Trajectories towards affirmation: Gender identity in mental health services after the ICD-11 / Trayectorias hacia la afirmación: La identidad de género en los servicios de salud mental después del CIE-11

Depathologisation of gender diversity in the ICD-11 marks a shift in psychological services for transgender and gender nonconforming people. Even though the stipulated changes are only practically applicable ever since early 2022, a general move towards affirmative psychothera-peutic and counselling practice has been noticed ever since 2018. The present paper covers three main models of mental health care for genderminorities, namely the conversion therapy model, the transsexual gatekeeping model, and the affirmative model, in order to view them under a novel lens. Drawing on Science, Technology and Society Studies, the universalist pre-sumptions and rigid gender roles of the traditional models are brought under scrutiny. Moreo-ver, the itinerary reveals the need for situated narratives that encourage self-determination and renovate the therapeutic relationship as a means of self-exploration instead of an institu-tionalcontrol mechanism. Concluding, it is remarked that intersectional knowledge is crucial in compensating for micro-aggressive practices and dynamics historically promoted by psycholo-gists and other mental health providers. (AU)

La despatologización de la diversidad de género en el CIE-11 marca un giro para los servicios psicológicos para personas trans y no conformes al género. Aunque los cambios estipulados so-lo se incorporan prácticamente desde principios de 2022, se ha estado observando un movi-miento general hacia la práctica psicoterapéutica y de asesoramiento afirmativo desde 2018. El presente artículo realiza un recorrido por los tres modelos principales de atención de salud mental para minorías de género, concretamente el modelo de terapias de conversión, el mode-lo transexual de vigilancia, y el modelo afirmativo, con el fin de contemplarlos bajo una nueva perspectiva. Partiendo de los Estudios de Ciencia, Tecnologíay Sociedad, se examinan las pre-sunciones universalistas y los roles rígidos de los modelos tradicionales. Además, el recorrido revela la necesidad de narrativas situadas que incentiven la autodeterminación y renueven la relación terapéutica como eje de autoexploración en vez de mecanismo de control institucio-nal. Como conclusión, se remarca que el conocimiento interseccional es crucial para compen-sar las prácticas micro-agresivas y dinámicas que históricamente han promovido psicólogos y otros prestadores de servicios de salud mental. (AU)

PLISSIT model: sexual counseling for breast cancer survivors.

OBJECTIVE: Reporting the experience of use of the PLISSIT model as tool for the nursing care of breast cancer survivors with sexual dysfunction. METHOD: case study developed from January to August 2017, in the outpatient mastology clinic and sexuality service of a maternity in Fortaleza, Ceará, Brazil, with 15 breast cancer survivors. RESULTS: sexual counseling sessions were conducted using the PLISSIT model to address sexual issues, highlighting the particularities of women who experience survival after the treatment of breast cancer. FINAL CONSIDERATIONS: the model used in the practice of nursing care is customary and allows identifying issues experienced by women, as it has easy availability and practicality for use by nursing professionals, helping to address sexual matters with greater tranquility.

PLISSIT model: sexual counseling for breast cancer survivors / Modelo PILSET: asesoramiento sexual para sobrevivientes del cáncer de mama / Modelo PILSET: aconselhamento sexual para sobreviventes do câncer de mama

ABSTRACT Objective: Reporting the experience of use of the PLISSIT model as tool for the nursing care of breast cancer survivors with sexual dysfunction. Method: case study developed from January to August 2017, in the outpatient mastology clinic and sexuality service of a maternity in Fortaleza, Ceará, Brazil, with 15 breast cancer survivors. Results: sexual counseling sessions were conducted using the PLISSIT model to address sexual issues, highlighting the particularities of women who experience survival after the treatment of breast cancer. Final considerations: the model used in the practice of nursing care is customary and allows identifying issues experienced by women, as it has easy availability and practicality for use by nursing professionals, helping to address sexual matters with greater tranquility.

RESUMEN Objetivo: Informar la experiencia del uso del modelo PILSET como herramienta de cuidado de enfermería para sobrevivientes de cáncer de mama con disfunción sexual. Método: relato de experiencia desarrollado de enero a agosto de 2017, realizado en el ambulatorio de mastología junto con el servicio de sexualidad de una maternidad-escuela de Fortaleza, Ceará, Brasil, con 15 sobrevivientes de cáncer de mama. Resultados: se realizaron sesiones de asesoramiento sexual, utilizando el modelo PILSET para trabajar cuestiones sexuales, destacando las particularidades de la mujer que vive la sobrevida tras el tratamiento del cáncer de mama. Consideraciones finales: el modelo utilizado en la práctica del cuidado de enfermería es usual y permite identificar cuestiones vivenciadas por la mujer, pues es una herramienta de fácil disponibilidad y practicidad para profesionales de enfermería, ayudando a abordar cuestiones sexuales con mayor tranquilidad.

RESUMO Objetivo: Relatar a experiência do uso do modelo PILSET como ferramenta de cuidado de enfermagem para sobreviventes de câncer de mama com disfunção sexual. Método: relato de experiência desenvolvido de janeiro a agosto de 2017, realizado no ambulatório de mastologia em conjunto com o serviço de sexualidade de uma maternidade-escola de Fortaleza, Ceará, Brasil, com 15 sobreviventes de câncer de mama. Resultados: realizaram-se sessões de aconselhamento sexual, utilizando o modelo PILSET para trabalhar questões sexuais, destacando as particularidades da mulher que vivencia a sobrevida após o tratamento de câncer de mama. Considerações finais: o modelo utilizado na prática de cuidado de enfermagem é usual e permite identificar questões vivenciadas pela mulher, pois é uma ferramenta de fácil disponibilidade e praticidade para profissionais de enfermagem, auxiliando abordar questões sexuais com maior tranquilidade.

Progress in sexual counseling by cardiac nurses, 1994 to 2009.

OBJECTIVE: To examine trends in the practice of sexual counseling by cardiac nurses. METHODS: A non-experimental descriptive design was used to analyze survey data collected at 2 time points: 1994 (n = 171) and 2009 (n = 288). RESULTS: Nurses in the 2009 sample reported more conservative values (P < .001) and greater sense of responsibility for providing sexual counseling (P < .0001) than those in the 1994 sample. Although sexual activities (cuddling, kissing, fondling, masturbation, oral sex) were discussed more frequently by nurses in the 1994 survey (P < .001), improvements in the specific discussion of myocardial infarction-related sexual activity and counseling were noted in the 2009 sample, including by patient age and gender (P < .0001). CONCLUSION: Comparison of the 2 data samples suggests an improving trend in provision of sexual counseling by cardiac nurses, which can be reinforced by including sexual counseling information and role-play opportunities in continuing education courses.

[Psychotherapy for sexual dysfunctions and desire disorders]. / Psychotherapie sexueller Funktions- und Erlebensstörungen.

Sexual problems do not always require specific psychotherapy. If missing or wrong sexual information is the main cause, sexual counselling can be sufficient. We define "sex-psychotherapy" as the methods which are based on Masters and Johnson as well as other symptom-focused and experience- oriented (exercise) psychotherapeutic methods for sexually disturbed couples and singles. These methods have significantly improved the treatment of sexual dysfunctions. In group- and in couple-settings they have proven to be effective in reducing sexual symptoms and improving sexual satisfaction and partnership-satisfaction. Long-term studies showed that sex-psycho- therapy leads to a stable improvement in sexual satisfaction, whereas the reduction of sexual symptoms is less stable. Therefore sex-psychotherapy should be combined with "relapse-prevention" methods. A number of sexual disorders are caused by psychological and organic factors; they need both psychotherapy and medical treatment. This is of special importance in elderly men and in women with symptoms of dyspareunia.

[Sex therapy for male sexual dysfunction]. / Sexualtherapie bei sexuellen Funktionsstörungen des Mannes.

A high prevalence and incidence of sexual dysfunctions as well as the availability of orally effective medications cause a rising interest in professional help. In diagnosing and treating sexual disorders, a holistic, biopsychosocial understanding of sexuality and a thorough analysis of the specific needs of the couple are of the utmost importance. Furthermore, the typical physician-patient relationship has to be transformed into a physician-couple relationship wherever possible. Sex therapy, then, focuses on the universal psychosocial fundamental needs and their relevance for the complaints of the couple. In this way the main focus of attention is shifted from the sexual dysfunction to the communicative meaning of sexuality within the relationship and to the quality of the partnership as a whole. Thus the sexual problem is put into a new perspective and sexual functions are relieved from the pressure of performance anxiety. Simultaneously intimacy and mutual satisfaction are promoted. The possibility of obtaining an additional qualification in sexual medicine (since 1997 in postgraduate, curricular trainings) is offering new opportunities for urologists to integrate aspects of sexual medicine into their clinical practice and thus to propose a more extensive form of therapy to their patients. This paper reflects the process of this integration, illustrating it with respective case reports; it stresses the necessity of a holistic approach to the treatment of sexual dysfunctions, also in regard to the economic advantages of a biopsychosocially oriented sex therapy.

Sex therapy: the successes, the failures, the future.

Sexual dissatisfaction or dysfunction occurs in one fifth to one third of the adult population. Although great advances have been made in the pharmacological treatment of impotence, psychological and relationship therapy remain the mainstay of the treatment of sexual problems within relationships.

Contraceptive use and counseling before and after an abortion in Ohio, 1981 and 1986.

PIP: The use of counseling to promote effective contraceptive use after abortion was evaluated through use of data from Ohio on abortions performed in 1981 and 1986. Ohio was selected because the Department of Health collects information on contraception used at time of conception and the contraceptive method the woman was counseled to use after her abortion. In both years, about 65% of abortion patients were not using a contraceptive method at the time of conception. This phenomenon was most common among teenagers. Contraception failures tended to involve the IUD, diaphragm, and spermicide in 1981 and the pill and condom in 1986. Of note was the finding that women who experienced pill failure were rarely advised to switch to another method after abortion. Women who were nonusers at the time of conception were generally counseled to use the pill. Over 9% of women counseled to undergo sterilization opted to have this surgery concurrent with the abortion. Although the findings are limited by incomplete reporting and insufficient coding categories, they provide some leads as to how abortion providers can improve patient care and highlight the importance of careful counseling of young women who are not using a contraceptive method.^ieng

Comprehensive sexual health centers: is it time?

Psychiatric epidemiologic research, mental health professionals, and nonpsychiatric physicians still largely avoid dealing with the problems of sexual identity and function. The Department of Psychiatry at Case Western Reserve University, in contrast to these trends, has established a Center for Human Sexuality, an innovative mental health center that employs full- and part-time staff to provide services, education, and research. The Center may serve as a model for other institutions that perceive the social, academic, and economic value of dealing with these high prevalence, underserved problems. The support of administration and the multidisciplinary interaction of mental health professionals among themselves and with nonpsychiatric physicians have been crucial to the Center's viability. Strategies for dealing with health care administration are discussed.

[Current problems in sex research]. / Aktuelle Probleme der Sexualforschung.

In this survey the sexuologic relevant research trends and recent items of discussion have been listed up. Regarding to sexual medical research endeavour there are special references to the problems of methodology. Concluding new concepts of sexual therapy are mentioned.

Sexual potency: a pioneer's thirty-five-year overview.

Thirty-five years of interest in human sexual potency are summarized, citing my clinical research and periodic publications during those decades. Emergence of scientific study of human sexuality has been rapid in recent years, leading to improved diagnostic and therapeutic techniques to benefit the impotent male. Although my approach pertained primarily to psychogenic etiology, the interdigitation of emotional and organic factors is emphasized. Currently utilized surgical and pharmacodynamic treatments are noted, as are probable future methodologies.