Norge. 14 inhabitants / km 2. Nederland. 400 inhabitants / km 2

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Justina Walton
5 years ago
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2 Norge 14 inhabitants / km 2 Nederland 400 inhabitants / km 2

3 Living with so many people together we are obliged to talk and discuss That is probably one of the reasons that we are rather liberal in socio-ethical and sexual matters

4 Results of this Dutch open and pragmatical attitude: The Netherlands Norway Low abortion rate 160% Low teenage (15-19 yrs) abortion rate 176% Low teenage (15-19 yrs) childbirth rate 138% High acceptance of diversity Same sex marriage: legal since 1998 since 2009 Prostitution legalised Sex education in primary schools (<age 12 yrs) is increasing

5 Results of this Dutch open and pragmatical attitude: The Netherlands In teaching rehabilitation professionals it is normal to integrate gay/lesbian case histories High acceptance of diversity Same sex marriage: legal since 1998 Prostitution legalised Specialised sex workers for people with various impairments are accepted and can be easily discussed

6 Results of this Dutch open and pragmatical attitude: The Netherlands In teaching rehabilitation professionals it is normal to integrate gay/lesbian case histories High acceptance of diversity Same sex marriage: legal since 1998 Prostitution legalised Specialised sex workers for people with various impairments are accepted and can be easily discussed

7 Structure of this presentation 1. A small introduction to sexuality 2. The development of sexual problems in disease and physical impairment 2. Dealing with sexual problems 3. Multidisciplinary approach: disciplines & sex 4. Teaching or training? 5. Unmet needs: single & lonely 6. Unmet needs: youngsters & transition Unstructured structure!

8 Many different ingredients make up the pleasurable stew that we call sexuality. Sexual relationship Culture Evolutionary biology

9 Why do people have sex? Why? Why is discussing sexuality important?

10 Why do people have sex? Relation (love, intimacy, etc) Procreation Recreation (fun, adventure, lust, etc) Habit

11 The function(s) of sex Procreation Recreation Relation To repair the damage after the battle between the sexes To console and comfort Improve the human self-esteem Improve the male / female self-esteem To cope with heavy emotions

12 Could these functions be useful in the process of rehabilitation? Feels good To console and comfort To improve self-esteem To cope with heavy emotions

13 The physical health function(s) of sex In males: More orgasms cause less prostate cancer More orgasms cause less cardiovascular disease & less cardiovascular death Regular sex improves fertility In females: Sex increases the pain threshold Sex diminishes some of the obstetric syndromes In both females & males: Sex relaxes the muscles Sex diminishes depression & increases QoL Sex maintains a youthful appearance & diminishes the hip-waist ratio The integration of sexuality and spirituality has a beneficial effect on quality of life and strength of relationships

14 Potential rehabilitation benefits? In males: Regular sex improves fertility In females: Sex increases the pain threshold Could pro-actively be used in: spinal cord injury various pain syndromes In both: Sex relaxes the muscles (even the bladder function!) MS, CP, SCI

15 Potential rehabilitation benefits? In both: Sex diminishes depression & increases QoL In both: Massage & orgasm increase the oxytocin level better sleep and more mutual trust Could be used pro-actively in: Next to the physical benefits there can be many other benefits in sexual identity Feeling well Feeling male / female / human Etcetera Hilde de Vogt s data many patients! many patients!

17 Sexuality How does it function?

18 The basics of sexual function male female desire excitement arousal orgasm

19 Needed for desire: Enough testosteron. Good enough neurotransmitter balance: male female dopamin, prolactin, Etc. Sexual desire

20 In the female: First contact & committment. Then eventually arousal. Then desire can develop and continuation to orgasm Man and woman are different In the male: First desire. Then continuation (more or less linear) Sexual desire Basson ea J Psychosom Obstet Gynaecol. 2003; 24:

21 Difference in fuel level nmol/l Puberty From the testes From the ovaries From the adrenals Testosterone (T) : The sexual fuel for both man and woman Menopause

30 28 26 24 22 20 18 16 14 12 10 8 6 4 2 0 nmol/l Average T - levels

22 nmol/l Average T - levels Falling in love T levels When falling in love How to deal with this difference?

23 nmol/l When desire problems this is an important question. Is there lack of desire? or Is there sexual aversion? Lack of desire frequently accompanies physical changes (cycle, disease, medication, etc) Sexual aversion is related to internal psychic troubles or relationship problems

24 What is needed for the physical aspects of erection or lubrication? Good enough circulation Good enough innervation What is needed for the emotional aspects of excitement / arousal? Enough stimulation Not too much performance pressure Enough safety to perform Enough safety to enjoy excitement arousal

25 Causes for (physical) erectile or lubrication dysfunction: Disturbed circulation: diabetes mellitus hypertension antihypertensive drugs beta blockers Disturbed innervation: spinal cord injury (SCI) multiple sclerosis (MS) after rectal cancer surgery or prostate cancer surgery In males! Causes for disturbed emotional arousal: Insufficient desire Performance pressure Insufficient stimulation excitement arousal

26 Male-female differences: Physically, the woman s orgasm potential is much higher She can have several orgasms in a row And she can orgasm from stimulation of various areas However, her orgasm is more difficult to reach Female orgasm resulting from penetration and tapping of the uterus is common in 6% of the women, and doesn t happen in 70% of the women! The male orgasm is more easy to reach, And accordingly more difficult to control When under steam the male usually wants to continue to orgasm For women this usually is not the case! However, many good lovers (males!) cannot cope with that. After orgasm with ejaculation the male has a refractory period orgasm

27 What is needed for the physical aspects of orgasm? Good enough stimulation Good enough innervation Good enough neurotransmitter status What is needed for the emotional aspects of orgasm? Enough relaxation Enough letting go possibility Enough safety to let it happen orgasm

28 Causes for physical disturbance of orgasm Disturbed innervation MS, SCI Disturbed neurotransmission (antidepressants, especially SSRI s) Causes for emotional disturbance of orgasm Shame & guilt Fear to let go Partner too pushing No investment in trying to get control (no masturbation, i.e. no learning process ) Fear of incontinence! In women with urinary incontinence one third loses urine also during sex. Especially during orgasm! orgasm

29 fluoxetine no desire paroxetine fluvoxamine excitement problems sertraline n venlafaxine Prozac Fevarin Efexor Seroxat Zoloft Cipramil citalopram Sexual dysfunction 100 after SSRI Montejo ea 2001 J Clin Psychiatry 62 drug therapy: 10-21

30 Antidepressants & sexual dysfunction delayed orgasm no orgasm fluoxetine paroxetine fluvoxamine sertraline venlafaxine citalopram

31 Male orgasm after antidepressant or anxiolytic treatment advantage of shorter interval between male and female orgasm Delayed orgasm is the reason why in sexual medicine we use SSRI antidepressants in the treatment of premature ejaculation orgasm

32 Antidepressant or anxiolytic treatment and female orgasm disadvantage of too long interval orgasm

33 Male-female difference?

34 Default Need for contact. Always relating and trying to be nice. Need for autonomy and disconnecting T acts on the genitals and on the brain At birth these differences are already measurable L Brizendine: The female brain 2006 L Brizendine: The male brain 2010

35 people-oriented thing-oriented

36 Mood (depression) Percentage of depression in the (Dutch) population (18-65 yrs) Women 20% Men 11% However, regarding the size of the penis, men can be very insecure and tend to underestimate the size.

antennae In female More oriented on relationship on contact on

37 Typical male female differences in bed In male More oriented on sex on genitals on orgasm on penetration more assertive no good antennae In female More oriented on relationship on contact on sensuality more submissivee more sensitiveee more feelings of guilt

38 The erogenic zones

39 For sexuality the most relevant T-receptors are situated in the brains & in the genitals

40 If in his mind this is true: what about SCI?

41 Definitive loss of an erogenous? What to do? Can one learn new zones? Various approaches? Exercise (in groups of 2-3 persons). Discussion (4 minutes): Question: Can one learn new erogenic zones? If yes: how to do that?

42 Definitive loss of an erogenous? What to do? Can one learn new zones? Various approaches? Exercise: Imagine your favorite fantasy star

43 Learning new erogenous zones Various approaches? Imagine that you meet him/her at a party He / she apparently likes you and comes closer. He / she invites you for a dance He / she then tenderly touches your cheek

44 Don t you think, you nearly will get an orgasm? That spot can become a new erogenous zone!

45 Give yourself 3 minutes Relax your body Take a deep breath. Stand up & bend your knees Lift your arms, etcetera. End of part 1

Disease (diabetic neuropathy, multiple sclerosis, tumors, and, rarely, tertiary syphilis)

Disease (diabetic neuropathy, multiple sclerosis, tumors, and, rarely, tertiary syphilis) COURSES ARTICLE - THERAPYTOOLS.US Individual Planning: A Treatment Plan Overview for Adult Men with Sexual Performance Problems Individual Planning: A Treatment Plan Overview for Adult Men with Sexual