Co-Occurring Disorders: Multiple Needs and WIPHL

1. Co-Occurring Disorders: Multiple Needs and WIPHL Wisconsin Initiative to Promote Healthy Lifestyles Speaker Series Thursday, March 27, 2008 Noon to 1:30 p.m.

2. Speaker Julie Meyers APNC-APNP Western Dairyland Women’s Health Center Whitehall and Black River Falls

3. Objectives • Participant will be able to • Discuss components of sexual health. • List causes and treatment options of sexual dysfunction. • List medical conditions associated with sexual dysfunction. • Discuss the effects of diabetes and depression on sexual health. • Discuss what we as health professionals can do to help our patients. • Discuss impact of sexual activity and violence on teenagers.

4. Sexual Health • Influenced by a complex web of factors Sexual behavior Attitudes Social Factors Biological Risk Genetic Disposition

5. Sexual Health • Encompasses HIV and STI’s Unintended Pregnancy and Abortion Infertility Cancer Sexual Dysfunction

6. Sexual Health • Can be influenced by mental health acute illness chronic illness violence

7. What causes sexual difficulties? • May be life long • May begin in response to certain life events • Illness • Medical treatment • Change in a relationship • Life change (retirement, stress, moving) • Combination of physical and emotional factors

8. What sexual difficulties can be treated? • About 50% are caused by physical and psychological symptoms of a medical condition such as: • Absent or low sexual desire • Painful intercourse or penetration • Difficulties in erection or ejaculation • Inability to have orgasm • Problems associated with an illness, accident, medical condition and/or treatment

9. Sexual Dysfunction and Disease Certain medical conditions are associated with an increased risk of sexual dysfunction. Most common of these are: Cardiovascular disease and peripheral vascular disease Diabetes Prostate Cancer Depression Menopause

10. Sexual Dysfunction and Diabetes Diabetes can affect: -the blood vessels -damage to the nerves (neuropathy) Both can or may contribute to problems with sexual function

11. So what happens In Men --hardening and narrowing of the blood vessels that supply the erectile tissue of the penis > problems achieving an erection > less firm during erection

12. So what happens In Women --hardening of the blood vessels of the vaginal wall > decreases blood flow can affect vaginal lubrication > in turn this seems to put women at a greater risk for recurring yeast infections > interferes with arousal --nerve damage (neuropathy) to the genital area, reproductive organs and/or vagina, or bladder > may have difficulty obtaining orgasm. > incontinence and urinary tract infections

13. What to do? The first step in treating sexual dysfunction in patients with diabetes is to control blood glucose levels. When the diabetes is well-controlled, there is a decreased risk for many complications, including sex-related problems and also results in higher energy levels and less anxiety.

14. Sexual Dysfunction and Depression • The BRAIN is the body’s most sensitive “SEX ORGAN”. Sexual desire starts in the brain and works its way down. Chemicals-neurotransmitters help the brain cells (neurons) communicate to simulate blood flow to the sex organs.

15. So what happens? • In depression, these chemicals are out of balance. Therefore: --sexual desire can be low or non- existent. --low levels of certain neurotransmitters can dull the feeling of pleasure.

16. So………. • The strain that a depressive illness can place on a patient’s relationship can further interfere with sexual functioning and pleasure.

17. So…………… • For both men and women, being unable to initiate, particpate in or enjoy sex can lead to a crippling loss of self-confidence, which –in turn—can undermine the recovery period.

18. And……… • Some medicines used to treat depression can further affect sexual functioning. Key word: SOME • Keep in mind that there are also ways to manage the sexual side effects associated with the medications, without compromising treatment.

19. What to do? • Encourage patients to be open and honest with their doctors and their partners. • Sexual problems associated with the medications can be reversible and negotiable.

20. What else is going on with sexual health????

21. Teenagers • Dating relationships start younger than realized: nearly half of 11- to 14-year olds have been in a dating relationship • Study earlier this year by Liz Claiborne, Inc.

22. Teenagers 11- to 14-years old • Sex is considered part of dating relationships by a surprising number of teens and parent-though parents believe it is not their teen who is having sex

23. Teenagers • Significant levels of abusive behavior are reported in 11- to 14- year old dating relationships. • Teens age 15 to 18 report that abusive behavior increases dramatically in these years.

24. Alarmingly---- • Date suggests that early sexual activity appears to fuel dating violence and abuse among teenagers.

25. What can we do??? • Understand the “dating” behavior of teens? >What defines dating? >When do teen relationships begin? >To what extent do these relationships include sexual behavior?

26. What can we do? • Assess potential abuse in teen dating relationships • Do teens recognize or understand abuse in their relationships? • When do signs of power and control enter teen relationships? • Do teens think they are in relationships that might be abusive? • Is there a relationship between early sexual behavior and subsequent dating abuse?

27. What can we do? • Understand what parents know about their teens dating behavior and signs of abuse. • Are parents in-the-know or clueless on the topic of abuse? • Would parents recognize the signs of abuse in teen relationships • Are parents having conversations with their teenagers about abuse?

28. In Conclusion • Sexual health is a state of physical, emotional, mental, and social well-being in relation to sexuality; it is not merely the absence of disease, dysfunction or infirmity.

29. AND • Sexual health requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination, and violence.

30. AND • For sexual health to be attained and maintained, the sexual rights of all persons must be respected, protected, and fulfilled.

31. Sexual Rights • Sexual rights include the right of all persons, free of coercion, discrimination, and violence, to: • the highest attainable standard of sexual health, including access to sexual and reproductive health care services. • seek, receive, and impart information related to sexuality. • sexuality education. • respect for bodily integrity. • choose their partner. • decide to be sexually active or not. • consensual sexual relations. • consensual marriage. • decide whether or not, and when, to have children; and • pursue a satisfying, safe, and pleasurable sexual life.

32. THANK YOU Happy Spring

33. Bibliography Bellavance, Alison. “Helping Stop Domestic Violence. Clinical Advisory Feb 2008, p.134. Brigham and Women’s Hospital. Our Bodies, Ourselves. New York: Touchstone, p. 118, p. 186, p. 587. Liz Claiborne, Inc. Tween Relationship Study. Jan/Feb 2008. World Health Organization, 2008.