Psychosexual Service Overview in Sheffield
The Relationship & Sexual Service in Sheffield provides psychosexual interventions for individuals facing sexual difficulties. The service, led by Jeanette Caw and Al Constant, offers support for various sexual dysfunctions and relationship issues. Updated referral criteria, service eligibility, and exclusion criteria are outlined, emphasizing the types of conditions addressed and individuals not suitable for the service. The service model includes triage, assessments, follow-ups, and re-referral options after six months. Referrals can be made through GPs or the query helpline, with expedited referrals prioritized. Certain exclusions like sexual compulsivity and acute mental health crises are noted.
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Presentation Transcript
The Relationship & Sexual Service, Sheffield Jeanette Caw, (Clinical Lead) & Al Constant (PST Trainee)
Background A regional service offering psychosexual interventions for people experiencing difficulties with their sexual functioning Service prior to 2015 Reduction in staffing as a result of closure of the teaching course, financial restrictions, move away from providing in-house medical assessment & intervention Service wholly psychotherapeutic, staffed with two psychosexual therapists
The Current Picture Updated referral and exclusion criteria - https://www.shsc.nhs.uk/services/relationship-and-sexual-service Referral form on the website Referrals to come from GPs Query Help-line Waiting List; expedited referrals Waiting well resources Service Model: triage, opt-in, 2x assessment, 10x follow-up Re-referral after 6 months
Service Eligibility Sexual Dysfunctions as identified by the DSM-V Premature (Early) Ejaculation Delayed Ejaculation Hypoactive Sexual Desire Disorder Erectile Disorder (Unreliable Erections) where an organic cause has been ruled out Genito-Pelvic Pain/Penetration Disorder (Vaginismus and Dyspareunia pain at the beginning of, during or after intercourse) Female Sexual Interest/Arousal Disorder Female Orgasmic Disorder Relationship difficulties where (i) these are present with a predominantly sexual problem, and (ii) the relationship is in a good enough position to make use of psychosexual therapeutic interventions for the sexual difficulty. Problems of libido, either reduced or excessive sexual interest/drive. Specific sexual phobias or fears.
Exclusion Criteria Exclusion criteria to take note of: Sexual compulsivity, paraphilia or addiction, including pornography. Sexual difficulties or behaviour have brought or are at risk of bringing them into conflict with the law. Sexual difficulties caused by a medical issue or physical health condition e.g., cardiovascular disease, neurological disorder, diabetes. Service users experiencing a crisis in their mental health, suffering from an acute psychotic illness, at risk of harming themselves. Service users seeking support with sexual orientation or gender identification.
Pathways with other services Andrology & Urology: will see all male bodied people with erectile dysfunction or a sexual dysfunction, where the difficulty is believed to be organic in origin. Psychosexual therapists in Andrology & Urology. Gynaecology: vulvodynia clinic. Pelvic floor physiotherapy. Birth in Mind
Pre-referral screening Female Bodied People Vaginismus & Dyspareunia: examination of vulva & vagina Anorgasmia: thyroid function, FBC & HbA1c Sexual interest & arousal disorder: thyroid function, FBC, U & E s, LFT. If amenorrhoea or oligomenorrhoea present, also check T levels, SHBG, FSH, LH & prolactin Male Bodied People Erectile dysfunction & hypoactive-sexual interest/desire: TF, U & E s, LFTs, early am T levels, SHBG, LH & FSH, HbA1c, prolactin, cholesterol & lipid profiles Provide details of BMI, drug & alcohol intake Check vascular status of lower limbs Delayed ejaculation: HbA1c https://bssm.org.uk/free-resources/ Goldstein, A., Pukall, C., Goldstein, I., Krapf, J. (2023). When Sex Hurts. Understanding and Healing Pelvic Pain. New York: Hachette Books. - https://www.vulvodynia.com/
Useful prescriptions/medicines Amielle Comfort Dilators Lidocaine Emlacream Condom Delay YES lubricants double glide Sildenafil women too Tadalafil Dapoxetine take 30 mins before, lasts 24 hours Seroxat 10mg to start, increase to 20mg; or Sertraline (Citalopram not as effective)
Helpful advice Vaginismus / Dyspareunia: Pelvic floor exercises When Sex Hurts Andrew Goldstein, Caroline Pukall, Irwin Goldstein, Jill Krapf My Broken Vagina Fran Bushe Squeezy app (this is not free, there are alternatives) Premature Ejaculation: PEA app Female Desire: Come As You Are Emily Nagoski Mind The Gap Dr Karen Gurney Sex and Relationships: Rewriting The Rules: Meg-John Barker
Case Example White, cis gender heterosexual woman in late 20s. Pain during intercourse Difficulties with penetrative sex
Vaginismus - lifelong Supportive partner Parental alcohol misuse Feels like a failure Anxious child, high achiever Shame & embarrassment about issue Limited sex education
Behaviour Feelings Treatment Psychoeducation Reflecting Challenge
What our clients say Very Satisfied, definitely would recommend the service. "Extremely helpful, kind, care and consideration has been shown to me throughout and I am eternally grateful to Jeanette and her team here for supporting me." Very Satisfied, definitely would recommend the service. "The sessions have been very helpful; we have learnt useful things and methods to help with our sexual and general relationship issues. Our relationship has been strengthened by what we have learnt and come to understand about each other and ourselves." Very Satisfied, would definitely recommend the service. "It's been really helpful. Provided a lot of advice and guidance and helped me get over my vaginismus." "The sessions have been so helpful and I'm noticing a change since my conversations with Alice but due to work commitments I think I'm going to have to discharge myself from the service. Will you pass on my thanks to Alice, she is amazing and has been super helpful." Mixed feelings around satisfaction, would definitely recommend. "Thank you to Jeanette for building up a rapport, being professional and being sensitive about the issues I have discussed (even if it is what she does for a living)."
Any Questions? Thank-you for your time.
