1	Maintaining intimate relationships Dr Rosie King MB BS, FAChSHM
2	Sexuality is… a central aspect of being human throughout life encompassing Sex Gender identity and role Sexual orientation Eroticism Pleasure Intimacy Reproduction
3	Sex does not occur in a vacuum
4	Sex is a continuum of bonding behaviours COMMUNICATION INTIMACY (emotional closeness) SENSUALITY (physical closeness) SEXUALITY (erotic activity)
5	Why relationships? Why sex?
6	Paradigm shift to a new view of ‘health’ Past challenge: treatment and cure of disease Now prevention and health optimisation
7	What factors contribute to health? Health is a state of complete physical, mental and social wellbeing not merely the absence of disease or infirmity
8	All aspects of health are inter-related Physical Intellectual
9
10	Clear link between poor social relationships and poor health People with weak social ties (marital, family, friends, religious and group affiliations) higher death rates Females 50 to 150% Males 100 to 300% Poor or absent relationships = higher mortality rates
11	We need close connections with others to stay HEALTHY
12	"Is marriage good for your..." Is marriage good for your health?
13	Positive links between marriage and health Married people Have less visits to the doctor Have less sick days p.a. Are less likely to die from a serious illness Lowered post surgical death rate Are more likely to survive after MI …than single, de facto, divorced or widowed people
14	Is sex good for you? Longitudinal studies have demonstrated a link between sexual activity and reduced mortality risk
15	"Frequency of sexual intercourse is..." Frequency of sexual intercourse is a significant predictor of longevity in men₁ Link between orgasm frequency and CHD death: Men who had orgasm twice week compared with less than twice a month had 50% decrease in CHD death Men with established CHD 63% reduction₂
16	Why is sex good for you?
17	Lovemaking is a specialised form of touching
18	Health benefits of Vitamin ‘T’
19	Study of female residents in aged care Comfort touch (back rub, massage, hand holding, a friendly hug) improved residents’ self perceptions including Self esteem Well being Health status Life satisfaction Self actualisation Faith and belief Conclusion: comfort touch enhances wellbeing and self regard
20	Hands on healing ‘Laying on of hands’ is therapeutic pulse and blood pressure drops secretion of endorphins pleasure and contentment relaxation and wellbeing pain relief boosts immune system relieves skin hunger
21	Should we be prescribing sex as a health measure?
22
23
24	Sexual Response Cycle Desire Arousal Orgasm/Resolution Refractory period (male)
25	What is desire? An appetite that motivates us to seek out sex and/or makes us willing to engage in sex (active and passive) Sexual desire is also known as lust, sexual hunger, libido, sex drive, horniness, sex urge or interest in sex
26	Desire originates in the limbic system of the brain
27	Desire fluctuates
28	Desire fluctuates Desire modulated by Inhibitors physical emotional sexual relationship Enhancers
29	Typical Female Enhancers Romantic gestures Communication Intimacy Affection - non demand Sensuality Quality time with partner Low level of conflict
30	Typical Male Enhancers Sexual availability Nudity Lingerie Responsive partner Varied lovemaking Novelty Spontaneity Feelings of sexual adequacy Erotica/ pornography
31	How to impress a woman Wine her, dine her, call her, hug her, hold her, surprise her, compliment her, smile at her, laugh with her, cry with her, cuddle her, shop with her, give her jewellery, buy her flowers, hold her hand, write her poetry and love letters, and finally, go to the ends of the earth and back for her…
32	How to impress a man Show up naked Bring beer
33	Sexual Response Cycle Desire Arousal Orgasm/Resolution Refractory period (male)
34	Process of sexual arousal:
35
36	Sexual arousal
37
38
39
40
41
42
43
44
45
46	Typical changes with age
47	Sexual Response Cycle Desire Arousal Orgasm/Resolution
48	ORGASM Reflex Enough blood in the pelvis (erotic focus) Adequate muscular tension 5 to 15 contractions of pelvic and genital muscles Peaking of subjective sexual pleasure Release of endorphins from the brain Men 20 to 30 secs Women 3 to 5 minutes up to 20 minutes
49	Sexual problems are common Men 31% Women 43% Most people don’t seek help CRF and its treatments are associated with increased prevalence of sexual dysfunction
50	Does sex matter to CRF patients? Life stressors in order: Uncertain future Limited physical activity Fatigue Reduced productivity Lack of sexual interest and activity Only 25% had discussed sexual function with doctors
51	Male sexual dysfunction in CRF
52	Female sexual dysfunction in CRF
53	Effects of CRF on reproduction Males Delayed puberty Impaired sperm formation (low T) Reduced sperm numbers and motility Possible infertility
54	Effects of CRF on reproduction Females Delayed puberty Menstrual disorders Irregular periods (low oestrogen) amenorrhea (40% premenopausal dialysis pts) oligomenorrhea (only 10% dialysis pts have regular periods) Heavy periods Earlier menopause (47 vs 51 years) Subfertility and difficulty reaching full term pregnancy Use barrier contraception - condom, diaphragm
55	CRF hormone imbalances and sexual dysfunction
56	CRF: organic causes of sexual dysfunction Anaemia due to low EPO - fatigue Low zinc levels - loss of libido and impotence Other medical conditions e.g. hypertension, diabetes, hyperparathyroidism Multiple drugs Beta blockers - loss of libido and ED Lasix and thiazides - ED Digitalis, cimetidine and maxolon - loss of libido Never cease or alter medication without consulting your doctor
57	CRF: organic causes of sexual dysfunction Uraemia Peripheral neuropathy Autonomic insufficiency Peripheral vascular disease 50% of uraemic men have ED Nausea, lack of energy Arterial blockage atheroma and calcium Fatigue, listlessness & lethargy
58	CRF: psychological causes of sexual dysfunction Psychological impact of chronic illness Grief, anger, anxiety, despair, depression, stress Losses (control, independence, activity, role, career, reproduction, income, normal eating and drinking, etc) Major adjustments in all areas of life Impact on spouse and family Body image issues
59	Body image issues Weight loss or gain Paler complexion Abdominal catheter CAPD patients worried about body image Males 47% Females 76% Fistula in the arm Gynaecomastia and galactorrhea Hair loss Bad taste in mouth Scarring after transplant
60	Causes of sexual dysfunction in CRF - other issues Smoking Excessive alcohol Illicit drug use Relationship difficulties Age-related changes
61	Managing sexual dysfunction Treat kidney failure Optimise delivery of dialysis Diet and fluid restriction Raise haemoglobin with erythropoietin (lowers prolactin and elevates testosterone) Vitamin D to control secondary hyperparathyroidsm (may lower prolactin) Alter medication if indicated Zinc in zinc deficient men?
62	Desire problems Do all you can to improve wellbeing Physical Emotional Relationship Sexual Many men and women have lack of sexual desire BUT sexual arousal and pleasure can still be enjoyed
63	Enhancing sexual arousal ‘Conditions for good sex’ Create and maintain focus on erotic pleasure Optimal stimulation: tell your partner what you like in bed
64	Arousal and orgasm problems Male: Erectile dysfunction Problems reaching orgasm Female: Lack of pleasure Dry, comfortable intercourse Problems reaching orgasm
65	Erectile dysfunction Viagra, Levitra, Cialis Vacuum enhancement device Intrapenile injection therapy Penile implant ‘Outercourse’ options
66	Viagra, Levitra, Cialis Tablet treatment Enhances natural erection response Not for men who Take nitrates Are not fit enough to resume sexual activity due to cardiovascular disease
67	Vacuum device Pump extracts air from cylinder and draws blood in Tension band keeps blood in penis for 30 minutes Semen may be trapped behind band but leaks out after removal of band
68	Intrapenile injection therapy Caverject - prostaglandin Creates a chemical erection Other combinations of drugs - ‘cocktail’
69	Penile implant
70	‘Outercourse’ options What is sex? 2 - 4 - 6 - 8 - 10 -
71
72	What is lovemaking? Lovemaking is a pleasurable, consensual emotional and physical interaction that need not include desire, arousal, erection, lubrication, orgasm or performance of any kind.
73
74	Lovemaking is a smorgasbord -choose what you like
75	Erectile dysfunction: outercourse options When erection is not possible due to physical causes, flaccid penis retains Sensitivity to sexual stimulation Erotic pleasure Ability to reach orgasm Try manual, oral or vibrator stimulation or frottage
76
77	www.intimatesolutions.com.au 1800 636 748
78	Outercourse is a helpful option Try outercourse when Intercourse is painful There is difficulty reaching orgasm through intercourse Intercourse is too demanding because of fatigue and lethargy
79	Painful intercourse Due to lack of arousal low levels of oestrogen Early menopause care with systemic oestrogen replacement therapy as increased risk of thrombosis low dose - transdermal therapy less likely to cause thrombosis Use of lubricants or local oestrogen therapy in women with uncomfortable intercourse
80	Managing sexual problems COMMUNICATION INTIMACY (emotional closeness) SENSUALITY (physical closeness) SEXUALITY (erotic activity)
81	Managing sexual problems Talk to your partner Share good times together More affection for its own sake Set aside time for intimacy Cuddle, hug and hold each other Massage - light stroking or caressing Be willing to explore new activities and pleasures Intercourse and orgasm may not be possible - enjoy the simmer, the sensation, the closeness and the pleasure of sex anyway Educate yourself and talk to your doctor about problems
82	Prescription for better health
83	Thank you!