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 21 .