Our Sexual Medicine program aims to teach and conduct research, and at the B.C. Centre for Sexual Medicine, implement exemplary clinical care of sexual difficulties experienced by men and women from across B.C.
Patients (couples or single) require a physician or nurse practitioner referral. Given the diversity of sexual issues in either healthy or 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. physiatrists, neurologists, oncologists, endocrinologists, cardiologists, gastroenterologists).
Our programs and individual treatments in sexuality are guided by our firm belief that the mind and body are inseparable, and we are respectful of sexual individuality and diversity.
The diverse referral base reflects the multiple ways illness, trauma or surgery 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 desire (too little, too much), experiencing little pleasure or arousal mentally, reduced genital sexual sensations/ swelling/ lubrication/ erection,.problems with 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
- Loss of sexual genital sensitivity
Specifically, sexual difficulties in men include:
- Sexual desire concerns
- Erectile dysfunction
- Too rapid ejaculation
- Too slow or delayed ejaculation
- Inability to ejaculate
- Orgasmic concerns
- 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 occasionally 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 the concern is primarily untreated past sexual abuse
- 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 complaint is a sexually transmitted disease.
- We do not decline referrals on the basis of gender, sexual preference, race, religion or culture
Treatments include individual or couple therapy or can also be in a small group format (5 to 10 persons).
We utilize medical ( which may require blood tests or imaging) and psychological treatments in an integrated fashion:
- 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 also seen at our Vancouver Sperm Retrieval Clinic at Vancouver General Hospital/Blusson Spinal Center location.
Upon assessment, if we find that the main issue is beyond our mandate (e.g. specific marital counselling for marital difficulties or past sexual abuse) the patients may be referred on to other specialists.
We currently offer small group programs for:
- Women with sexual pain
- Men with erectile dysfunction primarily in partnered situations
In the future, with increased staff, we would implement group programs for:
- Couples unable to consummate their marriage/relationship
- Women with low desire and arousal
Our staff has diverse research interests and we are fortunate to work with colleagues in other departments to enhance our research potential.
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 therapeutic programs for men and for women 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 complexity of the multifactorial sexual issues facing persons with new and chronic spinal cord injury via an Internationally Derived Standards, Data Bases and Surveys
- Assessing the safety on brain blood vessels when blood pressure rises ( autonomic dysreflexia) from techniques to obtain sperm in men with spinal cord injury
We have also been involved in several international guidelines including the Canadian Guideline on testosterone replacement, a TrueNTH International Guideline for the Sexual Health Care of men following Prostate Cancer treatments, the development of Canadian Spinal Cord Injury rehabilitation – High Performance Indicators ( SCI-HIGH), and Clinical Practice Guidelines for the Paralyzed Veterans of America Consortium on Spinal Cord Medicine Autonomic Dysfunction
Planned research includes:
- Modifying our MBCT-based small group programs as experience grows
- Developing and testing additional small group programs and making them transferrable to other clinicians across the province
- Exploring original pharmacological management of sexual pain
- 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 is located at the VGH Hospital Blusson Centre - 2nd Floor 818 West 10th Avenue Vancouver. The program’s clinical research is conducted at this site. The teaching component also occurs at this site for trainees and medical Residents as well as in undergraduate, postgraduate programs, hospitals and national and international conferences. Six physicians work full- or part-time and all see men and women referred from across BC with the various types of sexual dysfunctions at the BC Center for Sexual Medicine ( BCCSM) :
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
- Rachel Nicoletti
- We are also affiliated with the Prostate Cancer Supportive Care Program at the Diamond Center along with 2 sexual health nurse clinicians, Christine Zarowski and Monica Tancom
Furthermore, at the Vancouver Sperm Retrieval Clinic we see men with sexual issues affecting fertility (primarily those with spinal cord injury) and coordinate with Dr. Mark Nigro (urology )and infertility clinics to promote biological fatherhood for these men.
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 orthopedic issues are seen by the clinicians of the SHRS, with Dr. Elliott consulting .
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. These and other challenging cases require the expertise we offer.
The UBC Sexual Medicine Program is able to provide advanced training in sexual medicine to physicians. This is urgently needed given the large number of people suffering from sexual difficulties across the province. Please make a donation to support this advanced training 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 currently have small group programs for women with sexual pain and for men with erectile dysfunction during partnered sexual activity. With additional physicians we could also simultaneously implement our programs for couples unable to consummate their marriage/relationship, and for women with low sexual arousal and enjoyment of sex.
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.