Our program aims to teach, conduct research and, in the B.C. Centre for Sexual Medicine, implement exemplary care of sexual difficulties experienced by men and women from across B.C.
Patients (couples or single) require a physician referral. Given the diversity of sexual issues in healthy and in physically or mentally unwell persons, most referrals are from family physicians, psychiatrists, gynecologists, and urologists, but the broad spectrum of sexual dysfunction includes referrals from all types of physicians (e.g. neurologists, oncologists, endocrinologists, cardiologists, gastroenterologists).
Our programs and individual treatments are guided by our firm belief that the mind and body are inseparable, and we are respectful of sexual individuality.
The diverse referral base reflects the multiple ways illness can be associated with sexual symptoms. However, mood, stress, psychological issues, past experiences, relationships and cultural and religious factors are typically mixed with the medical changes.
Sexual symptoms may occur during times of good health or during chronic health conditions such as mood disorders, neurological disease, cancer, gynecological and urological problems, and from past injuries. Sexual concerns and/or dysfunctions include those of sexual drive (too little, too much), problems with mental or genital arousal, including arousal from atypical/alternative sources leading to distress, orgasmic issues, ejaculatory issues, sexual issues leading to fertility concerns and pain with sexual activity.
Specifically, sexual difficulties in women include:
- Sexual desire concerns
- Pain during sexual activity
- Inability to have intercourse/penetrative sex due to pain and tightness of muscles around the vagina
- Poor or absent orgasmic response and pleasure
Specifically, sexual difficulties in men include:
- Sexual desire or libido issues
- Erectile dysfunction
- Ejaculation problems
- Too rapid a response
- Too slow a response
- Inability to ejaculate
- Fertility problems requiring sperm retrieval procedures
- Pain with sexual activity or ejaculation
Our assessments are 1.0 hour minimum and often 2 to 3 visits are required. For couples, we see both partners together and separately. We trace the details and evolution of the sexual problem(s), past and present medical and psychological concerns, past sexual experiences, family background and upbringing. Information obtained during the single partner visits is shared only with that patient’s permission and only if necessary for managing the sexual dysfunction.Carefully listening to the patients’ histories gives us the most information. A physical examination may be necessary (e.g. when pain is present during sex). In some cases laboratory tests or other imaging is needed.
Since close to 400,000 persons in B.C. are thought to have ongoing troublesome sexual dysfunctions, our limited staff can only handle so many referrals. We do not perpetuate a waitlist, so unfortunately we decline referrals, for instance:
- When a mood disorder needs first to be stabilized
- When relationship difficulties need to first be addressed
- When other community resources are available
- When medicolegal issues are in process. Our experience is that sexual therapy or work around sexual issues needs to be deferred until litigation is over.
- When the concern is not a sexual dysfunction - but rather distress or discomfort with gender identity, or sexual orientation, or when the chief complaints is a sexually transmitted disease. We do not decline referrals on the basis of sexual preference, race, religion or culture
Treatments include individual or couple therapy or can also be in a small group format (5 to 8 persons).
Types of treatment include:
- Sex therapy, modified sensate focus
- Cognitive behavioural therapy (CBT)
- Mindfulness-based cognitive therapy (MBCT)
- Motivational interviewing; supportive, and interpersonal techniques
- Hormone replacement
- Medical interventions or sexual aids (for example in erectile or ejaculatory dysfunction)
Specialized techniques are used for sperm retrieval for men who have ejaculatory or erectile difficulties and who want to have children . These patients are seen at our Vancouver Sperm Retrieval Clinic at Vancouver General Hospital/Blusson Spinal Center location.
We currently offer small group programs for:
We plan to develop small group programs for:
- Men with low desire
- Men with erectile dysfunction during partnered sex
- Men and women with sexual side effects of antidepressants
- Couples unable to consummate their marriage/relationship
- Men with premature ejaculation
Our staff has diverse research interests and we are fortunate to work with colleagues in other departments to enhance our breadth of research potential. Currently we have two main areas of research: women’s sexual health, and sexuality and disability.
Our current research includes:
- Measuring stress responses and evaluating stress during childhood and adolescence in women with and without ongoing sexual desire difficulties as adults
- Developing and studying the outcome of the small group programs and making them transferrable to other clinicians across the province
- Providing a national, comprehensive pre-pregnancy, labour, delivery and post-pregnancy guide for women with disability (particularly spinal cord injury)
- Evaluating the sexual component via International Standards used in assessment of newly injured and chronically injured persons with spinal cord injury
- Assessing the safety on brain blood vessels when blood pressure rises from techniques to obtain sperm in men with spinal cord injury
Planned research includes:
- Modifying small group programs as experience grows
- Developing and testing additional small group programs and making them transferrable to other clinicians across the province
- Applying the principles of low intensity shock wave therapy to create new vessels in a pilot group of 30 men with vascular erectile problems
- Developing and implementing an educational and collaborative care model to support patients in the community with severe and persistent mental illness whose sexual concerns are often under-recognized and undertreated
- Examining and optimizing undergraduate and postgraduate medical education to ensure evidence-based competency in sexual medicine knowledge, attitudes, and skills for future physicians
The UBC Sexual Medicine Program includes two clinical sites: the Vancouver Sperm Retrieval Clinic (VSRC) at Vancouver General Hospital/Blusson Spinal Center for men whose sexual dysfunction has led to infertility; and the BC Center for Sexual Medicine (BCCSM) at UBC/Purdy Pavilion for the remaining sexual dysfunctions in men and women. The program’s clinical research is conducted at both sites. The teaching component occurs at both sites for trainees and medical Residents as well as in undergraduate, postgraduate programs, hospitals and national and international conferences. Five physicians work full- or part-time at the Purdy Pavilion and all see men and women referred from across BC with the various types of sexual dysfunctions:
- Dr. Rosemary Basson
- Dr. Lori Brotto (Biography)
- Dr. Shauna Correia
- Dr. Miriam Driscoll
- Dr. Stacy Elliott
- Dr. Kulwant Riar
We also work closely with our nurse sexual health clinicians in the Sexual Health Rehabilitation Service (SHRS) at the GF Strong Rehabilitation Center:
- Marie Carlson
- Shea Hocaloski
- Leslie Houle
- Christine Zarowski
Dr. Leslie Cockhill, a psychiatrist in private practice, provides further psychotherapy outside of the clinic for difficulties that underlie the sexual dysfunctions of clinic patients.
Our integrated clinics and patient referral centers therefore span a few sites, including:
- The Brain Health Centre at UBC, where men and women with Multiple Sclerosis, Parkinson’s Disease and other neurological diseases are seen.
- The Integrated Spine Center at Blusson, where men and women with neurological and orthopaedic issues are seen by the clinicians of the SHRS, with Dr. Elliott consulting to that service. Both Dr. Elliott and Dr. Mark Nigro, a urologist, are Co-Directors of the Vancouver Sperm Retrieval Clinic housed at the Blusson Center.
- GF Strong Rehabilitation Center, where men and women with neurological disease, stroke or arthritis are seen by the Clinicians of the SHRS.
Dr. Elliott is also a Sexual Medicine Consultant to two other programs outside the BCCSM: the Men’s Health Initiative (MHI) in the Diamond Health Centre, along with Dr. Richard Bebb, and also the Prostate Center’s Prostate Cancer Supportive Care program (PCSC), both being coordinated by Dr. Larry Goldenberg of Urologic Sciences at UBC. Drs. Basson, Driscoll and Correia work closely with academic psychologist Dr. Lori Brotto, a researcher in women’s sexual health, and based at Diamond Health Centre and with Dr. Andrea Grabovic, a psychiatrist based at Vancouver General Hospital and BCCA who is very experienced in mindfulness and its applications to western medicine. Together we develop and implement the 2 current small-group programs for women.
Some 370,000 adults in B.C. have very troublesome, ongoing sexual dysfunctions. Often, but not always, the context is one of chronic illness, including mood disorders, neurological disease, cancer, and/or negative past sexual and non-sexual experiences. The number of married couples unable to consummate their marriage is unclear, but new couples are referred to our clinic every week. The UBC Sexual Medicine Program is developing an outreach program to help meet the demands of the province. Please make a donation to support this program.
Our patients usually tell us that their sexual difficulty, whatever it is, is the most distressing problem in their life. With your support, we plan to develop evidence-based, transportable small group programs so that patients across the province can benefit. Physicians will be able to actively ask patients regarding sexual difficulties knowing evidence-based treatment is available. Funding for this program will mean patients will not have to travel to Vancouver and care can be ongoing and based closer to home
Our specific need at this time is support for physicians to develop the evidence-based transportable programs for health providers across BC. We have small group programs for women with sexual pain, and for women with low sexual desire and arousal, but we need similar format programs for men with low desire, men with erectile dysfunction during partnered sex, for men and women with sexual side effects of antidepressants, for couples unable to consummate their marriage/relationship, and for men with premature ejaculation.
All contributions to the UBC Sexual Medicine Program will be immensely appreciated. Donations will help us to recruit and train additional staff, to enable some of our physicians to devote time each week to developing and implementing the province-wide programs. Please give your support to this exciting and much-needed program.