Let’s talk about sexual dysfunction and anti-psychotics. Because let’s be fair, when do we? With a BSc and MSc in psychiatry and I have sat in clinic rooms whereby people with a diagnosis of a chronic mental illness, have their sexual concerns ignored. People struggling with an enduring mental illness are often ignored and clinicians minimise frustrations with sexual functioning claiming that managing the illness is more important. This is not only incredibly dismissing of needs but also increases the likelihood of wanting to take meds (I refuse to use the terms “non-compliance/adherence”).
If you can prescribe and/or work within the mental health field. I implore you to listen to the person in front of you and help them through the distress of a dysfunction and hear them in the importance of their sex life. Also be mindful of other medication that may be available, antipsychotic drugs most associated with dysfunctions are olanzapine, risperidone, haloperidol and clozapine. On the other hand, perphenazine, quetiapine and aripiprazole are associated with relatively low rates of SD.
However, if you are like me, you may not be able to prescribe, but that doesn’t deny us from being an advocate, that doesn’t deny us from educating ourselves on the impact and side-effects of medication, that doesn’t deny us from empathy and compassion.
If you are reading this and struggling with a mental health diagnosis that is impacting on your sexual health, if you can talk to your physician, please do so. You are worthy of a happy healthy sex life. Reach out to a psychosexual therapist who may be able to help navigate through some challenges.
Everyone is deserving of sexual pleasure.
I thought I would do a post on anti-fat bias within psychotherapy. Therapy should be a safe space for all, but as we know us therapists are not immune to bias. Fatphobia and sizeism are present, we can’t and shouldn’t deny that.
We are ethically bound to advocate for body liberation, without it we negate working holistically or even adequately to support clients. This maintains stigma, isolation creating corrosive damage.
Anti-fat bias, sizeism and body-based oppression are forms of; microaggressions, assumptions and shaming. Therapists with stronger anti-fat bias were more likely to attribute weight to behavioural causes, express frustration about fat clients, and perceive poorer treatment outcomes (Puhl, 2013).
Here are some ways to be a body liberating therapist.
1. It is not enough to be aware of biases, we also need to 𝐦𝐨𝐯𝐞 𝐭𝐨 𝐚𝐜𝐭𝐢𝐨𝐧; advocating, allyship, accessibility and accountability.
2.𝐈𝐬 𝐲𝐨𝐮𝐫 𝐭𝐡𝐞𝐫𝐚𝐩𝐲 𝐬𝐩𝐚𝐜𝐞 𝐢𝐧𝐜𝐥𝐮𝐬𝐢𝐯𝐞? Reflect on your therapy set up; from furniture to accessibility.
3.𝐈𝐧𝐭𝐞𝐫𝐫𝐨𝐠𝐚𝐭𝐞 𝐲𝐨𝐮𝐫 𝐯𝐢𝐞𝐰𝐬 on body image, diet culture and beauty standards.
4.𝐀𝐬𝐤 𝐪𝐮𝐞𝐬𝐭𝐢𝐨𝐧𝐬; be mindful of where you avoid, negate or change your language and tone that may maintain stigma.
5. Weight stigma falls into western beauty standards, is intersectional. Challenge how you work with 𝐢𝐧𝐭𝐞𝐫𝐬𝐞𝐜𝐭𝐢𝐨𝐧𝐚𝐥𝐢𝐭𝐲, 𝐭𝐡𝐞 𝐨𝐩𝐩𝐫𝐞𝐬𝐬𝐢𝐨𝐧𝐬 𝐚𝐧𝐝 𝐩𝐫𝐢𝐯𝐢𝐥𝐞𝐠𝐞 𝐲𝐨𝐮 𝐦𝐚𝐲 𝐡𝐨𝐥𝐝. Hold yourself to account.
6.Look at your social media feed, 𝐰𝐡𝐨 𝐝𝐨 𝐲𝐨𝐮 𝐟𝐨𝐥𝐥𝐨𝐰? Do you follow any fat individuals? If not, why? Listed below are some brilliant people.
7.𝐄𝐝𝐮𝐜𝐚𝐭𝐞, my fav books are 'FAT! SO? : Because You Don't Have to Apologize for Your Size' and 'You have the Right to Remain Fat'
𝐓𝐡𝐞𝐫𝐚𝐩𝐢𝐬𝐭𝐬, 𝐢𝐟 𝐰𝐞 𝐚𝐫𝐞 𝐧𝐨𝐭 𝐝𝐢𝐬𝐦𝐚𝐧𝐭𝐥𝐢𝐧𝐠 𝐰𝐞 𝐚𝐫𝐞 𝐜𝐨𝐥𝐥𝐮𝐝𝐢𝐧𝐠 𝐚𝐧𝐝 𝐭𝐡𝐚𝐭 𝐢𝐬 𝐭𝐡𝐞 𝐚𝐧𝐭𝐡𝐞𝐬𝐢𝐬 𝐨𝐟 𝐞𝐦𝐨𝐭𝐢𝐨𝐧𝐚𝐥 𝐰𝐞𝐥𝐥𝐧𝐞𝐬𝐬.
Yesterday I discovered how pearls are made.
Pearls are created by oysters as a natural defence mechanism against an irritant entering their shell or damage to their fragile body.
The oyster slowly secretes layers of materials that make up its shell. This creates a material called nacre, also known as mother-of-pearl, which encases the irritant and protects the mollusc from it.
The challenges that oysters face, trying to protect themselves from harm creates something so beautiful that us humans buy and cherish, wearing on our body to be adorned.
It got me thinking; how often do we look at situations or experiences that have been difficult and create a narrative that we are damaged, defective or broken?
That instead can we try look at ourselves as oysters, that the end result of these protective measures creates something beautiful, unique and to be treasured; our own magical pearl.
Today in the NY Times there was an article on Teletherapy (online therapy) and the increase since COVID, with 3/4 of therapists offering online only. Which got me reflecting: When I first started online therapy about 5 years ago, I remember having conversations with some therapists who vocalised their discomfort and resistance around it; some questioned the ethics, others the validity.⠀
I am a great believer in the importance of therapy being accessible for all. Sessions conducted online allow for people with disabilities or illnesses to have therapy without leaving their home. Individuals who live remotely or travel for work can have easier access. Not to mention for those with social anxiety, who are transitioning and may feel uncomfortable or fearful leaving their home. It can also be offered at a lower cost.⠀
I am not going to sit here and deny the limitations; technological issues, dropped calls, frozen video, body language and cues can be missed more easily, or perhaps the client can’t get a confidential spot. But as a therapist who not only conducts therapy online but equally receives it, the benefits really outweigh the limitations.⠀
Research that has been conducted over the years, has consistently displayed that online therapy is clinically efficacious and equivalent to traditional therapy. As much as I love seeing clients face to face, with the accessibility that online therapy offers, I am hoping that not only does it stay as a common place, but that it flourishes.
A Tampax ad was banned in Ireland this week. This was due to them describing how to ensure tampons were inserted correctly and comfortably. Most of us who have our periods can understand the discomfort and pain created and maintained by the improper placement of a tampon. Information that is received in schools is not always sufficient in educating on how to use tampons. Alongside this in some homes there is a lack of conversation around periods. Ads like Tampax put out are so important to educate and normalise conversations around periods.
So incase anyone wants some tips on inserting tampons, here you go!:
Try different positions; one foot on the toilet lid, squatting over the toilet, lying down with one knee towards your chest.
Before inserting, take a few deep breaths to relax and unclench your muscles.
Try different types of tampons too, you don't have to be stuck inserting with your finger.
Menstrual fluid should be enough to lubricate for tampon insertion. But if it's not, there is no harm in using lube.
If there are a lot of white, untouched areas on the tampon after removing it between 4 to 8 hours, try a lower absorbency tampon. On the other hand, if you bleed through, try a heavier absorbency.
Finally, maybe tampons aren't right for you. That's ok! Period pants, sanitary towels, cups are just some other options.
If there is consistent pain, difficulty removing or you're unable to insert your tampon, take a trip to your GP and get a check in case something else is going on that requires medical attention.
Let's stop minimising phrases that encourage power play, manipulation and gaslighting. Attempting to engage with someone by creating a dysregulation and instability, ultimately chipping away at self-esteem is not only harmful and toxic but abusive.
"Treat them mean, keep them keen" is a long standing phrase that is riddled with emotional abuse, and can be incredibly damaging for the person on the receiving end. We need to challenge and dismantle this narrative and encourage open, honest dialogue built on fundamental, mutual respect.
A study carried out (linked below) explained that greater dissatisfaction with genital appearance was associated with higher genital image self-consciousness during sex, which, in turn, was associated with lower sexual esteem. Labiaplasty has been on the rise. It is the most common form of female genital cosmetic surgery and involves the surgical reduction of the Labia minora (the inner lips of the vulva). You may also know it by a few different names: 'vulva reshaping', 'vulva and vaginal rejuvenation', 'designer vagina' and even 'the barbie doll'. The most common motivator for surgery is, aesthetic concerns (71%), followed by physical/functional (63%) and sexual reasons (38%). Furthermore (39%) had experienced teasing in regard to their genital appearance, predominantly from ex-partners. Comparative scrutiny includes vulvas and there are ramifications to that.
Playboy and Vulvas......For my next post I will be writing about labiaplasty, but I thought I would share some insight into a study I discovered while doing research. I found a paper that outlines changes of vulvas from the 1960s to 2013 in playboy magazine centrefolds. They studied over 493 magazines and discovered the vulva was fully exposed from 𝟎 instances in the 1950s to 𝟕𝟖.𝟔% in 2013. Alongside this is the grooming ( minimal to no hair) grew from 𝟏𝟏.𝟒% of images from the 1990s to 𝟕𝟖.𝟓% from 2010. Now, there isn’t a write up on what these vulvas look like, apart from bald or minimal hair! But they did say that it seems that Playboy digitally alters the image to fit into the "western ideal beauty standard".
Placik, O. J., & Arkins, J. P. (2014). Plastic surgery trends parallel Playboy magazine: the pudenda preoccupation. Aesthetic Surgery Journal, 34, 2
My gratitude journal sits by my bed. Every night I fill in two pieces: 1. What was my soul moment that day. 2. What am I most thankful for that day.
This journal has been transformative for me both personally and professionally. Not only does it help me fall asleep in a more positive manner, it also facilitates me waking up in a better mood (and I am NOT a morning person!) Equally it challenges me to be more mindful of my actions towards others and seek out those "soul moments" as I navigate through the day. Finding little bits of light on even the darkest of days can greatly alleviate stress, tap into happiness and help deal with adversity.
Let’s talk about penis pumps, we hear so much about Viagra and Cialis but very little about these handy devices. Penis pumps are also known as vacuum erection devices and vacuum constriction devices. It is a non-evasive treatment that can be used on its own, with oral medications (like some that I have just mentioned) or with ED treatment like extracavernous injections or intraurethral therapy. A vacuum pump is used to create an erection mechanically, in other words they draw in blood to the penis to make it hard. This is done by pushing blood into the penis using a vacuum seal (a cylinder that goes over the penis). The blood starts to flow back out once the seal is broken and a rubber ring is rolled onto the base of the penis after the vacuum-induced erection has occurred. This prevents most of the blood escaping when you remove the vacuum pump. The ring can be used for up to 30 minutes.
So why are penis-pumps useful?
They are super easy to use
They may help after procedures; prostate surgery or radiation therapy for prostate cancer.
They are not invasive.
They are not expensive.
They can be used with other treatment methods (like therapy or medication)
If you can’t /don’t want to take medication they are useful instead.
It is so important to know that there are so many ways in which ED and Peyronie’s can be assisted and are not limited to medication. There are side-effects too, such as numbness or coldness of the penis, pain or bruising and a feeling of trapped seman. Have a chat with your doctor, urologist or sexual health advisor for more information.
Using validation from others as proof as to our self-worth, results in a decrease of trust in our own judgement and self-belief. Self-acceptance is the foundation to affirmation, growth and contentment.
Challenge that; "is this good enough for them" to "is this good enough for me"
The term 'having sex' is a broad one, and is often perceived as penetration, this narrative ostracizes many. Always remember that you can characterise it as best fits you. Sex is whatever you (and your partner) define it as being.
Through this turbulent unprecedented time, riddled with uncertainty and fear, my thoughts are with the vulnerable. I wanted to particularly say that I am thinking of those who may be under threat or distress while quarantined, social distancing and/or restricted movement.
My solicitude is specifically with the individuals who are in isolation with an abusive partner, the LGBTQ+ kids who are on lockdown in homes where they can't be themselves, children who are unable to escape to the sanctuary of school, people with mental illness that may be exasperated more than ever. There are of course, many more who are at risk and vulnerable. If you know of anyone who may be in this position, reach out to them and let them know you are there. To those struggling, please know that despite feeling it; you are not alone and you are not forgotten
Following the incredibly sad news yesterday of the passing of Caroline Flack, I've seen my timeline explode with the importance of kindness, as Caroline spoke about herself. I’ve also seen the cruel and callous comments being made irrespective. As a therapist and as a person who is in therapy, I can say in great confidence that we really have no idea what goes on in peoples lives or in their heads. Treating people with kindness and compassion is vital. However, often that is difficult for many and as a result projecting anger, hurt and hatred through a screen. Sometimes this is through developmental, environmental and genetic issues. Not to mention biochemical aspects; GABA, Dopamine (which may give you hits when you act out) and Serotonin (depletion) all have a part to play. Wounds that are open and haven't healed can be a painful life to live: "hurt people, hurt people" - we have a responsibility, not only to others but to ourselves to be accountable for our actions. That doesn't lie just with being aware of our behaviours, but also reaching out for help and support. Unresolved trauma can be incredibly painful to live with, but it's not ok to displace it onto others. One of the most wonderful ways to heal is actually through self-compassion. So if you find yourself struggling with how you behave online or with others, seek out a therapist, talk to friends, journal, heal yourself in the best way you know how. When you create wounds in others you only deepen the ones you have yourself.
Alcohol dependency (alcoholism) and sexual dysfunction is so rarely spoken about and has such little research. Alcohol is believed to be an aphrodisiac but in reality, it has damaging effects on all aspects of sexual function. Unfortunately, sexual problems with alcohol dependency are multi-faceted. In one study* it was discovered that 59% of alcohol dependant men experienced erectile dysfunction and 84% reported some level of sexual dysfunction related to alcohol abuse. In another study* showed that 54% of those experiencing alcoholism faced greater sexual dysfunction than heavy social drinkers (28%). In women, one study reported that 85% of alcohol dependent women experienced some form of sexual dysfunction and 74% suffered from continued sexual dysfunction during early recoveryStruggling with alcohol dependency is overwhelming enough but the consequences that come with it can feel insurmountable.
If you are someone struggling with any of the above please know that there are many ways to receive treatment and I implore you to disclose any dysfunction you may be experiencing. AA alongside therapy is a great combination, speaking to your doctor is a brave first step and one that could considerably assist you.
*If you wish to read any of the studies please do drop me a line.
Sexual trauma manifest in different ways. Some survivors experience severe and chronic psychological symptoms, whereas others experience little or no distress. Every experience is different and of equal importance. Sexual trauma as adults is often associated with short-term and long-term psychological effects. These short-term effects include anxiety, fear, anxiety, confusion, and withdrawal. Many survivors encounter a decline in symptoms within a few months, whereas some may experience distress for years. The long-term trauma outcomes include PTSD, depression, eating disorders, sexual dysfunction, alcohol and drug use, suicidal thoughts and attempts alongside many other issues. It doesn’t matter what symptoms an individual may experience, it is vital to know that survivors deserve a safe space and their voice to be heard. If you are a survivor please remember not to measure yourself on anyone else's experience.
Celebrating milestones is significant in healing trauma, however, you don't have to wait until a certain time or occasions in order to do so. The fact that you are here and present is reason enough. You can celebrate as often as you want and any way that feels best for you. It has been shown that the nervous system can settle during times of trauma-healing when accomplishments are celebrated. Alongside this, it has been known to develop resilience. So, revel in the simple things; getting out of bed, leaving the house, talking through something difficult with your therapist-whatever feels right to you.
The celebration doesn’t mean popping a bottle of prosecco or writing a Facebook status (though if that is what you want, fire away!) There are lots of ways to can reward yourself subtly. Here are some of the ways I think are useful:
1. Reflection: Taking note of what you have been through and what you have just accomplished. Whether that is lying in bed or during a therapy session.
2. Being present: Some mindfulness or journaling. Maybe even going for a walk and revelling in your achievement/s.
3. Nurturing yourself: A bath, your favourite movie, a big slice of chocolate cake etc (though I encourage you to do these anyway!)
4. Self-compassion: Kind words, gentle words, positive affirmations. I have this habit of doing a small smile when nobody is watching, it always picks up my mood! By smiling, you are signalling the emotional centres of your brain and promotes the release of dopamine, serotonin and endorphins through your bloodstream. Ultimately releasing tension.
A topic rarely spoken about are symptoms of a mental illness that can create hypersexuality. This is mainly seen in manic or hypomanic episodes of bipolar (some 2.4 million people are diagnosed in the UK) where hypersexuality can occur. It is defined as the increased desire for sexual gratification, characterized by lowered inhibitions. Approximately 57% of individuals with a diagnosis of bipolar will experience sexual distress and dissatisfaction (FYI this can also be linked to hyposexuality due to depressive episodes/side effects of medication).
People experiencing hypersexuality may never feel satisfied with sex. They may want to continue having sex or masturbating for hours without truly feeling that they have completed the act. Not everyone experiencing a manic episode will become hypersexual, but it is linked to an elevated mood and pleasure-seeking behaviours which means it can be hard to control behaviours. This can be stressful for the person and any partners.
The heightened need for sex or sexual activity is not an issue in itself, it is, however, when it causes distress for the individual or couple. Particularly when it is compared with risk-taking, impulsivity or decrease in self-awareness.
Hypersexuality can’t be treated solely. Bipolar hypersexuality responds to treatment and will diminish when the symptoms of mania are brought under control. When the bipolar is effectively treated and symptoms are under control, those hypersexual feelings will dissipate. From my experience as a mental health professional, those who have sought treatment and have regulated their moods are often left feeling ashamed or hurt. It is absolutely vital to work at supporting the individual (and perhaps couple) through compassion and reassurance plus a non-judgemental approach.
None of us are perfect. Failing is part of life, it's part of being flawed, it's part of being human - none of us are exempt. Accepting that we will fail at some point or have failed previously, that it is perfectly normal and OK, can greatly decrease anxiety. Much like my previous post on control, holding onto the fear of failure can result in catastrophic emotions (anxiety, depression, envy, unhealthy anger, shame). You can, of course, feel disappointed or upset but understanding that failing does not indicate your worth can be incredibly empowering. You are of course, only human.
Whenever a new client with erectile dysfunction comes to me. I always encourage them to see a GP first. Physiological causes of erectile dysfunction (ED) be due to; hormones, side effects of medications, stroke, Parkinson's, structural issues to the penis and many more.
But in this post I am going to talk about cardiovascular disease (CVD) because it has been shown that ED occurs at rates as high as 50% in individuals with CVD. CVD can be used to predict the risk of ED because both conditions have the same risk factors. Conversely, ED may trigger events that further lead to coronary artery disease. Atherosclerosis (never ask me to pronounce it!) this is when plaque builds up inside your arteries and it is normally the reasons there is difficulty getting an erection. It can be caused by high blood pressure, diabetes or high cholesterol. It's basically a sign that the lining of blood vessels aren't working as well as they could.
The research out there is telling us that screening for ED could actually be an early detection of CVD or a sign of it already existing. So if you are someone at risk of CVD and experience ED please do go to the doctor and have a check up. ED could actually be a real saving grace.
