The PICSSL Model
Path to Intimacy, Connection, Sexual Satisfaction and Love A new strategy for addressing patient’s intimacy concerns
Maureen Ryan DNP, AHNP, CHWC, CST
April 10, 2014
Following this presentation, participants will be comfortable utilizing the PICSSL Model to discuss sexual issues with patients to:
1) Identify strategies to increase emotional intimacy in relationships.
2) Identify techniques to enhance a sense of connection within one’s body.
3) Offer approaches for enhancing sexual satisfaction.
No Conflict of Interest to Disclose
1 The Purpose of PICSSL Model
For Healthcare professionals discussing sexual issues: Educate & empower Increase practitioner comfort Ultimately to improve quality of life
Path to Intimacy, Connection, Sexual Satisfaction and Love PICSSL
2 Is there a Problem?
The 2005 epidemiological study: The Global Study of Sexual Attitudes and Behavior, identified the prevalence of sexual problems among men and women in 29 countries. Of the 12,500 respondents, over half were not fully satisfied with their sex life
In the U.S. Sexual Dysfunctions affects – 43% of women – 30% of males 20% of marriages are sexless
Mulhall, 2008 Brandon, 2010.
Why don’t health care providers ask the questions? Do not feel knowledge able enough to deal with sexual dysfunctions Do not have enough time Opens a can of worms It is a private matter It does not occur to me
3 Rosemary Basson’s Circular Model
Sexual & Sexual Emotional Motivation Satisfaction
Willingness to be Sexual Responsive Desire Spontaneous Desire
Sexual Arousal Stimulation Arousability
Gina Ogden’s ISIS Wheel
Vision or Goal
4 Barriers
The Physiology of Love
The Chemistry of Love
Dopamine Norepinephrine Serotonin Oxytocin Vasopressin
5 Elevated Dopamine Levels
Focused attention Unwavering motivation Goal-directed behavior Ecstasy Think persistence!
Dopamine: Dog after a Bone!
Norepinephrine High
Exhilaration Excessive energy Sleeplessness Loss of appetite Increased memory for new stimuli
6 Decreased Serotonin
Incessant thinking about beloved Lovers are obsessed Romantic ecstasy intensifies – Compulsion to daydream – Fantasize – Obsess over romantic partner
Chemistry of Attachment
Oxytocin and Vasopressin The cuddle and bonding hormones
Oxytocin
Produced in hypothalamus Promotes relaxation Anti-stress hormone Induces calm state Promotes healing Release occurs – Psychological intimacy, and trust – During sexual activity
7 Unreciprocated Love
You can run, You can hide. But you can’t escape my love
Intimacy Builders
Barriers to Intimacy
8 Barriers to Intimacy Relationships are Complicated
Intimacy Enhancers
1. Self Care 2. A PIE 3. The 7 C’s 4. The 5 T’s of Togetherness
Intimacy Enhancer #1 Self Care: Put on Your Oxygen Mask First Take care of physical, mental, emotional and spiritual needs Diet Exercise Sleep Stress Be your own best friend
9 Self Awareness
In order to do what you want… you need to know what you do.
Intimacy Enhancer #2 A PIE
Appreciation
Appreciation emerges from: An attitude of acceptance Kindness Open heartedness Non judgment Compassion
10 Presence
I see you, I hear you, I value you Attention in and of itself is healing Awareness of the present moment is mindfulness
Intention
Personal vision Sets the stage for what is possible Setting the compass of the heart
Emotional Intimacy
Foundation for emotional intimacy are trust and vulnerability For many is a necessary precursor to sexual intimacy
11 Mindfulness
Intimacy Enhancer #3 The C’s Commitment Calendar Connection Communication Compassion Compliment Courage
Intimacy Enhancer #4 5 T’s of Togetherness Thoughts Talk Time Trust Touch
12 Body Connection
Disconnectors
Drugs & Alcohol Food Television Electronics Emotional Baggage Inaccurate Beliefs
Body Connection Enhancers 1. Personal Hygiene 2. Breathwork 3. Relaxation 4. Yoga 5. Exercise 6. Body mapping 7. Bibliotherapy 8. Self Pleasuring 9. Pelvic floor health 10. Erectile Preservation
13 Body Connection Enhancer #2 Relaxation
Body Connection Enhancer #4 Benefits of Yoga Strength Flexibility Pain prevention Better breathing Mental calmness Stress reduction Body awareness Relaxation
Body Connection Enhancer #5 Exercise Why Exercise? Enhance sexual function As effective as antidepressants in treatment of depression Improved body image No sexual side effects!
14 Body Connection Enhancer #6 Body Mapping
Body Connection Enhancer #7 Bibliotherapy
Body Connection Enhancer #8
Self Pleasuring Safe and healthy sexual activity Increases confidence about ability to respond Pleasurable Releases stress Sexual substitute if no partner available Increases sexual self awareness to share with partner No performance anxiety Vibrators/Toys
15 Body Connection Enhancer #9 Strong Pelvic Floor Supports pelvic organs Helps prevent urinary stress incontinence Enhances sexual pleasure and intensity of orgasm Kegals
Physical Preparation for Her
Gyn exam, vaginal mucosa, what can be done to maximize vaginal tissue health Lubricants, moisturizers Estrogen Vaginal dilators Labs when indicated
Body Connection Enhancer #10 Erectile Preservation PDE5-I Vacuum Erection Device (VED) ICI Injections Pelvic Floor Muscle Exercises Outercourse
16 Enhancing Sexual Satisfaction
Sexual Satisfaction Enhancers
1. Sexual empathy 2. Create the environment 3. Foreplay 4. Sensate Focus 5. Novelty 6. Fantasy 7. Making love mindfully 8. Educational material
17 Sexual Satisfaction Enhancer #1 Sexual Empathy
Improved communication, understanding, compassion Sexual generosity
Sexual Satisfaction Enhancer #2 Create the Environment Candles Music Aromatherapy Lotions Lingerie Props Don’t forget the bath
Sexual Satisfaction Enhancer #3 Foreplay
Women require more foreplay than men to reach full sexual arousal Slow down Add a zero for women: 2 minutes vs 20 minutes Variety Starts at the end of the last orgasm!
18 Body Connection Enhancer #4 Sensate Focus An anxiety reduction technique Step-by-step sequence of pleasurable body touching exercises Begins with nonsexual touching Evolves to more sensual & sexual touching
Sexual Satisfaction Enhancer #5 Novelty
Openness and willingness to explore what is possible Imagination, creativity to keep the spark New activities stir passion Staying in the present moment Tantric practices
Imagination Sex outside the bedroom More fantasy In the shower Role play Try something naughty CAT Tantric Practices
19 Sexual Satisfaction Enhancer #6 Fantasy
Sexual Satisfaction Enhancer #7 Making Love Mindfully
Intention Attention Eyes Heart Pelvis
Sexual Satisfaction Enhancer #8 Educational Material
20 References
A Woman’s Touch/Sexuality Resource Center. www.sexualityresources.com Basson, R. (2002). Women’s sexual desire - disordered or misunderstood? Journal of Sex and Marital Therapy, 28, 17-28. Brandon, M. (2010). Monogamy: The untold story. Santa Barbara, California: ABC-CLIO, LLC. Carter, J. G. (2011). Simple strategies for vaginal health promotion in cancer survivors. Journal of Sexual Medicine, 8, 549-599. Chapman, G. (2010). The 5 love languages: the secret to love that lasts. Chicago, IL: Northfield Publishing Esybron Institute Female Sexuality Research Center (2007) – www. esybron.org Francois, D.C., & Gilles, T. (2006). Effects of a new functional-sexological treatment for premature ejaculation. Journal of Sex and Marital Therapy, 32,97-114. Mulhall, J., King, R., Glina, S., & Hvidsten, K. (2008). Importance of and satisfaction with Sex among men and women worldwide: Results of the global better sex survey. Journal of Sexual Medicine, 5, 788-795. Levine, S. B., Risen, C. B., & Althof, S. E. (2010). Handbook of clinical sexuality for mental health professionals (2nd ed.). New York, NY: Taylor and Francis Group, LLC. Ogden, G. (2013). Expanding the Practice of Sex Therapy. New York, NY: Routledge/Taylor & Francis. Sinclair Institute Online – www.sinclairinstiute.com Volker, Marilyn, Sexologist, Miami, Florida
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