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3. DR LUCY LOVE Clinical Director g4s FMS (Forensic and medical services) Psychosexual counsellor

4. A review of patients in a psychosexual clinic AIM: To explore the relationship between a history of sexual abuse/ assault and the subsequent development of psychosexual problems. METHOD: Review of notes of 100 patients who attended my psychosex clinic in Medway, Kent, UK between 2011-2013. Patients with obvious physical cause e.g Diabetes or Lichen Sclerosus were excluded

5. METHOD (CONT) Medway is an urban conurbation with high deprivation and unemployment 93% British White population with 1.5% Asian Frequency with which sexual abuse/ assault disclosed was calculated as %patient notes reviewed.

6. STUDY SAMPLE 17 Males and 83 Females ( normal gender ratio in my P/S clinic) Age range: Male-23-73. Female-16-59. Wide range of psychosex problems reported and relationship between disclosure of abuse and specific type of psychosex problem studied.

7. RESULTS OF STUDY 100 Patients-59 (59%) voluntarily reported past history of sexual abuse or assault. 59 patients-11male and 48 female Psychosex problems reported: Females-Vaginismus [muscle spasm], Dyspareunia [painful sex], Loss of libido, Phobia of STIs, Anorgasmia, Body dysmorphia [labia of vulva perceived as abnormal]

8. RESULTS [CONT] Males: Erectile dysfunction, Premature ejaculation, Sexual addiction, Retarded or non-ejaculation, Loss of sensation, Loss of libido. 59 Patients with a P/S Problem had a history of CSA/Assault 48 were female and 26/48 (over 50%) had vaginismus or dyspareunia and 21 loss of libido

9. RESULTS [CONT] 59 Patients- Male data: 11 of these were male 5 out of these 11 males went on to develop a Sexual addiction- this is a small study but this is a high number.

10. DISCUSSION % of patients reporting sexual abuse/ assault almost 60%- could be an under-estimate as some patients reluctant to disclose abuse, when never previously reported. Small study and demographic variables not controlled for- 93% B.W and high deprivation. Age range for females [16-59] younger than for males [23-73]- Why?.Men –why do they develop sexual addiction-see next slides

11. DISCUSSION [CONT] Age range of males and females –why different? ? women quicker to present with p/s problem than men- women generally seek medical help when men don’t. ? Women have p/s from 1 st consensual sex. Whereas for men, p/s problems only present later in life when arousal diminished and erections less strong.

12. FURTHER DISCUSSION ? Do women have less choice of when they become sexually active whereas men who have been sexually abused might choose to wait until older to have 1 st consensual sex. Other possible explanations?

13. P/S PROBLEMS IN SEXUALLY ABUSED MALES AND FEMALES Women-commonest problem- Dyspareunia [painful sex] or vaginismus [vaginal muscle spasm]- strongly linked with extreme anxiety or phobia of sex. Men- commonly the opposite effect, leading to Sexual Addiction –WHY? ANSWER- because Traumatic events are reversed and eroticised, as they are in paraphilias- in these conditions the brain is thought to take unpleasant sensations/feelings and make them pleasant as a solution to childhood trauma.

14. CONCLUSION AND WHAT MIGHT HELP? More measures required to encourage victims to disclose abuse and seek counselling and support before they develop psychosexual problems. Further financial support needed to develop strong sexual assault referral services, increasing the numbers of crisis workers,ISVAs [independent sexual violence advisors] and counsellors and ensuring quality of training.

15. THANK YOU THANK YOU FOR LISTENING CONTACT DETAILS Lucy.love@uk.g4s.com Lucy.love2@nhs.net. Lucy.love2@nhs.net

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