1. Powered by Introduction to Psychosexual Medicine: Session 2

2. COURSE OBJECTIVES To be familiar with different approaches to the treatment of sexual dysfunction To understand the use of the ‘doctor-patient relationship’ in psychosexual medicine To have confidence to manage presentations of sexual dysfunction in your normal practice

3. SESSION 2 Revision of session 1 Superficial dyspareunia and vaginismus Case discussion

4. SESSION 1: REVISION Explain what is meant by ‘psychosexual dysfunction’ Outline different approaches to treatment Understand IPM training

5. By the end of this session you will be able to: List the causes of superficial and deep dyspareunia Appropriately manage a presentation of dyspareunia including an explanation of vaginismus

6. Causes of deep dyspareunia Gynaecological: PID Endometriosis Ovarian cysts Fibroids Malignancy

7. Deep dyspareunia:2 Related to bowel problems: IBS Crohns/ulcerative collitis Constipation Malignancy Other: Bladder infection Musculoskeletal Pelvic adhesions

8. Causes of superficial dyspareunia:1 Infectious: Candidiasis HSV Trichomoniasis/bacterial vaginosis Dermatological: Eczema Psoriasis Contact dermatitis Lichen sclerosis Lichen planus Behcets

9. Causes of Superficial Dyspareunia: 2 Surgical/traumatic: Episiotomy/tears Radiotherapy/excisions FGM Malignant Anatomical

10. VAGINISMUS “Vaginismus occurs when the muscles around the outer third of the vagina contract involuntarily when vaginal penetration is attempted (during sexual intercourse).”

12. Managing a consultation Take a history: 1.Superficial or deep? 2.Associated symptoms? 3.Underlying conditions? 4.Duration of symptom? 5.Does anything help? 6.Previous investigations/treatment? Examine Explain Plan future management

13. By the end of this session you will be able to: List the causes of superficial and deep dyspareunia Appropriately manage a presentation of dyspareunia including an explanation of vaginismus

14. HOMEWORK: DEVELOPING FREE-FLOATING ATTENTION 1.During a consultation When you are with the patient notice: What is she (he) like? How is she sitting? What are her opening words? How are you feeling? Do you find yourself behaving differently from normal? Try and notice exactly what is said, what is her particular choice of words How does the consultation end? How do you feel afterwards?

15. HOMEWORK: DEVELOPING FREE-FLOATING ATTENTION 2.During an examination When you examine a patient notice: How she behaves before you examine her, what she says, can you detect any emotions How does she hold herself on the couch? What does she say? What do you say? How do you feel when you examine her? Is it different from usual? What happens afterwards? Her words, her manner. Has the atmosphere in the room changed? If so, how?

16. PRESENTING A CONSULTATION Describe what happened in detail, setting, referral, opening words, appearance of patient, what you were thinking/feeling Try and report what was said by you and your patient rather than a traditional ‘medical history

17. GROUP DISCUSSION Listen carefully to the presentation, noticing what you are feeling about the patient Try not to bombard the presenting doctor with questions (some questions are fine) but rather try and express your thoughts and feelings abut the case, the patient, and the interaction Think about how the consultation (doctor patient relationship) and the patient’s story might relate to their sexual problem