access • Personalised email support Online Program
  28. 28. Sensate Focus • Week 1 & 2: Non-genital sensual touch • Week 3 & 4: Genital tease • Week 5 & 6: Genital stimulation • Week 7 & 8: Vaginal containment • Week 9 & 10: Vaginal containment with movement (intercourse)
  29. 29. Dyspareunia 1. Where is the pain? 2. When did it start? 3. What was done? 4. What treatments has been attempted? 5. Is it hormonal? 6. Ask about arousal/ lubrication 7. Recommend lubricant 8. Suggest pelvic floor specialist 9. Begin with self-exploration 10. Keep pain journal 11. Explore doing genital massage
  30. 30. Lack of Sexuality Education
  31. 31. We Don’t Ask Because Of… • Personal embarrassment • Lack of knowledge re: clinical relevance • Ignorance re: who, when, how, or what to ask • Concern re: not knowing how to answer questions • Concern re: becoming aroused/uncomfortable • Concern re: appearing seductive/intrusive • Uncertainty about legal issues • Time constraints
  32. 32. ISIS Model
  33. 33. 1. A couple comes in and cannot consummate their marriage. A sexologist would… a) Tell them to use lubricant and try harder b) Clarify if they mean never had penetrative sex c) Check for their reasons of why unable to have sex d) Ask if they know what vaginismus is e) All except a What Would You Do? - Quiz
  34. 34. 2. A couple comes in and say the wife has low sex drive. A sexologist would… a) Find out what their definition of low sex drive is b) Ask if they have gone for medical check ups c) Check what they tried d) Explore the sexual attitude of the woman e) All of the above What Would You Do? - Quiz
  35. 35. 3. A lady comes in and attribute her low sex drive to being sexually violated when she was 5 - 15. A sexologist would… a) Encourage her to get over it – it’s all in her head b) Insist she must tell her husband about it c) Tell her to go to the police so justice is served d) Teach her to do kegels e) Explore what her goals are What Would You Do? - Quiz
  36. 36. 4. A couple comes in and say the wife has low sex drive. The lady is very negative about everything that is discussed. She gets angry and defensive. A sexologist would… a) Ask if she has gone for a medical check up b) Tell her she has an attitude problem c) Sit back and let her talk – It’s her money d) Admit she is beyond hope e) Check if she has depression What Would You Do? - Quiz
  37. 37. 5. Your patient starts crying in consultation. She admits she is feeling depressed. Do you… a) Pass her tissue, and tell her to stop crying b) Just do your job and give her the drugs she came for c) Refer her to staff nurse d) Send her to a mental health professional e) Ask if she has suicidal thoughts What Would You Do? - Quiz
  38. 38. Odds and Ends GROW Model Permission to self – Pleasure; to use vibrator, Ask for certain kinds of touch, caress. Limited Information – Changes in sexual response with pregnancy, menopause, aging. Impact of medication(s) on sexual function. Specific Suggestions – HRT benefits and risks, use of lubricants; Positions. Intensive Therapy – Refer to specialists for couple therapy, resolution of long-standing problems. PLISSIT Model Counseling Skills
  39. 39. Don’t Ask Don’t Care What We Want to Avoid…
  40. 40. What is Your Approach? •Sex-positive •Non-judgemental •Educational •Client-centered •Do no harm
  41. 41. Dr. Martha Tara Lee Clinical Sexologist Eros Coaching Pte Ltd Website: www.eroscoaching.com Email: drmarthalee@eroscoaching.com

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