Woet Gianotten, MD-psychotherapist consultant in physical rehabilitation sexology De Trappenberg, Huizen. Part 2

Size: px

Start display at page:

Download "Woet Gianotten, MD-psychotherapist consultant in physical rehabilitation sexology De Trappenberg, Huizen. Part 2"

Juliana West
5 years ago
Views:

1 Woet Gianotten, MD-psychotherapist consultant in physical rehabilitation sexology De Trappenberg, Huizen Part 2

2 Physical impairment and sexuality

3 Differentiation A change in approach and a change in consequences! bio- psychosocial causes Disease Sexual dysfunction a pro-active responsibility! sexual function sexual identity sexual relationship

4 Let s talk about sex

5 What do you have already for that? You are expert in your own patient group You are seen as an expert! You know more than average on sexual health! Sex is no more a big deal (this is 2011) Proper communication is part of your jobs In sexual matters that is not so very different!

6 Many of you have children What else do you have? Talking about young people So, you have to think sex By chosing your specific profession you have responsibilities! Why should that not be the same in matters of sexuality / intimacy?

7 Avoiding the sexual topic in people with a chronic disease or impairment is a sign of bad care!

8 If you address sexuality, butdat notwél in the doen, senior maar population, niet bij senioren, that is een is a vorm form van of leeftijdsdiscriminatie! age discrimination!

9 The majority of people is very happy when you address the topic of sexuality / intimacy! An example: Erasmus MC Women with urinary incontinence What about sexuality? How do you consider our questions / interest in this matter? van hethoe et This overgrote is suchdeel a shameful topic! van de mensen But I am so glad that you ask this! is bovendien erg gelukkig als u het thema aankaart. Vierhout & Gianotten. Eur J Obs Gyn Repr Biol 1993;52:45-7

10 Hilde de Vocht (psychologist with thesis in NL and UK topic: sexuality & intimacy in the terminal stage ( in cancer or muscular diseases / ALS) Q 1. Did the professionals ever ask about sex? A.: Never! Q 2. What about sexuality / intimacy? A.: Big range of behavior! Q 3. How should you have reacted, when that had been asked? A.: Happy and thank you! My guess: You need not be so afraid about using the exact phrases.

11 How can one do that? Integrate it as something normal function of the bladder,... sexual function,... function of the bowels,... Anamnestic phase Make a clear connection with the disease / treatment ( and as such with your role as professional in this process) Is, since the medication... Is, since your stroke (CVA)... Is, as a result of the intervention... Is, in this position your sexual desire changed?... the erection less strong?... something changed in orgasming?... intercourse still possible?

12 In the education We know that multiple sclerosis can seriously influence sexual functioning. Don t be too surprised if that happens also with you. By the way, we have solutions for the majority of those changes or problems!

13 For the physiotherapist So this movement is rather difficult. This is also the movement that most people make during lovemaking. If that movement is giving you problems or pain, we most probably will have solutions for that.

14 In education I don t know if you are already in the mood for sexual contact. In case you are, do you realise that you have to use condoms? Are you sufficiently informed about that? Do you know how to arrange that and do you know how to use them?

15 Prevent undesired pregnancy Prevent STD / HIV transmission The big 5 Prevent sexual abuse Prevent / diminish homophobia Positive sexuality A mixture of personal rights and citizen duties! In education Not only genital, but also to develop interaction competence

16 Rehab. physician Now, you are using this antidepressant since two months Since then, did you observe changes in sexual function? Did anything change in your sexual desire? Did anything change in your erection ( getting hard )? And what happens most frequently with these drugs, did anything change in your orgasm?

17 What else can you offer? The skill to deal with topics that are politically NOT-CORRECT, and the skill to deal with people that are politically NOT-CORRECT (and not so sexy?) Why not do the same with the areas of sexuality and intimacy?

18 3 examples M1. Anne (22 years, married) with a neurological disease. She has an orthodox religious background. Nevertheless you ask about the changes in sexual function. Her orgasm gradually has disappeared. Both she and her husband really miss that orgasm. Then you explain how that most probably has developed Strong stimuli most probably will lead to an orgasm. I guess in your case orgasm can be reached with a vibrator. However, with your religious background, I am not sure, if a vibrator could fit in your sexual life?

19 M2. Erik (18 yrs) has an advanced stage of a muscular disease. Your question: Erik, what else can we do for you? Erik s answer: You know... I don t want to die as a virgin. I d like once to have sex... Please, take 4 minutes to discuss this request with your colleagues.

20 M3. Leif 24 yrs with serious cerebral palsy. He is intelligent, but his speech is very problematic. Will you ask him about sexuality / relations / intimacy? He cannot masturbate without aids (tools) He never had physical sexual contact and he really misses that. What now? We tended to say Every Jack will find his Jill But that is not very realistic (and maybe not fair?) Maybe it is wise to approach your situation in a different way! mourning? adapted vibrator? professional sex care? Please discuss with your colleagues. What solutions could be available here?

21 Where are the boundaries of what you can do yourself? The P LI SS IT model P LI SS IT P LI SS IT P LISS IT P LI SSIT

22 P LI SS IT P LI SS IT Every discipline! Folders Matter of course approach Room for being together with partner Attention for sexuality in history taking Attention for sexual side effects For most professionals (every discipline!) Forget the limited once in a while. The extensive (good and bad) information of internet prices us out of the market!

23 P LI SS IT Every discipline? Physiotherapy Occup. Ther. Social work Physician Rehab nurse positions tools, toys & timing contacts medication / pain / side effects continence matters, etc

24 P LI SS IT For instance rehabilitation sexologists NB we lack much expertise and subspecialisation Two examples: Sexology trained relationship therapists with specific TBI / stroke expertise Treaters for the young (orthopedagogy / psychology) trained in sexology (child sexology)

25 Conclusion: There is enough to be done! End of part 2

LET S TALK ABOUT CANCER AND SEX

Teva Pharmaceuticals Europe BV, Piet Heinkade 107, 1019 GM Amsterdam, Netherlands Date of preparation: March 2017. HQ/ONCO/17/0001 LET S TALK ABOUT CANCER AND SEX Woet L. Gianotten Consultant in oncosexology