1. Medical issues that impact on sexual function – a blessing in disguise? Nic Beets & Verity Thom Psychologists at “CoupleWork” Auckland

2. “I had cancer. As a result, our sex life improved and our relationship became more intimate”

3. #1: We have to talk about our clients' (patients') sex life not just their sexual functioning For most people their sex life is an interactional/relational issue 4 key points:

4. #2: Sex is a team sport It's vital the impact on their partner and the relationship is addressed 4 key points:

5. #3: It is our responsibility to facilitate best possible outcome Hold out for them the possibility that their sex life & relationship could become stronger, more intimate, more resilient than before 4 key points:

6. #4: Our purpose & intention shapes our clients' outcomes Are we focused on harm reduction AND facilitating growth? 4 key points:

7. Harm reduction & facilitating growth Focus on function Emphasis on intercourse Criteria for success = medical condition cured/halted with minimal harm Focus on selfhood & intimacy Emphasis on connection & communication Criteria for success = changes forced by medical condition lead to more intimacy

8. Case: The 'Blessing' of Peyronies Ruth 48 uni educated working part time Paul 55 a self made business man Together 20 years, two children 11yrs and 9yrs 2 years ago Paul noticed mild curvature of penis, no other change in shape

9. Paul comfortable mentioning to GP, had previously discussed ageing and erectile functioning Referred to Urologist Diagnosed with early stage Peyronies

10. Urologist enquired re any impact on his sex life and how his wife was about this Urologist outlined future likely progression, increased impact on sex life and benefit of addressing with partner sooner rather than later Hopeful, positive adjustment implied

11. Paul reported to GP a year later symptoms of mild depression, reduced hardness of erection, increased curvature and decline in his sex life GP's enquiry led to Paul speaking of his fears about no longer being able to satisfy his wife who now seemed disinterested in sex.

12. GP encouraged discussion with his partner & mentioned non intercourse based sexual pleasure Discussed idea of partner coming to future consultations Paul receptive as ideas seeded year earlier by Urologist but nervous about talk with partner going well >> GP referral to me.

13. Got them talking with me and each other about their sex life. Initially their history and then current state of play Then about their fears, assumptions, beliefs and attitudes

14. Discussed intimacy-based versus intercourse-based sex life Developed sexual repertoire beyond intercourse Established strong talking/team approach to future sex life

15. Established hopeful attitude to maintain sexual relationship whatever the future might bring After 3 sessions they reported: “really good soulful and erotic sex... different from what we usually have”

16. Potential benefits of a prompt, growth oriented & intimacy focused approach: - less intervention required - increased self-awareness - improved ability to talk about sex and other challenging topics - more resilient relationship - BETTER sex than pre-morbidly

17. Case: Decimation caused by fatigue Eve (53) & Adam (57) Both managerial (university educated) Together 25 years 2 children: boy 20 & girl 18

18. Eve problems with severe fatigue last 7-8 years LOTS of investigations, no diagnosis Given advice on diet, stress, self- care... NO mention of impact on her relationship let alone sex life Eve feeling a failure & defective, Adam feeling rejected, unimportant

19. 3 years ago Eve seeks support from individual psychologist Encouraged her to say “no” to sex and characterised Adam as unsupportive and selfish for wanting sex Relationship on verge of ending: Eve withdrawn & feeling hopeless, Adam avoidant, irritable & feeling unwanted

20. Late intervention – huge cost in suffering over 8 years They did get sorted eventually Required more therapy (20+ sessions) because had to address years of hurt and confusion

21. IDEALLY: Early & ongoing discussion of implications of condition on sexuality & sex life Check clients not catastrophising Consider inviting partner in: model awareness of relationship impact Stress hopeful possibilities of challenges to sexual functioning

22. IDEALLY: Encourage discussion with partner – stress import of this despite difficulty NB: EASIER to do this in relationship to a medical problem HARDER if you can't do it in your own relationship Refer to relationship therapist who works with sexual issues if necessary