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3. PSYCHOSEXUAL PATIENTS AND SEXUAL ASSAULT 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 1st 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 1st 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.

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