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Seeking Help for Female Sexual Dysfunction in Alberta: a Manual

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SEEKING HELP FOR FEMALE SEXUAL DYSFUNCTION IN ALBERTA: A MANUAL KATHLEEN LAROCQUE Bachelor of Education, University of Lethbridge, 2010 Bachelor of Music, University of Lethbridge, 2008 A project submitted in partial fulfilment of the requirements for the degree of MASTER OF EDUCATION in COUNSELLING PSYCHOLOGY Faculty of Education University of Lethbridge LETHBRIDGE, ALBERTA, CANADA © Kathleen LaRocque, 2021 SEEKING HELP FOR FEMALE SEXUAL DYSFUNCTION IN ALBERTA: A MANUAL KATHLEEN LAROCQUE Dr. Noëlla Piquette Associate Professor Ph.D. Project Supervisor Dr. Toupey Luft Assistant Professor Ph.D. Project Committee Member Dedication This project is dedicated to the many women who were not believed when they sought help for their sexual dysfunctions and the many women were told that their sexual dysfunctions were all in their heads, that they would resolve with time or marriage, that they just needed to relax, that sexual problems are normal for women/mothers, or that women do not need orgasms. This project is also dedicated to those who experience, and especially those who have died by suicide due to, the devastating consequences of post-SSRI sexual dysfunction, post-retinoid sexual dysfunction, post-finasteride syndrome, and persistent genital arousal disorder/genito-pelvic dysesthesia. May you rest in peace, may your deaths fuel a passion for future research, and may we find the cures. iii Abstract The proposed final project addresses the need for a bridge between women with sexual dysfunction and the healthcare available for these conditions. Many women experience sexual function problems but there are significant barriers to help-seeking for these conditions. As systemic change takes time, I aim instead to arm women with information that will help work within the current system. I conducted a literature review on female sexual dysfunction and women’s help-seeking prior to developing a web-based guide for Albertan women seeking help for sexual dysfunctions. This web-based guide, available at www.femalesexualproblems.ca,was designed to help empower women with increased knowledge about why, when, where, and how to seek help in order to improve their help- seeking experiences, sexual dysfunction, and overall physical and mental health. Keywords. Female sexual dysfunction, help-seeking, women, sexuality, experiences, barriers, sex therapy, sexism iv Acknowledgements I have many people to thank, as I could not have done this alone. Thank you to Dr. Noëlla Piquette, my supervisor, for helping me to secure funding, for guiding me in the expansion of this project, and for steering me when I became lost. Thank you for believing in me and for the time you invested in helping me complete this project. Thank you to my committee member, Dr. Toupey Luft, for discussions, support, friendship, moral support, and continued employment. And thank you to Dr. Kaitlyn Hillier and Dr. Jeffrey McCormack for your support in starting my research proposal. Many friends and family have provided so much essential support. To Rylan Spenrath, thank you for support in almost every way imaginable, including endless discussion, reviewing, and moral support. You know more about this project, and the many ideas that were ultimately not included in it, than anyone else. To Cody Fong, thank you for generally taking care of me during this entire process. Thank you to my cohort members, Aliza Dadani and Shaylah Swan, for helping to keep me accountable and for supporting me in the decision to transition from a thesis to a project. Thank you also to the many, many women who helped me conceptualize important ideas by sharing their stories and insights with me, especially Évéline Poirier and Linda Cataldo. This project would not have been possible without financial support or the work of research in sexual medicine. Thank you to the Canadian Institutes of Health Research, Alberta Advanced Education, the Rupertsland Institute, the Métis Education Foundation, and the Faculty of Education at the University of Lethbridge for your generous scholarships. And finally, thank you to the International Society for the Study of Women’s Sexual Health for your tireless and revolutionary work in women’s sexual health and sexual dysfunction. v Table of Contents Dedication ................................................................................................................................ iii Abstract .................................................................................................................................... iv Acknowledgements ................................................................................................................... v Table of Contents ..................................................................................................................... vi List of Tables ......................................................................................................................... xiii List of Figures ........................................................................................................................ xiv List of Abbreviations .............................................................................................................. xv Chapter I: Introduction .............................................................................................................. 1 Final Project Overview ................................................................................................. 1 The Second Sex............................................................................................................. 2 Theoretical Foundations................................................................................................ 3 Female Sexual Dysfunctions......................................................................................... 4 Rationale ....................................................................................................................... 5 Significance of This Project .......................................................................................... 8 Chapter II: Literature Review ................................................................................................. 10 Definition of Important Terms .................................................................................... 10 Female(s) and Woman/Women ...................................................................... 10 Dysfunctions, Disorders, Problems, and Concerns ......................................... 11 Vaginal Intercourse ......................................................................................... 12 Cunnilingus ..................................................................................................... 12 Sex and Masturbation ..................................................................................... 12 vi Healthcare Providers, Medical Professionals, and Mental Healthcare Professionals ................................................................................................... 12 Importance of Seeking Answers for Women with FSD ............................................. 13 Impact on Women’s Mental Health ................................................................ 14 Impact on Other Areas of Women’s Sexual Function .................................... 17 Impact on Women’s Relationships and Partners ............................................ 18 Physiological Implications of FSD ................................................................. 20 Anatomy of Female Sexual Pleasure: An Owner’s Manual ....................................... 21 External Genital Anatomy .............................................................................. 22 Mons Pubis.......................................................................................... 23 Outer and Inner Labia ......................................................................... 23 External Clitoris .................................................................................. 24 Vestibule ............................................................................................. 26 Perineum and Anus ............................................................................. 28 Internal Genital Anatomy ............................................................................... 29 Internal Clitoris ................................................................................... 29 Vagina ................................................................................................. 32 Uterus and Cervix ............................................................................... 34 Muscles ............................................................................................... 35 Theoretical Lens.......................................................................................................... 36 Biopsychosocial .............................................................................................. 36 Intersectional Feminism .................................................................................. 38 Models of Female Sexual Response ........................................................................... 39 vii Linear Models of Female Sexual Response .................................................... 40 Circular Incentive-Based Model of Female Sexual Response ........................ 43 Dual Control Model and Sexual Tipping Point .............................................. 45 Healthy Sexual Functioning
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