Introduction to Psychosexual Medicine Doctor Gillian Vanhegan Member of the Institute of Psychosexual Medicine

Course Objectives To understand psychosexual problems To be familiar with different treatment methods for psychosexual problems To be able to use the practitioner/patient relationship therapeutically and the psychosomatic examination of the genitalia To have confidence to manage psychosexual problems in your normal practice

Session Three Any comments on the study of the consultation? At what stage of the consultation do we examine the patient, any triggers Observations on a non examination Interpretation of the psychosomatic examination and parallels with other life events

Session Three continued Different treatment options CBT Relationship counselling Sensate focus Use of vaginal trainers Medication in session four

The examination (1) Avoidance or refusal Preparation Placement of underclothes Embarrassment or distaste Attitude on the couch

The Examination (2) Involved or detached Eye contact or looking at the ceiling Overly sexualised Comments made during the examination Parallels with sexual activity or lack of it

The Examination (3) Always listen to the patient’s anxieties Consider what is said after the examination

Other Therapies Cognitive Behavioural Therapy Relationship Counselling Sensate Focus Vaginal Trainers

Cognitive Behaviour Therapy Problem orientated Doctor/therapist takes expert role Specific aims established ‘Homework set’ Both partners attend therapy

Sensate Focussing Patient develops heightened awareness of sensations rather than focussing on performance Immediately achievable goals set—to ‘enjoy touching’ rather than to ‘achieve penetration’ Explicit instructions given—’non-genital pleasuring’,’genital pleasuring’, ‘containment without thrusting’

Ground Rules Choose a place where you will not be disturbed Turn off phones Use music, candles, aromas etc. Take turns giving and receiving touching Enjoy the journey Take time and only move on when both are ready

Desensitisation Digital self examination Using dilators

Conclusion So now you can put the two most important parts of the psychotherapeutic treatment together The analysis and reflection of the D/P/R The reflection of the psychosomatic examination of the genital area

Conclusion continued Also be aware of other therapies, which require the doctor/therapist to take the ‘expert role’ and work out a programme and give homework Remember that the psychodynamic approach is patient led

Reminder Case Presentation Develop free floating attention Think about what the patient was like What was said and how it was said How did you feel and what were the feelings in the room? What happened during the examination Reflections on the case

Reminder Case Discussion Listen carefully to the presentation, noticing what you are feeling about the patient In the discussion express your thoughts and feelings about the case, try not to ask too many questions Think about how the practitioner/patient relationship might relate to the patient’s problem

Next Session Male problems Physical treatment Surgical treatment Psychological treatment