Colombia - Massachusetts Medical Interpreter Training · 2020-01-03 · pregnancy, premarital sex...

Colombia

Hernando Restrepo Payán Medical Sexologist

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How to interpret in a sexual context?

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OVERALL WORKSHOP GOAL

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Provide theoretical and practical tools in a specialized medical consultation in order to provide a comfortable environment in which patients feel comfortable to express their sexual concerns and improve their quality of life.

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At the conclusion of this presentation, you will:

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Know the object of study of medical

sexology.

Recognize the profile of people who works in a sexual context.

Have fluency in sexological terms.

Know the main reasons for sexological

consultation.

Improve your interpretation skills in sexological topics.

Understand the process of a

sexological medical record.



At the conclusion of this presentation…some things that will not

happen:

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You will not leave here as an expert in

the field of sexology.

You will not be able to make sexologic

diagnosis.

You will not leave here erotized.

You will not learn more sexual positions.



MEDICAL SEXOLOGY.

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Sexology is a field of knowledge.

Medical Sexology is one area in the field

of Sexology

Medicine is a field of knowledge.

Medical Sexology is a new specialty in

the field of Sexology.

Principles



SEXOLOGY

B

E

C

D

A Medical Sexology

Psychological Sexology

Educational Sexology

Philosophical Sexology

Sociological Sexology

Anthropological Sexology

F

MEDICAL SEXOLOGY.



SEXOLOGY HAS TWO MAIN AREAS OF STUDY

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S

EX

SEXUAL FUNCTION

• Sex Development

• Sexual Function

Both are understood as a Process



Time of Process Functioning: Variable

MASTER TEMPLATE PROCESS OF SEX

DEVELOPMENT PROCESS OF SEXUAL FUNCTION

EXPRESSION PHASE

Spermatozoon

Ovule

PROGRAMMING PHASE

♂ ♀Diverse sex-gender

DIFFERENTIATION PHASE

Testicles Ovaries

Anatomical

Neural

Hormonal

Vascular

Endothelial

Functional

Administration

Frequency

Method

Quality

Sexual Desire

R S/S PHASE

Zigote

PHASE

Diagnostic Manual Of Sexological Diseases Second Revised Edition, FLASSES y WAMS 2010

Social

Biologic

Environmental

Psychologic



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Copyright©2010 Companyname Free template by Investintech PDF Solutions Haas, AP et al (2014). Collecting sexual orientation and gender identity data in suicide and ohter violent deaths…LGBT Health. Vol.

0, Numb 0.

Intentos de suicidio 3-4 veces mayores que en población heterosexual

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FLASSES, WAMS, AISM. Manual Diagnóstico en Sexología. III ed. Caracas, 2014

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MEDICAL SEXOLOGY. Objetives

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Treatment

Rehabilitation Promotion

Sex and

Sexual Function

Prevention



PROMOTE functionality of Sex Development Process in three phases



PROMOTE functionality of the sexual process

Kegel’s Exercises

Assertion

Sleep - Repose

Diet Time and leisure for ESF


http://demoda.com.es/wp-content/uploads/2011/06/220.jpg


PREVENT alterations of Sexual Function process

Urologic examination

Gynecologic Examination

Unwanted pregnancy

Prevention of STD Evaluation of relationship with partner



TREAT sexual dysfunctions

Surgical Treatment Pharmacology Therapy

Psychotherapy Sex and Marital Therapy



The sexual response (Masters and Johnson)

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Sexual Rehabilitation

• Spinal Cord injuries. • Pubococcygeus muscles.



Are attitudes important toward sexuality?

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Conservative attitudes avoid making treatment decisions. Training in sexology would help improve sexual health.

Recognize and correct attitudes toward sexuality that may interfere with an objective and comprehensive clinical practice.

M.J., Tijeras. Influyen las actitudes hacia la sexualidad de los profesionales sanitarios? Anuario de Sexología, No.12; pp 43-50. 2010,



Are attitudes towards sexuality important?

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Incorporate topics pertaining to sexual health in the training curriculum of health professionals.

Management of sexual health issues can help us feel more comfortable and prepare us for an integral treatment.

M.J., Tijeras. Influyen las actitudes hacia la sexualidad de los profesionales sanitarios? Anuario de Sexología, No.12; pp 43-50. 2010,



Prevalence of more common sexual dysfunctions

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Dysfunctions Edad Prevalence (%) Source

Erectile Dysfunction

25-39 3.9% Eardley I. The incidence, prevalence, and natural history of erectile dysfunction. Sex Med Rev 2013;1:3–16. 40-49 6%

50-59 15.9%

60-69 32.2%

70-80 41-76%

Premature Ejaculation

1998**- 2013

3-83% Stanley E, Althof. An Update of the International Society of Sexual Medicine's Guidelines for the Diagnosis and Treatment of Premature Ejaculation (PE). J Sex Med 2;2, 2014.

Hipoactive Sexual Desire

in women

18-44 45-64 Over 65

8.9% 12.3% 7.4%

Sharon J.P. Hypoactive Sexual Desire Disorder: A Review of Epidemiology, Biopsychology, Diagnosis, and Treatment. Sex Med Rev 2016 .

**Studies between



Special challenges for interpreters

Sexual attitudes are expressed through who we are, what we do, and how we feel about our sexuality and that of others.

Continuous self-assessment process and restructuring of attitudes, fears, beliefs and conceptions is necessary.

23 Sánchez, M. La educación para la sexualidad. Available in: www.monografías.com http://massmedicalinterpreting.org/sites/massmedicalinterpreting.org/files/Anatomy officeVisit




Interpreters need to demonstrate a mastery of medical knowledge and terminology to be perceived as competent and trustworthy by providers. (Flores et al., 2003; Hsieh et al., 2010; Nailon, 2006).

24 Nsieh, E. Et al. Bilingual health communication: distinctive needs of providers from five specialities. Health communication, 28: 557-567, 2013.




LA people tend not to say anything when they do not have an understanding.

Identify nationality because vocabulary and expectations are different.

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Register vocabulary

Hi

General

Low

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Colombia Cuba Chile Ecuador España Venezuela

Pene Chimbo Bicho Tula Verga Polla Güevo

Vulva Vagina Crica Choro Chucha Chocho Cuchara

Senos Tetas Tetas Melones Tetas Bubis Tetas

Masturbación Paja Paja Halar el ganzo

Paja Cascar Paja

Relación sexual

Pichar Zingar Culiar Tirar Follar Coger

Erección Pararse Pararse Armar carpa

Pararse Empalmar Pararse

Eyaculación Venirse. Polvo.

Venirse Irse Acabar Correrse Acabar

Infidelidad Cachos Pegar los

tarros

Gorrear Cachudo/a Cuernos Poner cachos

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Ethical principle of impartiality – the obligation not to judge, take sides, or express personal opinions and biases with respect to the content of communication in the clinical encounter.

28 NCIHC, 2004. A National code of ethics for interpreters in health care



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"(…) Anyone can teach anatomy, but not everyone can give a serene and healthy image of the implications of sexuality in life, not before, put himself into question review". Ariza, 1991



The interpreter profile in a sexual context

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Characteristics, values, attitudes, conditions and skills expected of a person who aims to create a formal and intentional sexual communication processes.

Sánchez, M. La educación para la sexualidad.




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• Assumes and accepts his/her own sexuality, recognizes.

• Feels comfortable discussing sexual issues.

• Understands and deeply

respects individual differences and the variety of lifestyles.

The best resource available to the sexual educator is himself or herself.





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• Authentic.

• Practices active listening, empathy, expression of feelings.

• Strives to achieve coherence, consistency, and solidity between what he/she says and his/her attitudes.





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• Promotes respect for the ideas and personal, social, religious, ethnic, moral, and human values.

• Speaks openly




KEY CONCEPTS AND DEFINITIONS

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SEXUALITY “It refers to a fundamental dimension of being human: based

on sex, including gender, gender identities and sexual orientation, eroticism, emotional attachment, love and reproduction. It is expressed in thoughts, fantasies, desires, beliefs, attitudes, values, activities, practices, roles and relationships ....

…Sexuality is expressed in all that we are, we feel, think and do”. Giraldo, O., 2002

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SEX

Organic condition that distinguishes the male

from the female.

DRAE FLASSES, WAMS, AISM. Manual Diagnóstico en Sexología. III ed. Caracas, 2014

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GENDER

Social concepts of roles, behaviors, activities and attributes that each society considers appropriate

for men and women.

WHO

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Sexual Transmitted Infections (STI)

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Infections that are spread primarily through person-to-person sexual contact. (bacteria, viruses and parasites). WHO.



SOME TERMS

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Secreción vs Flujo o

pus

Lesión vs granito, peladura

Vesículas vs bombas

Adenopatías vs bolitas, ganglios



MEDICAL and SEXUAL RECORD

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IDENTIFICATION

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Name : Current desease:

Sex/Gender: Age: Place of born: Date of born:

I.D.: Religion: Marital status:

Educational attainment:

Current job Home address:

Monthly Income Referred by:



GENOGRAM

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65 years old.

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48 years old. 55 years old

X

33 37 40



REASON FOR CONSULTATION

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“I have problems reaching orgasm

forever”



CURRENT DISEASE

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Female patient 28 years old, from USA, single, no children, Manager, Evangelic Christian practitioner who feels female and states that her sexual education was very religious, restricted and founded on fear of sexuality, especially about early pregnancy, premarital sex and STI. She said that since she began her first consented ESF with her boyfriend, at the age of 19, she couldn´t get aroused even if she had precoito for about 1 hour. When penetration was attempted, it was so painful for her that he pulled out. On the next attempt penetration was achieved but it was painful and bleeding occured. She said that she was not lubricated during that time in any of her sexual encounters. She does not fantasize , does not seek sex and does not desire it. When she practices the ESF alone or with a partner, she cannot get excited and never has experienced an orgasm.



CURRENT DISEASE

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It has been a pattern that has been similar with all her sexual partners although they have practiced precoito 30 minutes to 60 minutes. She never has been abused by any of them and she has a good image about men. She denies homoerotic fantasies and practices. She has practiced masturbation since she was 25, but the first time was out of curiosity. She states that she didn´t feel much of a result: arousal 3-4/10, no lubrication, no fantasies, no orgasm. This situation makes her relationships short.



WHAT WAS YOUR MOTIVATION FOR CONSULTATION TODAY?

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“It’s impossible to enjoy my sexuality. I want to get a stable relationship, and have children.”

“I have problems reaching orgasm

forever”



PERSONAL HISTORY

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Pathologic/ Allergies

Gastritis, irritable bowel Allergies: dust, cold.

Surgeries Adenoids and

turbinates

Injuries No Vaccines All for her age

Infections Bacterial Vaginosis.

No STI

Gyno-Obstetrics

Menarche At 13 years old

Cycles 26-27 days. Duration: 6 days

Family Planning:

No

Pregnancy:

0

Childbirth

0

Abortion:

0

D.L.M.

15-02-13

Papa-nicolau:

07-02-13. Normal



PERSONAL HABITS

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Voidings 3 times/day

Defecates 1 time/day

Feed 3 times/day

Exercise No Sleep 6-7 hours/day

quiet, restful.

Coffee 1 cup/day

Tobacco No Alcohol No Drugs No

Medicines No



FAMILY HISTORY

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Mother was treated for arterial hypertention.

Father died of a Myocardial Infarction.



BIOGRAPHY

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PREG

NAN

CY

and

CH

ILD

BIR

TH

-Not planned. -Kindergarten at 6. -Institutional. No complications.

ADO

LESC

ENC

E -17. Completed High school. Limitations to go out. -22. Graduated with a Master in IT. Very good student.

ADU

LT

-23. Got a job at a bank. -26 Professional status. -Responsible, punctual, conciliatory, impatient, accelerated.

ADU

LT

-Responsible, consistent, punctual, autodidactic, communicative, conciliatory -Impatient, -Demanding -Accelerated

ADU

LT

-Roles: Daughter: ++ Personal +++ Partner ++ Negative view of her bosom, lips and ears.



SEXUAL EDUCATION RECIVED

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Mother: S.T.I. and pregnancy!! “Fornication is a sin”

Religious beliefs generate conflict for me…



SEXUAL HISTORY

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Nowdays, she doesn´t have any boyfriend or sexual partner, but she is worried about her situation and wants to know her diagnosis and improve her condition because she wants to be sexually active, get married, and have children.

0 years old

E.C.S.F.

8 31 y. old

Menach

13 years old 4

E.S.F.P 19 20 24 25 27 29



TYPES OF FANTASIES USED

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She doesn´t fantasize



SEXUAL RESPONSE IN SITUATIONS WITH NO PARTNER

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Incomplete sexual response: no lubrication or very little, arousal:

3-4/10. No orgasm.



MENTAL EXAMINATION

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ORIENTATION MEMORY INTELLECTUAL FACULTIES

LANGUAGE

Oriented in P.T.P. Fixation, short and long term: retains facts

Without abnormality

Coherent; speed: ok, tone: acute

volume: ok.

THOUGH THIMIC SENSOPER- CEPTION

MOTOR ACTIVITY

Curse: Adequate Content:

Coherent. Ideas anticipating functionality

Euthimic Maintains Consistent with no alteration



PHYSICAL EXAMINATION

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With emphasis on the sex organs



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COMPLEMENTARY TESTS

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• Prolactine

(4.0-30)

Normal (15.6)

• Tiroxina T4:

(6-12)

Normal (6.0)

• TSH (0.3-4.0)

Normal (1.13)

• Negative.

VIH.

• LH • FSH • Estrogens • Progesteron.



DIAGNOSIS POSIBILITIES

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• HYPOACTIVE SEXUAL DESIRE •Deficient (or absent) sexual fantasies and desire for sexual activity.

•Marked distress or interpersonal difficulty • It is not due by aonther Axis I disorder o drugs…)

Desire Disorders

• EXCITABILITY SUBJECTIVE DISORDER •Rigid sexual education •No pleasure during ESFP or AESF •Precoito with no pleasure •Physical Examination: Normal. •Organic manifestations or arousal present: lubrication and muscle contractions

Arousal Disorders

• LUBRICATION DEFICIT IN WOMEN •Precoito, coito, post: ok. •No lubrication •Complete sexual response



DIAGNOSIS IMPRESSION

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Type 2 Orgasmic Dysfuntion MDS B 56

Hypoactive Sexual Desire? (secondary to Orgasmic Dysfunction) MDS B 44



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PROCEDURES, TECHNIQUES AND REVIEWS Y N DATE

Approach A Masters and Johnson principles Bianco´s principle Breathing exercises Verbal modeling Stop ESF

THERAPEUTIC PLAN

Bianco, FJ et al. Manual de tratamiento de las enfermedades en Sexología. Editorial CIPV, Caracas, Venezuela, 2002.



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PROCEDURES, TECHNIQUES AND REVIEWS Y N DATE Considerations about orgasmic experience and its importance Breathing, verbalization and pelvic movements Perineal muscle training Coito in Superior Femina Free coito Orgasmic chain Others

THERAPEUTIC PLAN

Bianco, FJ et al. Manual de tratamiento de las enfermedades en Sexología. Editorial CIPV, Caracas, Venezuela, 2002.



Hypoactive Sexual Desire, Erectile Dysfunction and Premature Ejaculation

How long have you had symptoms?

How many times out of 10 does this

occur?

Under what circumstances

does this occur?

Does this also occur when you

masturbate?

Do you have an extra partner?

Same or different sex?

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Hypoactive Sexual Desire, Erectile Dysfunction and Premature Ejaculation

Is there a difference between them?

Do you have morning or night erections?

What kind of thoughts do you have

before, during and after sex?

How often do you feel the desire? Do you

feel desire before or during ESFP

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General recommendations

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Interpreters can reduce client isolation by allowing each client to express complex feelings and concepts.

Interpreters can bridge existing cultural gaps by educating counselors regarding the client´s culture and culturally informed behaviors. (Goh, Dumingang & Scwchman, 2004; Rechtman, 1997; Tribe, 1998)

Paone, TR; Malott, KM. Using interpreters in mental health counseling: a literature review and recommendations. J of multicultural counseling and development; 36, 2008.



Pre-session recommendations

Interpreters and therapists should receive specific training to work collaboratively (Miller et al, 2005).

69 Paone, TR; Malott, KM. Using interpreters in mental health counseling: a literature review and recommendations. J of multicultural counseling and development; 36, 2008.



Recommendations during session

Present the goal of medical session, focused on topics that may be emotionally difficult for the client or the interpreter. (Goh et al, 2004).




Recommendations post-session

Doctor-interpreter: Similar perception of the session?

Doctor could also elicit the interpreter`s insight into the client`s culturally informed behaviors. (Goh et al, 2004).




Recommendations post-session

…Confidentiality (López, 2002) and to assess any negative or excessive reactions related to the sessions.

Should be a routine component of counselor-interpreter collaboration. (Raval, 2005).




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Conclusions • We, as health interpreters can help people to

alleviate human suffering about sexual issues, which so often is suffered in silence.

• To become a good health interpreter in a sex context, it is important to be properly educated in this field, improve interpersonal communication skills, and have a comprehensive and open attitude.

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Conclusions • Our greatest tool is not medical knowledge, but a

listening ear and a warm heart. • Mr./Ms. interpreter: be aware of your own

prejudices at all times. • Awareness of a sensitivity to sexual differences.

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Contacto

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www.medicosexologo.com

[email protected]



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QUESTIONS?



Resources

• Ariza, 1991. • FLASSES, WAMS, AISM. Manual de Diagósticos en Sexología. Editorial CIPV, Caracas,

Venezuela, 2010. • Giraldo, O., 2002. Nuestas sexualidades. Digiprint Editores E.U. , Cali, Colombia. • Haas, AP et al (2014). Collecting sexual orientation and gender identity data in suicide and ohter

violent deaths…LGBT Health. Vol. 0, Numb 0. • http://massmedicalinterpreting.org/sites/massmedicalinterpreting.org/files/Anatomy%20of%2

0an%20Office%20Visit_June%202015.pdf

• NCIHC, 2004. A National code of ethics for interpreters in health care. Available in: www.ncihc.org [04-22-16].

• Hsieh, E. Et al. Bilingual health communication: distinctive needs of provideres from five specialities. Health communication, 28:557-567, 2013.

• Paone, TR; Malott, KM. Using interpreters in mental health counseling: a literature review and recommendations. J of multicultural counseling and development; 36, 2008.

• Sánchez, M. La educación para la sexualidad. Available in: www.monografías.com [04-21-16]. • M.J., Tijeras. Influyen las actitudes hacia la sexualidad de los profesionales sanitarios?

Anuario de Sexología, No.12; pp 43-50. 2010

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Colombia - Massachusetts Medical Interpreter Training · 2020-01-03 · pregnancy, premarital sex...

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Transcript of Colombia - Massachusetts Medical Interpreter Training · 2020-01-03 · pregnancy, premarital sex...