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Sexuality in O&G
8 March 2016
Dr. Martha Tara Lee
Clinical Sexologist
• Doctorate in Human Sexuality
• Masters in Public Policy and
Management
• Bachelor of Arts (Comm)
• Certificate in Sex Therapy
• Certitificate in Practical Counselling
• Cert in Life Coaching
Agenda
1. What is Sexology
2. Sexual Desire
3. Myths/ misconceptions
about sex
4. My observations
5. Yin/ Yang
6. Suggestions of what to
do
What is Sexology?
Study of sexual interests, behavior, and function which combines:
Biology Physiology Medicine Psychology Statistics Epidemiology
Criminology Religion Philosophy Zoology Anthropology Sociology
Sexologists study:
Sexual
development
Sexual
orientation
Sexual
relationships
Sexual activity Sexualities of
special
group
Common Sexological Issues
• Body image and sex-negative conditioning
• Sexual desire
• Courtship concerns
• Obstacles to Intimacy
• Sexual development, maturation and aging
• Sexual communication and negotiation
• Medical considerations affecting sexuality
• Atypical sexual behaviours
• Sexual trauma
• Gender identity
• Sexual orientation
• Sexual education for parents
• Women’s concerns
• Men’s concerns
Sexuality in O&G
PLISSIT Model
Permission to self – Pleasure; to use vibrator, Ask for certain
kinds of touch, caress.
Limited Information – Changes in sexual response with
pregnancy, menopause, aging. Impact of medication(s) on
sexual function.
Specific Suggestions – HRT benefits and risks, use of
lubricants; Positions.
Intensive Therapy – Refer to specialists for couple therapy,
resolution of long-standing problems.
Sexual Response
Sexual Desire
• Begins in the brain.
• The experience of sexual
fantasies, thoughts, and
wanting to engage in or be
involved in sexual activity.
• Includes being responsive or
receptive to sexual advances
by a partner and of wanting
to continue the activity once
physical contact begins.
Responsive
Desire
Spontaneous
Desire
Factors Influencing Sexual
Response
• Vascular (Blood Vessels)
• Neurological (Brain)
• Hormonal
• Psychological (Mental mind)
• Relational
• Psychosexual skills
• Hypoactive Sexual Desire
Disorder
• Sexual Arousal Disorder
• Sexual Aversion Disorder
• Female Orgasm Disorder
• Sexual Pain Disorder
 Dyspareunia
 Vaginismus
Female sexual
interest/
arousal
disorder
Genito-pelvic
pain/penetration
disorder
DSM-5 Female Sexual Dysfunctions
Frigidity
Inhibited Sexual Desire
Disorder - DSM-3
Hypoactive sexual desire
disorder - DSM-3-R
Female sexual interest/
arousal disorder - DSM-5
A Name is Just a Name?
• Sexual dysfunctions (except substance-/medication-
induced sexual dysfunction) now
o Require a duration of approximately 6 months and
o More exact severity criteria
• Subtypes for all disorders include only
o “Lifelong vs. acquired" and
o “Generalized vs. situational”
• Two subtypes were deleted:
o “Sexual dysfunction due to a general medical
condition" and
o “Due to psychological versus combined
factors"
More on DSM-5
Consider the Impact of Culture
Culture Impacts Function
• Sex is not discussed 
– Ignorance re: anatomy, function, technique
• Sense of self ≠ societal expectations 
– Anxiety, confusion, shame, isolation
– More depression, substance abuse, unprotected sex
• Gender role inequities 
– Poor communication re: safer sex, sexual needs
– Sexual inhibition/avoidance after sexual trauma
Misconceptions of
Sexual Function & Satisfaction
• Men want sex more than women
• Women care about intimacy more than men
• If you love your partner, sex will be wonderful
• My partner should know what I want
• Good sex is spontaneous
• Movies and TV portray sex as it really is
• Bigger is always better
Facts about Sexual Function
• Both women and men enjoy sex / intimacy
• Fulfilling sex often requires planning / effort
• Changes in function occur with life stress, aging,
illness, and many medications
• Lifestyle adaptations preserve sexual satisfaction
in many circumstances
Laumann EO, Paik A, Rosen RC. Sexual dysfunction in the United
States: prevalence and predictors. JAMA 1999;281:537-544.
Sex and Gender Differences
• Sexiness criticized in women; admired in men:
– ‘Slut’ vs. ‘stud’
• Premarital / extramarital sex unacceptable for women;
condoned in men:
– Intact hymen, chastity belt
• Sexual pleasure valued less / taboo for women:
– ‘My husband’s needs come first’
– Female genital circumcision
• Stigma greater for older women than men:
– ‘All dried up’, ‘withered’ vs. ‘he’s a real Don Juan’
• Sex means sexual intercourse
• Talking about sex is not natural, proper, or
necessary
• Sex is for younger people
• Men should initiate sexual activity
• Sex should be spontaneous
• A firm penis is a requirement for satisfying sex
• Quality sex ends with a orgasm
Myths about Sexuality
Madonna/ Whore Syndrome
Masculine/ Feminine
1. Projecting
2. Active
3. Solar/ Warming
4. Discharges energy
5. Prefers raw sex
6. Rational/ Logical
7. Needs adventure
8. Gives love to get sex
1. Receptive
2. Passive
3. Lunar/ Cooling
4. Retains energy
5. Prefers cuddly sensuality
6. Intuitive/ Emotional
7. Geared for survival
8. Gives sex to get love
Sexuality in O&G
1.Receive
2.Feel
3.Moon
4.Water
1.Project
2.In control
3.Sun
4.Fire
Yin/ Yang
Are modern-day women more yin or yang?
My Observations
1. Before Pregnancy
• Female: Fears/ anger/ dismissive – just sperm
• Male: Sexual performance anxiety
2. During Pregnancy
• Female: Mood swings
• Male: May not have any sex
3. After Baby
• Female: Tired
• Male: When are things going to get better?
1. Guilt – much to be grateful for
2. Dismissed – I’d just go away/ withdraw
3. Rationalized - she’s a good person/ wife/
mother
4. Frustrated – why am I always last on the
list?
5. Anger – towards wife/ child
For Men - Persistent lack of sex
6. Rejected – no longer a priority
7. Self-esteem - No longer attractive to their
partner – own self-perceived lack of
attractiveness
8. Used – to procreate only
9. Internalize things – must have done
something wrong
For Men - Persistent lack of sex
Relationship Problems
• Anger
• Poor Communication
• Criticism
• Neurotic Interactions
• Incompatible Sexual
fantasies
• Alcoholism & Sexual Abuse
• Phobic Avoidance of Sexual
Intercourse
• Unconscious Conflict about
Sex, Commitment, Pregnancy
• Sexual Abuse Issues
Psychosocial Issues
• Lifelong or acquired
• Symptom or situational
• Unresolved history of sexual abuse or trauma
• Body image/ Self-esteem issues
• Psychiatric history
• Stress, anxiety, sadness
• Relationship conflict
• Partner’s sexual dysfunction
Treatment for Low Sexual Desire
1.Physical possibility
2.Tired
3.Stressed
4.Scared
5.Unfit
6.No Time
The Low Down on Low Libido
• Increase sea vegetables
• Increase beans
• Increase root vegetables
• Increase water
• Increase spicy foods
• Increase chocolate
• Reduce alcohol
Source: Vitti, A. (2013) Woman Code,
HarperOne, p. 298
The Orgasmic Diet
1. Take supplements (especially fish oil); a multivitamin; calcium,
magnesium, and zinc; and extra iron and vitamin C.
2. Balance of 40 percent carbs, 30 percent protein, and 30 percent
fats at every meal.
• Avoid trans fats and polyunsaturated fats, including
vegetable oils such as corn oil, soybean oil, and safflower
oil, that counteract the benefits of the omega-3 fatty acids
• Eat monounsaturated fats like olive or canola oil or
moderate amounts
• Eat a half-ounce of quality dark chocolate every day.
3. Avoid things that interfere with sexual function, including caffeine,
cigarettes and other stimulants; hormonal birth control; and
drinking alcohol to excess.
4. Exercise the PC muscles
Lindberg, M (2008) The Orgasmic Diet: A Revolutionary Plan to Lift Your Libido and Bring You to Orgasm, Harmony
Sensate Focus
• Week 1 & 2: Non-genital sensual touch
• Week 3 & 4: Genital tease
• Week 5 & 6: Genital stimulation
• Week 7 & 8: Vaginal containment
• Week 9 & 10: Vaginal containment with
movement (intercourse)
Lack of Sexual Drive
1.Communicate
2.Get Tested
3.Arms on Deck
4.Schedule Sex
5.Prepare for sex
6.Self care
a. Exercise
b. Quit smoking
c. Food
7. Expand your ways of having sex
a. Masturbation witnessing
b. Mutual masturbation
c. One-way sex
d. Sex toys
8. Recruit a Taskforce
9. Give it some time
Lack of Sexual Drive
7%-38%-55% rule by Albert
Mehrabian
Sexuality in O&G
Don’t Ask
Don’t Care
What We
Want to Avoid…
Lack of Sexuality Education
We Don’t Ask Because Of…
• Personal embarrassment
• Lack of knowledge re: clinical relevance
• Ignorance re: who, when, how, or what to
ask
• Concern re: not knowing how to answer
questions
• Concern re: becoming
aroused/uncomfortable
• Concern re: appearing seductive/intrusive
• Uncertainty about legal issues
• Time constraints
ISIS Model
We Can Make a Difference
By Talking about Sex
1. A couple comes in and say the wife has low sex
drive. A sexologist would…
a) Find out what their definition of low sex drive is
b) Ask if they have gone for medical check ups
c) Check what they tried
d) Explore the sexual attitude of the woman
e) All of the above
What Would You Do? - Quiz
2. A lady comes in and attribute her low sex drive to
being sexually violated when she was 5 - 15. A
sexologist would…
a) Encourage her to get over it – it’s all in her head
b) Insist she must tell her husband about it
c) Tell her to go to the police so justice is served
d) Teach her to do kegels
e) Explore what her goals are
What Would You Do? - Quiz
3. A couple comes in and say the wife has low sex
drive. The lady is very negative about everything that is
discussed. She gets angry and defensive. A sexologist
would…
a) Ask if she has gone for a medical check up
b) Tell her she has an attitude problem
c) Sit back and let her talk – It’s her money
d) Admit she is beyond hope
e) Check if she has depression
What Would You Do? - Quiz
4. Your patient starts crying in consultation. She admits
she is feeling depressed. Do you…
a) Pass her tissue, and tell her to stop crying
b) Just do your job and give her the drugs she came for
c) Refer her to staff nurse
d) Send her to a mental health professional
e) Ask if she has suicidal thoughts
What Would You Do? - Quiz
What is Your Approach?
• Sex-positive
• Non-judgemental
• Educational
• Client-centered
• Do no harm
Dr. Martha Tara Lee
Clinical Sexologist
Eros Coaching Pte Ltd
Website: www.eroscoaching.com
Email: drmarthalee@eroscoaching.com

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Sexuality in O&G

  • 1. Sexuality in O&G 8 March 2016
  • 2. Dr. Martha Tara Lee Clinical Sexologist • Doctorate in Human Sexuality • Masters in Public Policy and Management • Bachelor of Arts (Comm) • Certificate in Sex Therapy • Certitificate in Practical Counselling • Cert in Life Coaching
  • 3. Agenda 1. What is Sexology 2. Sexual Desire 3. Myths/ misconceptions about sex 4. My observations 5. Yin/ Yang 6. Suggestions of what to do
  • 4. What is Sexology? Study of sexual interests, behavior, and function which combines: Biology Physiology Medicine Psychology Statistics Epidemiology Criminology Religion Philosophy Zoology Anthropology Sociology
  • 6. Common Sexological Issues • Body image and sex-negative conditioning • Sexual desire • Courtship concerns • Obstacles to Intimacy • Sexual development, maturation and aging • Sexual communication and negotiation • Medical considerations affecting sexuality • Atypical sexual behaviours • Sexual trauma • Gender identity • Sexual orientation • Sexual education for parents • Women’s concerns • Men’s concerns
  • 8. PLISSIT Model Permission to self – Pleasure; to use vibrator, Ask for certain kinds of touch, caress. Limited Information – Changes in sexual response with pregnancy, menopause, aging. Impact of medication(s) on sexual function. Specific Suggestions – HRT benefits and risks, use of lubricants; Positions. Intensive Therapy – Refer to specialists for couple therapy, resolution of long-standing problems.
  • 10. Sexual Desire • Begins in the brain. • The experience of sexual fantasies, thoughts, and wanting to engage in or be involved in sexual activity. • Includes being responsive or receptive to sexual advances by a partner and of wanting to continue the activity once physical contact begins.
  • 12. Factors Influencing Sexual Response • Vascular (Blood Vessels) • Neurological (Brain) • Hormonal • Psychological (Mental mind) • Relational • Psychosexual skills
  • 13. • Hypoactive Sexual Desire Disorder • Sexual Arousal Disorder • Sexual Aversion Disorder • Female Orgasm Disorder • Sexual Pain Disorder  Dyspareunia  Vaginismus Female sexual interest/ arousal disorder Genito-pelvic pain/penetration disorder DSM-5 Female Sexual Dysfunctions
  • 14. Frigidity Inhibited Sexual Desire Disorder - DSM-3 Hypoactive sexual desire disorder - DSM-3-R Female sexual interest/ arousal disorder - DSM-5 A Name is Just a Name?
  • 15. • Sexual dysfunctions (except substance-/medication- induced sexual dysfunction) now o Require a duration of approximately 6 months and o More exact severity criteria • Subtypes for all disorders include only o “Lifelong vs. acquired" and o “Generalized vs. situational” • Two subtypes were deleted: o “Sexual dysfunction due to a general medical condition" and o “Due to psychological versus combined factors" More on DSM-5
  • 16. Consider the Impact of Culture
  • 17. Culture Impacts Function • Sex is not discussed  – Ignorance re: anatomy, function, technique • Sense of self ≠ societal expectations  – Anxiety, confusion, shame, isolation – More depression, substance abuse, unprotected sex • Gender role inequities  – Poor communication re: safer sex, sexual needs – Sexual inhibition/avoidance after sexual trauma
  • 18. Misconceptions of Sexual Function & Satisfaction • Men want sex more than women • Women care about intimacy more than men • If you love your partner, sex will be wonderful • My partner should know what I want • Good sex is spontaneous • Movies and TV portray sex as it really is • Bigger is always better
  • 19. Facts about Sexual Function • Both women and men enjoy sex / intimacy • Fulfilling sex often requires planning / effort • Changes in function occur with life stress, aging, illness, and many medications • Lifestyle adaptations preserve sexual satisfaction in many circumstances Laumann EO, Paik A, Rosen RC. Sexual dysfunction in the United States: prevalence and predictors. JAMA 1999;281:537-544.
  • 20. Sex and Gender Differences • Sexiness criticized in women; admired in men: – ‘Slut’ vs. ‘stud’ • Premarital / extramarital sex unacceptable for women; condoned in men: – Intact hymen, chastity belt • Sexual pleasure valued less / taboo for women: – ‘My husband’s needs come first’ – Female genital circumcision • Stigma greater for older women than men: – ‘All dried up’, ‘withered’ vs. ‘he’s a real Don Juan’
  • 21. • Sex means sexual intercourse • Talking about sex is not natural, proper, or necessary • Sex is for younger people • Men should initiate sexual activity • Sex should be spontaneous • A firm penis is a requirement for satisfying sex • Quality sex ends with a orgasm Myths about Sexuality
  • 23. Masculine/ Feminine 1. Projecting 2. Active 3. Solar/ Warming 4. Discharges energy 5. Prefers raw sex 6. Rational/ Logical 7. Needs adventure 8. Gives love to get sex 1. Receptive 2. Passive 3. Lunar/ Cooling 4. Retains energy 5. Prefers cuddly sensuality 6. Intuitive/ Emotional 7. Geared for survival 8. Gives sex to get love
  • 26. My Observations 1. Before Pregnancy • Female: Fears/ anger/ dismissive – just sperm • Male: Sexual performance anxiety 2. During Pregnancy • Female: Mood swings • Male: May not have any sex 3. After Baby • Female: Tired • Male: When are things going to get better?
  • 27. 1. Guilt – much to be grateful for 2. Dismissed – I’d just go away/ withdraw 3. Rationalized - she’s a good person/ wife/ mother 4. Frustrated – why am I always last on the list? 5. Anger – towards wife/ child For Men - Persistent lack of sex
  • 28. 6. Rejected – no longer a priority 7. Self-esteem - No longer attractive to their partner – own self-perceived lack of attractiveness 8. Used – to procreate only 9. Internalize things – must have done something wrong For Men - Persistent lack of sex
  • 29. Relationship Problems • Anger • Poor Communication • Criticism • Neurotic Interactions • Incompatible Sexual fantasies • Alcoholism & Sexual Abuse • Phobic Avoidance of Sexual Intercourse • Unconscious Conflict about Sex, Commitment, Pregnancy • Sexual Abuse Issues
  • 30. Psychosocial Issues • Lifelong or acquired • Symptom or situational • Unresolved history of sexual abuse or trauma • Body image/ Self-esteem issues • Psychiatric history • Stress, anxiety, sadness • Relationship conflict • Partner’s sexual dysfunction
  • 31. Treatment for Low Sexual Desire 1.Physical possibility 2.Tired 3.Stressed 4.Scared 5.Unfit 6.No Time
  • 32. The Low Down on Low Libido • Increase sea vegetables • Increase beans • Increase root vegetables • Increase water • Increase spicy foods • Increase chocolate • Reduce alcohol Source: Vitti, A. (2013) Woman Code, HarperOne, p. 298
  • 33. The Orgasmic Diet 1. Take supplements (especially fish oil); a multivitamin; calcium, magnesium, and zinc; and extra iron and vitamin C. 2. Balance of 40 percent carbs, 30 percent protein, and 30 percent fats at every meal. • Avoid trans fats and polyunsaturated fats, including vegetable oils such as corn oil, soybean oil, and safflower oil, that counteract the benefits of the omega-3 fatty acids • Eat monounsaturated fats like olive or canola oil or moderate amounts • Eat a half-ounce of quality dark chocolate every day. 3. Avoid things that interfere with sexual function, including caffeine, cigarettes and other stimulants; hormonal birth control; and drinking alcohol to excess. 4. Exercise the PC muscles Lindberg, M (2008) The Orgasmic Diet: A Revolutionary Plan to Lift Your Libido and Bring You to Orgasm, Harmony
  • 34. Sensate Focus • Week 1 & 2: Non-genital sensual touch • Week 3 & 4: Genital tease • Week 5 & 6: Genital stimulation • Week 7 & 8: Vaginal containment • Week 9 & 10: Vaginal containment with movement (intercourse)
  • 35. Lack of Sexual Drive 1.Communicate 2.Get Tested 3.Arms on Deck 4.Schedule Sex 5.Prepare for sex 6.Self care a. Exercise b. Quit smoking c. Food
  • 36. 7. Expand your ways of having sex a. Masturbation witnessing b. Mutual masturbation c. One-way sex d. Sex toys 8. Recruit a Taskforce 9. Give it some time Lack of Sexual Drive
  • 37. 7%-38%-55% rule by Albert Mehrabian
  • 39. Don’t Ask Don’t Care What We Want to Avoid…
  • 40. Lack of Sexuality Education
  • 41. We Don’t Ask Because Of… • Personal embarrassment • Lack of knowledge re: clinical relevance • Ignorance re: who, when, how, or what to ask • Concern re: not knowing how to answer questions • Concern re: becoming aroused/uncomfortable • Concern re: appearing seductive/intrusive • Uncertainty about legal issues • Time constraints
  • 43. We Can Make a Difference By Talking about Sex
  • 44. 1. A couple comes in and say the wife has low sex drive. A sexologist would… a) Find out what their definition of low sex drive is b) Ask if they have gone for medical check ups c) Check what they tried d) Explore the sexual attitude of the woman e) All of the above What Would You Do? - Quiz
  • 45. 2. A lady comes in and attribute her low sex drive to being sexually violated when she was 5 - 15. A sexologist would… a) Encourage her to get over it – it’s all in her head b) Insist she must tell her husband about it c) Tell her to go to the police so justice is served d) Teach her to do kegels e) Explore what her goals are What Would You Do? - Quiz
  • 46. 3. A couple comes in and say the wife has low sex drive. The lady is very negative about everything that is discussed. She gets angry and defensive. A sexologist would… a) Ask if she has gone for a medical check up b) Tell her she has an attitude problem c) Sit back and let her talk – It’s her money d) Admit she is beyond hope e) Check if she has depression What Would You Do? - Quiz
  • 47. 4. Your patient starts crying in consultation. She admits she is feeling depressed. Do you… a) Pass her tissue, and tell her to stop crying b) Just do your job and give her the drugs she came for c) Refer her to staff nurse d) Send her to a mental health professional e) Ask if she has suicidal thoughts What Would You Do? - Quiz
  • 48. What is Your Approach? • Sex-positive • Non-judgemental • Educational • Client-centered • Do no harm
  • 49. Dr. Martha Tara Lee Clinical Sexologist Eros Coaching Pte Ltd Website: www.eroscoaching.com Email: drmarthalee@eroscoaching.com