1: Patient Care
5 Topics
2: Normal Obstetrics
7 Topics
3: Abnormal Obstetrics
13 Topics
4: General Gynecology
8 Topics
7: Neoplasia
6 Topics
Counseling Patients About Sexuality
Duration 11:58
00:00
welcome to the APGO sexual health
00:02
video series in this first video we will
00:05
review how to counsel your patients
00:07
about issues pertaining to sexuality and
00:09
sexual health sexual health is important
00:13
to a woman’s overall health and
00:15
well-being and the American College of
00:18
Obstetricians and Gynaecologists ACOG
00:21
recommends that sexual health be
00:23
incorporated into every well-woman visit
00:26
across the lifespan
00:29
data suggests that most women want
00:32
providers to bring up the topic of
00:34
sexuality during their healthcare visits
00:37
discussion of sexual health can prevent
00:39
unnecessary sexual health related
00:41
outcomes such as HIV and other sexually
00:44
transmitted infections unintended
00:47
pregnancies and sexual assaults it can
00:52
also uncover sexual problems gynecologic
00:55
and medical conditions and sexual
00:58
dysfunctions
01:01
although female sexual dysfunction is
01:04
common estimated to affect 43% of women
01:07
most OBGYNs don’t spend much time on
01:10
sexual health a 2012 survey found that
01:15
although 63% of practicing OBGYNs
01:18
routinely asked their female patients
01:19
about the types of sexual activities
01:21
they engage in they didn’t usually ask
01:24
about other sexual issues such as sexual
01:27
dysfunction as a clinician you must be
01:31
open to the idea that your patient may
01:33
be heterosexual lesbian bisexual or
01:38
sexually fluid she may not be sexually
01:42
active or she may be active with one or
01:45
many partners she also may have other
01:48
thoughts about her sexual identity do
01:52
not assume that all women are in stable
01:54
loving relationships monogamous using
01:58
contraception if they are of
02:00
reproductive age and sexually active and
02:03
are not being abused or coerced into
02:06
sexual activity by their partner this is
02:08
why it is so important to proactively
02:10
ask your patients about sexuality and
02:12
sexual health there are a number of
02:16
identified barriers to healthcare
02:18
provider patient discussions about
02:20
sexual health and history one of the
02:23
most common barriers is provider
02:25
discomfort in discussing sexually
02:27
related topics it is important to
02:30
reflect upon your personal comfort level
02:33
and identify your biases about sexuality
02:35
to reduce your discomfort
02:38
by routinely engaging in sexuality
02:41
discussions with your patients you will
02:43
increase your confidence level in this
02:45
area just as you would with any other
02:47
skill other provider barriers are the
02:52
fear that screening will be too
02:53
time-consuming for a busy clinical
02:55
practice and the mistaken belief that
02:57
there are no or few safe yet effective
03:00
treatment options available another
03:03
barrier is the notion that you have
03:05
failed a patient if you have to refer
03:07
her to a specialist in fact you may help
03:10
her more by developing a referral
03:12
network of specialized providers who
03:14
have the skills to treat her to overcome
03:19
provider barriers consider scheduling
03:22
visits specifically for the purpose of
03:24
focusing on sexual health issues with
03:26
patients particularly if a patient
03:29
expresses a sexual concern it is also
03:33
helpful to offer and discuss handouts
03:35
and educational website information as
03:37
well as provide other resources on
03:40
sexuality topics to patients
03:43
specific practical conversation
03:46
techniques for overcoming provider and
03:48
patient barriers include asking
03:50
open-ended questions to solicit more
03:53
revealing answers beyond yes or no
03:56
examples include what sexual concerns
03:59
would you like to talk about instead of
04:02
do you have any sexual concerns you want
04:05
to discuss or how does your sexual
04:08
concern affect your relationship with
04:10
your partner instead of does your sexual
04:14
concern affect your relationship with
04:15
your partner you may also consider
04:19
pointed detailed questions thereafter to
04:22
better characterize our sexual problem
04:25
follow a pattern of asking an open-ended
04:28
question educating and then asking
04:32
another question
04:35
other effective communication techniques
04:38
include speaking and neutral and
04:40
inclusive terms meaning you are
04:42
non-judgmental and include all forms of
04:45
possible sexual expression heterosexual
04:48
lesbian etc for instance use the term
04:53
partner instead of husband or boyfriend
04:56
if you are uncomfortable you should
05:00
strive not to over react this requires
05:03
that you take care and what you say and
05:05
in how you communicate non-verbally in
05:08
terms of your body language and posture
05:11
also be aware of the effective use of
05:13
silence as it may take patients some
05:17
time to reveal awkward but salient
05:19
information about their sexuality
05:22
in order to effectively counsel and
05:25
educate patients it is important that
05:27
you understand the female sexual
05:29
response the traditional model of female
05:33
sexuality developed by William masters
05:35
in Virginia Johnson suggested that like
05:38
in men arousal and sexual desire
05:40
proceeded in a linear manner to plateau
05:43
orgasm and resolution it should be noted
05:48
that women can also experience
05:49
resolution without orgasm Kaplan added
05:53
the concept of desire to that model but
05:57
it’s clear that a woman’s sexual
05:58
response is much more dynamic and
06:00
multifactorial than a straight line
06:02
progression there are now multiple
06:04
different models and theories and there
06:06
is no one accepted model
06:10
dr. rosemary Bosson of the Center for
06:13
sexual medicine at Vancouver General
06:15
Hospital has developed a circular model
06:18
of female sexuality that incorporated
06:20
emotional components this model suggests
06:24
that female sexuality is multifactorial
06:27
and heterogeneous and that the desire
06:30
for sexual activity may be motivated
06:32
more by a desire for emotional intimacy
06:34
than for sexual release to put it
06:38
another way
06:39
this model demonstrates that women can
06:42
have a reactive libido they may start
06:45
off in a sexually neutral frame of mind
06:46
but become interested in sex if their
06:49
partner approaches them they may also
06:52
experience arousal before desire many
06:56
physical psychological societal cultural
07:00
and interpersonal factors impact sexual
07:03
health including changes in sexual
07:06
function throughout the lifecycle life
07:10
transitions such as divorce or death of
07:13
a partner chronic or acute illness
07:16
including gynecologic disorders and
07:18
long-term disability medications
07:24
sexually transmitted infections or sti’s
07:28
violence and trauma stigmas and
07:32
religious beliefs use of tobacco drugs
07:36
and alcohol work life family and
07:40
financial stress changes in sexual
07:44
self-esteem including body image and the
07:46
perception of oneself as a sexual being
07:50
although it is acknowledged that sexual
07:53
problems are common the definition of
07:56
sexual dysfunction hinges on whether or
07:59
not it causes quote clinically
08:02
significant distress in the individual
08:06
in other words a woman is unable to
08:09
participate in sexual activity as she
08:12
wishes without distress treatment for a
08:16
sexual problem may not be necessary
08:20
statistically speaking 43% of American
08:23
women report a sexual problem but sexual
08:27
dysfunction causing distress is less
08:29
common at around twenty two point eight
08:31
percent newer definitions of sexual
08:35
dysfunctions released with the
08:37
Diagnostic and Statistical Manual
08:38
Edition 5 in 2013 specify that a problem
08:43
should be present for a minimum duration
08:45
of six months to be diagnosed as a
08:48
sexual dysfunction the provider is also
08:52
advised to rule out other potential
08:54
reasons for the sexual problem again
08:57
many problems although distressing may
09:01
be transient and may not meet the
09:03
official definition for a sexual
09:05
dysfunction prior to the release of the
09:08
dsm-5 OBGYNs relied on the DSM fourth
09:12
edition text revision which had four
09:14
categories of sexual dysfunction for
09:16
women some providers find these older
09:20
categories more clinically useful than
09:22
the dsm-5 categories and terms used in
09:26
the DSM 40 are such as hypoactive sexual
09:29
desire disorder or HSDD are still used
09:33
today in the dsm-5 patterns of female
09:37
sexual dysfunction focus on chronic
09:39
symptoms involving interest arousal
09:42
orgasm and pain female sexual
09:47
dysfunctions are interrelated and
09:49
overlapping and the presenting
09:51
dysfunction may not be the primary
09:53
dysfunction for example decreased
09:58
arousal can lead to a lack of vaginal
10:00
lubrication and thus pain with
10:02
intercourse
10:03
which can decrease desire alternatively
10:07
decrease desire can lead to decreased
10:09
arousal which can lead to pain which is
10:12
the presenting dysfunction in the next
10:16
few slides we will review the dsm-5
10:18
categories low desire with distress is
10:23
the most frequent female sexual
10:25
dysfunction with 8 to 10 percent of
10:28
women meeting the diagnostic criteria
10:32
female sexual interest arousal disorder
10:35
is defined as lack of or significantly
10:38
reduced sexual interest arousal in 3 of
10:42
the following aspects
10:50
female orgasmic disorder is the presence
10:53
of either of the following 75 to 100
10:57
percent of the time during sexual
10:59
activity
11:01
jeanna doe pelvic pain penetration
11:04
disorder is defined by persistent or
11:07
recurrent difficulties with one or more
11:10
of the following
11:16
for more information on counseling
11:18
sexual health response cycles and sexual
11:22
health dysfunctions please refer to the
11:24
references at the end of this video
11:28
continue on to the next video in this
11:30
series to learn more about how to take a
11:32
sexual history and assess and treat
11:34
female sexual dysfunctions
11:44
you
English (auto-generated)