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

2. 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

3. 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

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

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

6. 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

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

8. Other Therapies Cognitive Behavioural Therapy Relationship Counselling
Sensate Focus
Vaginal Trainers

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

10. 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’

11. 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

12. Desensitisation
Digital self examination
Using dilators

13. 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

14. 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

15. 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

16. 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

17. Next Session Male problems Physical treatment Surgical treatment
Psychological treatment