MEN'S SEXUALITY PRACTICAL SOLUTIONS FOR COMMON CONCERNS JAN BURNS SEXUAL THERAPIST VIRTUOS0 850 CAMERON TAURANGA

Transcription

1 MEN'S SEXUALITY PRACTICAL SOLUTIONS FOR COMMON CONCERNS JAN BURNS SEXUAL THERAPIST VIRTUOS0 850 CAMERON TAURANGA

2 Patient presentations include include: Post op prostatectomy, bowel surgery, spinal surgery, heart surgery, ostomy surgery, vascular surgery, other significant surgeries Medical conditions diabetes, arthritis, Parkinson s, medications Altered body perception scarring, loss of limbs, ostomies, weight loss/gain ACC assessments for treatment/therapy/product Gender reassignment Lifestyle Issues drugs, stress, unrealistic expectations Premature Ejaculation (PE or EE) Others torn frenulum, Peyronies Disease, fractured penis, adverse interactions!

3 A typical clinic consultation will include: - medical history - surgical history - sexual history if appropriate Medications interactions and cautions Screening labs undiagnosed conditions Counselling or refer on if appropriate Physical examination if indicated Implement practical solutions Ideally couples couple concern

4 PRACTICAL APPLICATIONS Implement practical common sense realistic achievable solutions solution focused therapy Give permission to implement changes, new ideas, options, ideas, fantasy, play (PLISSIT Model) ED Therapy treatment implementation PE Therapy medication & exercises Intimate positions use of pillows, tilt pillows, sex swings, toys, aural therapy, use of all senses power of touch, massage Assessments for referral on to other clinicians physio, couple therapy, counselling, hydro therapy, plastics, ACC Arrange make overs men and women therapist image consultant Seamstress pillows, full length body bean bags, intimate apparel, belly bands, altered garments Cabinet maker altered bed heights, custom made furniture, seats, attach sex swings, rails...

5 Common conversations include the use of Ostomies, Ileostomies, tracheostomies - Belly bands, stoma caps, how to deal with spillage, odour control, what happens if a bag bursts or comes off during sex, use of scarves, bandanas more recently H&N silence, huffing, breath in face, - new skill set confidence & control new skill set Scaring scar therapy, paper tape, compressions garments, cosmetic garments, satin boxers, urethral dilation, scars badges of courage Positioning/support of sacral area, injured or post op area using bean bags, micro beans bags, pillows, supportive undies lighter options like satin boxers

6 My role is to provide choices, options & common sense advice & implement treatments or therapy reintroduce confidence, self esteem and manliness through treatments, therapy, education, knowledge & choices Remind men that intimacy is not all about penetrative sex but that other options may be just as fulfilling such as smell, touch, taste, skin on skin, sniffing, flirting, caress, mutual pleasure, visual stimulation, toys, & explore alternatives

7 Work with other clinicians - Develop questionnaires appropriate to patient, area/department tangible information packages take home messages Provide books, DVDs, written information, clinical evidence Sessions on how to initiate that difficult conversation PLISSIT model ED treatments

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9 SEXUAL DYSFUNCTION TREATMENTS Oral Mediations Phosphodiesterase 5 (PDE5) - Sildenafil - Avigra, Viagra, Cialis LA & Daily,Levitra,Silvasta. Silagra, Vedafil Penile Injections Custom mixes - Caverject Vacuum Device Penile prosthesis Natural Therapies ignite/excite/horny goat weed

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11 Oral Medications Phosphodiesterase inhibitors (PDE5) - Need to be taken correctly education Need to be taken proactively when trialling Food and alcohol is a consideration Erotic thought process required timing & attempts critical Correct trial of samples Manual stimulation critical self pleasuring - therapeutic indications Expensive to affordable - Cialis 4 pk 20mgs $ compared to Silvasta 4 pk100mgs $30.00 Side effects facial flushing, headache, nausea, vomiting, visual disturbances, nasal congestion, dyspepsia, nerve ending irritation sciatica, shingles, arthritis, wheeze

12 Intracavernosal Penile Injections Surprisingly not painful small diabetic syringe 27g needle Can use an auto injector Fast, quick acting effect 30 secs to 5 mins Safe localised effect not systemic less side effects Cost varies - $7.90 to $55.00 per shot after starter pack ($120.00) Range of mixes aids tolerance Some control over use budget Visual disturbances injecting own flesh especially the penis Side effects include localised pain, bruising, priapism risk of Peyronies Disease

13 PENILE INJECTION SITE

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15 Vacuum Device Nothing visually stimulating to most couples/men Hydraulic process the more you pump, the harder you ll be Useful post op as a penile workout Can increase target area if using penile injections Patient must have good dexterity & good eyesight Need to determine right ring tension Manual and automatic (battery powered) Cost ranges from $50.00 to $ Side effects can include bruising, frenulum splitting

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17 VACUUM DEVICE

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19 PENILE PROSTHESIS: Becoming more popular with education & awareness of device Often covered by insurance 80% - 100% depending on policy Expensive - $30,000 NZD One button push - activation required at time Hydrophilic & Antibacterial coated Non-carcinogenic balloon is saline filled Surgical procedure overnight 6 weeks to activation Risk of penile shortening Side effects haematoma, bruising Last choice in options once inserted

20 Penile Prosthesis Continued. In USA considered Gold Standard & often 1 st treatment choice - insurance Activation required on demand Climax still possible Erections often better than before surgery or treatment natural decline from wear & tear Lifetime guarantee of device Stunning erections!

21 PENILE IMPLANT

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25 PEYRONIES DISEASE

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27 FRACTURED PENIS

28 Useful contacts.. Counsellingformen.org.nz project from Canterbury Men's Centre Rekindleonline.org.au online resource addresses sexual concerns for adults affected by cancer personally tailored to suit journey Praxis on Seventh Clinical psychologists/psychotherapists Relationships Aotearoa Mana Tane Ora O Waitaha CHCH & Canterbury - local champions making a difference for Maori Men lingerie, swings, toys etc toy shop for adults/patients/clients

29 THE DREADED D.R.E.!