Medical issues that impact on sexual function – a blessing in

disguise?

Nic Beets & Verity ThomPsychologists at

“CoupleWork” Auckland

“I had cancer.As a result, our sex life improved

and our relationship became more intimate”

#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:

#2: Sex is a team sport

It's vital the impact on their partner and the relationship is

addressed

4 key points:

#3: It is our responsibility to

facilitate best possible outcomeHold out for them the

possibility that their sex life &

relationship could become stronger, more

intimate, more resilient than before

4 key points:

#4: Our purpose & intention shapes our clients' outcomes

Are we focused on harm reduction AND

facilitating growth?

4 key points:

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

Case: The 'Blessing' of PeyroniesRuth 48 uni educated working part timePaul 55 a self made business manTogether 20 years, two children 11yrs and 9yrs2 years ago Paul noticed mild curvature of penis, no other change in shape

Paul comfortable mentioning to GP, had previously discussed ageing and erectile functioning

Referred to UrologistDiagnosed with early stage Peyronies

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

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.

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.

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

Discussed intimacy-based versus intercourse-based sex lifeDeveloped sexual repertoire beyond intercourseEstablished strong talking/team approach to future sex life

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

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

Case: Decimation caused by fatigueEve (53) & Adam (57)Both managerial (university educated)Together 25 years2 children: boy 20 & girl 18

Eve problems with severe fatigue last 7-8 yearsLOTS of investigations, no diagnosisGiven advice on diet, stress, self-care...

NO mention of impact on her relationship let alone sex lifeEve feeling a failure & defective, Adam feeling rejected, unimportant

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

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

IDEALLY:Early & ongoing discussion of implications of condition on sexuality & sex lifeCheck clients not catastrophisingConsider inviting partner in: model awareness of relationship impactStress hopeful possibilities of challenges to sexual functioning

IDEALLY:Encourage discussion with partner – stress import of this despite difficultyNB: 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