ࡱ> ![q` bjbjqPqP .*::B B B B V v L : \X 0&(((((($]hL L a   & &\ j 9B . ^&w0   LL  DB B  SEXUAL DYSFUNCTION IN PSYCHOLOGICAL DISEASE Introduction: Sexual dysfunction is extremely common in psychological disease. 30-50% of the general population report sexual dysfunction compared with 90% of depressed patients. Sexual dysfunction can be caused by the disease, its treatment, or by its social and relationship consequences. Sexual dysfunction can cause significant psychological morbidity in its own right. It seems that patients are far more prepared to answer sexual questions than doctors are to ask them. One study showed that 79% of patients would have found it helpful if they had been asked about their sexual lives, in only 32% had their doctor actually discussed sexual matters. Sexual function and dysfunction: Normal sexual function can be divided into 4 phases, with problems possible in each, (see fig 1.) It relies on complex interactions between central and peripheral neuro-transmitters, autonomic and somatic nervous systems, and arterial / venous circulation. Normal sexual responses are also profoundly affected by experiential, social, and religious pressures. It is not surprising therefore that sexual dysfunction is usually multifactorial, and that unravelling contributing causes can often be complex, and time consuming. Figure 1.)  EMBED PowerPoint.Slide.8  Assessment: Any assessment of sexual dysfunction must start with a careful history- medical, psychological, social and sexual. The sexual history leads to most diagnoses and has to be quite specific in its enquiry. It is important to ask clearly about sexual desire, arousal, and orgasm. It is also important to ask about the partners sexuality as more than 50% of partners will have associated sexual dysfunction. Likewise a psychological history is an integral part of the assessment of sexual dysfunction. Direct questioning will often elucidate previously undiagnosed depression or anxiety disorders. Such diagnoses will allow a more holistic treatment programme for the presenting sexual problem. Symptoms of sexual dysfunction and psychological problems are both intensely private, and may present obtusely. Sexual dysfunction types are summarized in Figure 2.) Figure 2.)  EMBED PowerPoint.Slide.8  Neuro-transmitters: As our understanding of psychological disease and neuro-transmitter modulation improves, it becomes apparent that sexual function is dependant on the same chemicals. In simplistic terms Dopamine seems to raise sexual desire, and drugs reducing it lower libido. Noradrenaline seems to be involved with arousal, and Serotonin with satiety and orgasm. Recent research is once again being directed at the hypothalamo-pituitary axis, and its role in psychological disease, meanwhile we are becoming increasingly aware of the modulating or sensitizing effects of hormones on sexual function. For example: low testosterone in men, and probably women can lead to depression as well as reduced libido. However depressed patients, and those with low sexual frequency tend to have lower testosterone levels; the three variables therefore producing an eternal triangle. Supplementing testosterone may help treatment-resistant depression as well as improving libido! Most psychological diseases are associated with particular sexual problems, and will be dealt with seperately: Depression: The vast majority of depressed patients will report sexual difficulties. Most will suffer reduced libido, although some, particularly younger men, may develop obsessive, hyperactive sexual desire perhaps in an attempt to boost a flagging serotonergic system. Arousal disorder is common, and relationship problems will further exacerbate the situation. Sexual dysfunction further undermines the sufferers self esteem and feelings of worthlessness. The integral relationship between depression, its treatment, and sexual dysfunction can be summarized in the following figure. Figure 3)  EMBED PowerPoint.Slide.8  Anxiety Disorders: Patients suffering with anxiety disorders may have increased or reduced libido. Arousal is often reduced by performance anxiety or an over-aroused sympathetic nervous system. Orgasmic dysfunction is extremely common, indeed premature ejaculation can be described as an anxiety disorder in its own right. OCD may be complicated by hygiene concerns, or by body dysmorphic disorder. Social phobia patients find it difficult to develop relationships, and are often sexually nave; initial attempts are doomed to failure, convincing them further of their ineptitude. Patients with sexual obsessions or paraphilias will often respond to treatment with SSRI/SNRIs suggesting that these conditions may also have their origins in neuro-transmitter imbalance. Major Psychosis: Psychosis may be associated with high or low libido. We are coming to an understanding that DA is important in sexual desire. Sexual dysfunction caused by anti-psychotics is a major cause of poor compliance. Social isolation and frequent hospital admissions cause difficulty in initiating and maintaining relationships. Substance Abuse: All may cause sexual dysfunction and tend to be associated with risk-taking behaviour, promiscuity, and relationship problems. Many are associated with underlying psychological disease and possible child sexual abuse. Conclusions: Sexual and psychological function is intimately related both at a neuro-chemical, practical and relationship level. Adequate diagnosis and management of sexual dysfunction in patients will greatly enhance their overall care. Revealing underlying psychological disease in sexual dysfunction patients will allow appropriate treatment and the avoidance of unnecessary morbidity or even mortality. I have come across several men with active suicidal thoughts, presenting with sexual problems.  EMBED PowerPoint.Slide.8  ,-;     & ITjAB]^ξ娈|ndUjz!4> h'UVmH sH h'<B*phh'B*aJ mH phsH h'B*mH phsH h'>*mH sH jh'Uj#4> h'UVmH sH h'mH sH h'B*CJmH phsH h'>*B*CJmH phsH h'B*phj""4> h'UVmH sH jh'U h'>*h'h( h'5>*,-;  & Iz{67 ^`gd( gd( $a$gd( gd( 7Aabcvefw ^`gd( dgd( $a$gd( gd( ^_`acvfwõѦjdh'Uj.4> h'UVmH sH h'B*CJmH phsH h'>*mH sH  h'>*h'h'>*B*phh'B*phh'mH sH jh'UjAh'U,1h/ =!"#$% Dd 0  # A2Hr<uBa$D`!r<uBa޳@ p`ER4x Źǫת{c" "( " Ya4"|%r5ƈhyDDpQQDa 2+x_}lUޢEr.__{ԿQ "TBCQ\=VR)#**b Tǡ4^@|{5^@_iEE4^@Zz#/ v"OvΣ/ >DEl@u?I"@G{PHz]cTx *b T5^@EE=%u&ST hT>>Siȣ"?"5u P T wi؇go;/ "OsT T"5c %/b:钏4^@(j/ LT 0k  1S4^@بY"O5^@8x"ٟiOCqBkH"dcjiTRhkXZNTs(Tn)GE381_^@FE|{.-*bmi{~T[I'b/ "v>{13Pɨ ]b/ "vx{Q O])b0*b垺ST{Q"6D2Lx1S]z@§/*>S TFu?>}ST #Ht- TKZ$|SL >ég(3Ht#6 ڈO_+u$|S[k+>ɩV ϩ}$|S{k>s*/P+O wpZ/§SL:j>-T@uz!vj'P^i'Nu.ZNHzTWW$|ڗS}֫/>ĩA]5 0OԙuL$|TVziHt"& ToD$|:SSD$|:S3k>S T?eHt. T\$|z^W!k8u@ z]OoԍuF$|z nAZ[RN-ZHǜ@ z ˩{j^$|kNZNz >̩ja$|(Ӵ^"?p5\$|Sjk=>}S Ty$|^3^/!9@z WUy@§r]:[.>ͩuk7>T@C§Nj֫O]CTVR |ڂS-j֫>mͩ5V vTG:O vT7ꆄOO 5^u>5A5 PO+8U!PZ $|:Sjk>ǩq5Y5 ^ |Ht: ZHt6f Կif#9u9m_5hSsO5U; A.z݀Opj0%Xm~0E9܆O]5M;=GkA§+9RJA^PbD§9Zm5|?!6C;'ӜzZitoFD; HEN("|7 m3>Ʃmh۰^5Xi- .sE§paO}OÚO-` ]ohb@ǚ|/}=\fk=>©.h]^KšOzk>냅`t^?]UOG§gslaӱ>VŚO'$> k>/bͧx}P5Vz5S4V#ӈSkޚQfgEşBnvz9ǞǠVInrVΙϜ-CNqgh}̵2V};Şnr:/KVtSIݍ˶<1nAg0"/㡅l'[4?hu>"}$Z|'U㻟-*+~⻟*+~⻟*+~⻟*+~⻟*+~⻟*+~⻟*+~⻟*+~⻟*+~⻟*+~⻟*+~⻟*+~⻟*+~⻟*+~⻟*+~⻟*+~C|S5ໟ9w?Us~w?Us;jnT~w?Uw?Ur仟{T=CU:On`;u#v&9I~m?8R( @lPd{@ z!yd{C ֢B6OFiiBVx12 U;b/ DlDe5^@lCN 6 2 x+%j  b*d@&ۯq7*d$|oBvD]D$JWb*d@&+*d $")b"HMx we_їBSt Bd}P!4l4. Bdcj5DM@F jP!ku 2,?ȤA!@=< gHxZE{s]j㌷ {v~xξ'&<2é8 78W;m;ך?ulkY۝,frWY.  #$VW&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUXYZ]^_`abcdefghijklmnopqrstuvwxyz{|}~Root Entry) FP|&9"Data WordDocument(.*ObjectPool+ J9P|&9_1043604002 dO) J9`W 9Ole CompObjuObjInfo !"#$%&'(+.012346789:;<=@CEFGHIKLMNOPQSTUVWXY[\]^_a dO)Microsoft PowerPoint SlideMSPresentationPowerPoint.Slide.89q%_` ]Stephen AdamsStephen AdamsZOh+'0 `h|  Pictures Current UserGSummaryInformation( DPowerPoint Document( %"a Sexuality Stephen AdamsoStephen Adamso1epMicrosoft PowerPointP@@`׾@`׾GZ՜.+,0    ( \On-screen ShowuAdams Medical Services Pty LtdT( / 0LDTimes New Roman ]bbv 0b( 0 ` .  @n?" dd@  @@`` 8+ T5%@8B:2___PPT9/ 0? %O = Sexuality   Libido Arousal Orgasm Resolution:!((( ! /~*  0` ff33f` ffD3f` MMM` f3fD"Yf` f3f6f3f` 3f̙f>?" dd@,|?" dd@   " @ ` n?" dd@   @@``PR    @ ` ` p>> 0 &&^&(    H2,$@ 0>   0e0e     ?B)CDElFt @ 5% 8c8c     ?1 0u0@Ty2 NP'p<'p @A)BCD|E?||c $)6N_i> _4% #j +  y  p  d(78@ #  3 0e0e     ?BCnDEF @ 5% 8c8c     ?1 0u0@Ty2 NP'p<'p @A)BCD|E?||//  MoK0YVS_^tT, [v] T5  G r C  ]smm#h g:Y/x|!  L  _`@e   3 0e0e     ?BC DEF @ 5% 8c8c     ?1 0u0@Ty2 NP'p<'p @A)BCD|E?||44S.e'w : v   E n OV?5^B<Shjv  _UEf"X( w 8  lQ<e$<. il@  3 0e0e     ?BC%DEF @ 5% 8c8c     ?1 0u0@Ty2 NP'p<'p @A)BCD|E?||11_eskw$ h % U  m`*W`/kcy$yu:^V]I\& iWB0' cd@3   3 0e0e     ?BCDE`Fh @ 5% 8c8c     ?1 0u0@Ty2 NP'p<'p @A)BCD|E?||S>VO\Nb2h"n?}w; I i  Ij KtN14@j4(  3 0e0e     ?BC$DEpFx @ 5% 8c8c     ?1 0u0@Ty2 NP'p<'p @A)BCD|E?||##6Th DXncq u Cm ^w yr ^ho|9<@   3 0e0e     ?BCDEF @ 5% 8c8c     ?1 0u0@Ty2 NP'p<'p @A)BCD|E?||,,n/vg^L : "X B   ]_>^ 8ZI* 9 l ] )@8nJVbhncqnY\@X    0BD CDE@FH@? C u, <C !$@D    0@[ P [ X Click to edit Master title style!!    s *:[  [ RClick to edit Master text styles Second level Third level Fourth level Fifth level!    S    s *L%F `` [ R*    s *8F `  [ T*    s *XrF `  F T*  T  <޽h? ffD3f  Pulse '  0 4 && )&(    H2,$@ 0   3 0e0e     ?B)CDElFt @ 5% 8c8c     ?1 0u0@Ty2 NP'p<'p @A)BCD|E?||c $)6N_i> _4% #j +  y  p  d(78@ #  3 0e0e     ?BCnDEF @ 5% 8c8c     ?1 0u0@Ty2 NP'p<'p @A)BCD|E?||//  MoK0YVS_^tT, [v] T5  G r C  ]smm#h g:Y/x|!  L  _`@e   3 0e0e     ?BC DEF @ 5% 8c8c     ?1 0u0@Ty2 NP'p<'p @A)BCD|E?||44S.e'w : v   E n OV?5^B<Shjv  _UEf"X( w 8  lQ<e$<. il@  3 0e0e     ?BC%DEF @ 5% 8c8c     ?1 0u0@Ty2 NP'p<'p @A)BCD|E?||11_eskw$ h % U  m`*W`/kcy$yu:^V]I\& iWB0' cd@3   3 0e0e     ?BCDE`Fh @ 5% 8c8c     ?1 0u0@Ty2 NP'p<'p @A)BCD|E?||S>VO\Nb2h"n?}w; I i  Ij KtN14@j4(  3 0e0e     ?BC$DEpFx @ 5% 8c8c     ?1 0u0@Ty2 NP'p<'p @A)BCD|E?||##6Th DXncq u Cm ^w yr ^ho|9<@   3 0e0e     ?BCDEF @ 5% 8c8c     ?1 0u0@Ty2 NP'p<'p @A)BCD|E?||,,n/vg^L : "X B   ]_>^ 8ZI* 9 l ] )@8nJVbhncqnY\@X    0BD CDE@FH@? C u, <C !$@D    H[F? ??p [ X Click to edit Master title style!!    B̷F? ?? `   F [#Click to edit Master subtitle style$$    s *@] `` F R*    s *C] `  ] T*    s *E] `  ] T*  T  <޽h? ffD3f0 0 N(     0O] P   ] `*     0O]    ] b*   d  c $ ?  ]  0S]  @ ] RClick to edit Master text styles Second level Third level Fourth level Fifth level!    S   6\X] `P  ] `*     6@Z] `  ] b*   H  0޽h ? ̙33  0 4 @$(    S ~b]xaxa1 ? P  ]   S ~,e]xaxa1 ? <$ 0 ]  B  s *޽h ? 'X{I^=\0 P(   C x`g]xaxa1 ? @+  ]    N1 ?2   ]H  0޽h ? a(r`rU].x[v^ `0DocumentSummaryInformation8 _1043604461dO)`W 9`W 9Ole CompObju"a Times New RomanPulse Sexuality  Fonts UsedDesign Template Slide Titles dO)Microsoft PowerPoint SlideMSPresentationPowerPoint.Slide.89qObjInfoPicturesCurrent UserGSummaryInformation(\%_g_ 5Stephen AdamsStephen AdamsZOh+'0, `h  "Sexual dysfunction Male FemaleMiStephen AdamstiStephen Adamsti1epMicrosoft PowerPointle @@p翕@p翕GPowerPoint Document(\_DocumentSummaryInformation8 _1043603834dO)`W 9`W 9Ole )78( / 0LDTimes New Roman؛5bbv 0b( 0W ` .  @n?" dd@  @@`` 0) T5%@8B:2___PPT9/ 0? %O =B!Sexual dysfunction Male Female "$! pHypoactive desire Hyperactive desire Erectile dysfunction Premature ejaculation Retarded ejaculation paraphiliasqq<%   7    oHypoactive desire (Hyperactive desire) Arousal disorder Orgasmic dysfunction Dyspareunia Vaginismus Paraphiliaspnp"M " ~*  0` ff33f` ffD3f` MMM` f3fD"Yf` f3f6f3f` 3f̙f>?" dd@,|?" dd@   " @ ` n?" dd@   @@``PR    @ ` ` p>> 0 &&^&(    H2,$@ 0>   0e0e     ?B)CDElFt @ 5% 8c8c     ?1 0u0@Ty2 NP'p<'p @A)BCD|E?||c $)6N_i> _4% #j +  y  p  d(78@ #  3 0e0e     ?BCnDEF @ 5% 8c8c     ?1 0u0@Ty2 NP'p<'p @A)BCD|E?||//  MoK0YVS_^tT, [v] T5  G r C  ]smm#h g:Y/x|!  L  _`@e   3 0e0e     ?BC DEF @ 5% 8c8c     ?1 0u0@Ty2 NP'p<'p @A)BCD|E?||44S.e'w : v   E n OV?5^B<Shjv  _UEf"X( w 8  lQ<e$<. il@  3 0e0e     ?BC%DEF @ 5% 8c8c     ?1 0u0@Ty2 NP'p<'p @A)BCD|E?||11_eskw$ h % U  m`*W`/kcy$yu:^V]I\& iWB0' cd@3   3 0e0e     ?BCDE`Fh @ 5% 8c8c     ?1 0u0@Ty2 NP'p<'p @A)BCD|E?||S>VO\Nb2h"n?}w; I i  Ij KtN14@j4(  3 0e0e     ?BC$DEpFx @ 5% 8c8c     ?1 0u0@Ty2 NP'p<'p @A)BCD|E?||##6Th DXncq u Cm ^w yr ^ho|9<@   3 0e0e     ?BCDEF @ 5% 8c8c     ?1 0u0@Ty2 NP'p<'p @A)BCD|E?||,,n/vg^L : "X B   ]_>^ 8ZI* 9 l ] )@8nJVbhncqnY\@X    0BD CDE@FH@? C u, <C !$@D    0}] P ] X Click to edit Master title style!!    s *q[  ] RClick to edit Master text styles Second level Third level Fourth level Fifth level!    S    s *r[ `` ] R*    s *x[ `  ] T*    s *lz[ `  [ T*  T  <޽h? ffD3f  Pulse '  0 A && )&(    H2,$@ 0   3 0e0e     ?B)CDElFt @ 5% 8c8c     ?1 0u0@Ty2 NP'p<'p @A)BCD|E?||c $)6N_i> _4% #j +  y  p  d(78@ #  3 0e0e     ?BCnDEF @ 5% 8c8c     ?1 0u0@Ty2 NP'p<'p @A)BCD|E?||//  MoK0YVS_^tT, [v] T5  G r C  ]smm#h g:Y/x|!  L  _`@e   3 0e0e     ?BC DEF @ 5% 8c8c     ?1 0u0@Ty2 NP'p<'p @A)BCD|E?||44S.e'w : v   E n OV?5^B<Shjv  _UEf"X( w 8  lQ<e$<. il@  3 0e0e     ?BC%DEF @ 5% 8c8c     ?1 0u0@Ty2 NP'p<'p @A)BCD|E?||11_eskw$ h % U  m`*W`/kcy$yu:^V]I\& iWB0' cd@3   3 0e0e     ?BCDE`Fh @ 5% 8c8c     ?1 0u0@Ty2 NP'p<'p @A)BCD|E?||S>VO\Nb2h"n?}w; I i  Ij KtN14@j4(  3 0e0e     ?BC$DEpFx @ 5% 8c8c     ?1 0u0@Ty2 NP'p<'p @A)BCD|E?||##6Th DXncq u Cm ^w yr ^ho|9<@   3 0e0e     ?BCDEF @ 5% 8c8c     ?1 0u0@Ty2 NP'p<'p @A)BCD|E?||,,n/vg^L : "X B   ]_>^ 8ZI* 9 l ] )@8nJVbhncqnY\@X    0BD CDE@FH@? C u, <C !$@D    HXv[? ??p ] X Click to edit Master title style!!    B[? ?? `   [ [#Click to edit Master subtitle style$$    s *[ `` [ R*    s * [ `  [ T*    s *h[ `  [ T*  T  <޽h? ffD3f0 0 N(     0lm[ P   [ `*     0o[    [ b*   d  c $ ?  [  0[  @ [ RClick to edit Master text styles Second level Third level Fourth level Fifth level!    S   6h[ `P  [ `*     6(\[ `  [ b*   H  0޽h ? ̙33  0 A  @(  x  c $[ P  [ x  c $[   [ x  c $̠5 p  [ H  0޽h ? ffD3frPV/\ G_0Z՜.+,0    ( tOn-screen ShowAdams Medical Services Pty Ltd_ Times New RomanPulse"Sexual dysfunction Male Female  Fonts UsedDesign Template Slide Titles dO)Microsoft PowerPoint SlideMSPresentationPowerPoint.Slide.89q%_e [Stephen AdamsStephen AdamsZOh+'0, `CompObj*uObjInfo,PicturesCurrent User-GSummaryInformation(/\PowerPoint Document(@eDocumentSummaryInformation85_1043607242#dO)`W 9`W 9h  !Depression & Sexual Dysfunction MiStephen AdamsexStephen Adamsex1epMicrosoft PowerPointysf@@@=u@ uGZ՜.+,0    ( s( / 0LDTimes New RomanCbbv 0b( 0 ` .  @n?" dd@  @@`` 8+ T5%@8B:2___PPT9/ 0? %O = Depression & Sexual Dysfunction !( ! Depression can cause sexual dysfunction Sexual dysfunction can cause depression Treatment of depression can cause sexual dysfunction Correct treatment of depression can alleviate sexual dysfunction Treatment of sexual dysfunction can alleviate depression  /*  0` ff33f` ffD3f` MMM` f3fD"Yf` f3f6f3f` 3f̙f>?" dd@,|?" dd@   " @ ` n?" dd@   @@``PR    @ ` ` p>> 0 '&&(    H2,$@ 0>   0e0e     ?B)CDElFt @ 5% 8c8c     ?1 0u0@Ty2 NP'p<'p @A)BCD|E?||c $)6N_i> _4% #j +  y  p  d(78@ #  3 0e0e     ?BCnDEF @ 5% 8c8c     ?1 0u0@Ty2 NP'p<'p @A)BCD|E?||//  MoK0YVS_^tT, [v] T5  G r C  ]smm#h g:Y/x|!  L  _`@e   3 0e0e     ?BC DEF @ 5% 8c8c     ?1 0u0@Ty2 NP'p<'p @A)BCD|E?||44S.e'w : v   E n OV?5^B<Shjv  _UEf"X( w 8  lQ<e$<. il@  3 0e0e     ?BC%DEF @ 5% 8c8c     ?1 0u0@Ty2 NP'p<'p @A)BCD|E?||11_eskw$ h % U  m`*W`/kcy$yu:^V]I\& iWB0' cd@3   3 0e0e     ?BCDE`Fh @ 5% 8c8c     ?1 0u0@Ty2 NP'p<'p @A)BCD|E?||S>VO\Nb2h"n?}w; I i  Ij KtN14@j4(  3 0e0e     ?BC$DEpFx @ 5% 8c8c     ?1 0u0@Ty2 NP'p<'p @A)BCD|E?||##6Th DXncq u Cm ^w yr ^ho|9<@   3 0e0e     ?BCDEF @ 5% 8c8c     ?1 0u0@Ty2 NP'p<'p @A)BCD|E?||,,n/vg^L : "X B   ]_>^ 8ZI* 9 l ] )@8nJVbhncqnY\@X    0BD CDE@FH@? C u, <C !$@D    0 T[ P [ X Click to edit Master title style!!    s *V[  [ RClick to edit Master text styles Second level Third level Fourth level Fifth level!    S    s *[[ `` [ `*    s *Ta[ `  [ b*    s *(c[ `  [ b*  T  <޽h? ffD3f  Pulse7'  0 ۚ && S&(    H2,$@ 0   3 0e0e     ?B)CDElFt @ 5% 8c8c     ?1 0u0@Ty2 NP'p<'p @A)BCD|E?||c $)6N_i> _4% #j +  y  p  d(78@ #  3 0e0e     ?BCnDEF @ 5% 8c8c     ?1 0u0@Ty2 NP'p<'p @A)BCD|E?||//  MoK0YVS_^tT, [v] T5  G r C  ]smm#h g:Y/x|!  L  _`@e   3 0e0e     ?BC DEF @ 5% 8c8c     ?1 0u0@Ty2 NP'p<'p @A)BCD|E?||44S.e'w : v   E n OV?5^B<Shjv  _UEf"X( w 8  lQ<e$<. il@  3 0e0e     ?BC%DEF @ 5% 8c8c     ?1 0u0@Ty2 NP'p<'p @A)BCD|E?||11_eskw$ h % U  m`*W`/kcy$yu:^V]I\& iWB0' cd@3   3 0e0e     ?BCDE`Fh @ 5% 8c8c     ?1 0u0@Ty2 NP'p<'p @A)BCD|E?||S>VO\Nb2h"n?}w; I i  Ij KtN14@j4(  3 0e0e     ?BC$DEpFx @ 5% 8c8c     ?1 0u0@Ty2 NP'p<'p @A)BCD|E?||##6Th DXncq u Cm ^w yr ^ho|9<@   3 0e0e     ?BCDEF @ 5% 8c8c     ?1 0u0@Ty2 NP'p<'p @A)BCD|E?||,,n/vg^L : "X B   ]_>^ 8ZI* 9 l ] )@8nJVbhncqnY\@X    0BD CDE@FH@? C u, <C !$@D    Ht][? ??p [ X Click to edit Master title style!!    Bpp[? ?? `   [ [#Click to edit Master subtitle style$$    s *t[ `` [ `*    s *\x[ `  [ b*    s *z[ `  [ b*  T  <޽h? ffD3f0 0 N(     0@[ P   [ `*     0[    [ b*   d  c $ ?  [  0[  @ [ RClick to edit Master text styles Second level Third level Fourth level Fifth level!    S   6[ `P  [ `*     6\[ `  [ b*   H  0޽h ? ̙33  0 ۚ @$(    S ~[xaxa1 ? P  [   S ~[xaxa1 ? <$ 0 [  H  0޽h ? 'Xf7y=I0  P(   C x8[xaxa1 ? @+  [ There is an intimate relationship between psychological function and sexuality. Enquiries into sexual functioning is an important part of a psychological assessment. Depression will almost always cause some degree of sexual dysfunction, but the reverse is also often the case. Many treatments for depression or anxiety disorders will cause alteration of sexual functioning. It is important to warn patients about these side effects. The patient may be reluctant to volunteer these and direct questioning is most effective. Choose an appropriate medication to improve, rather than worsen sexual symptoms: e.g.. Moclobemide or Nefazadone for low libido SSRI/SNRI for PME :_0_0    N1 ?2   [H  0޽h ? a(r`V^/\_ d0On-screen ShowAdams Medical Services Pty Ltd@e Times New RomanPulse!Depression & Sexual Dysfunction  Fonts UsedDesign Template Slide Titles dO)Microsoft PowerPoint SlideMOle >CompObj "?uObjInfoAPictures!%SPresentationPowerPoint.Slide.89q%_] 6Stephen AdamsStephen AdamsZOh+'0 `h   Take-Home MessagesStephen AdamsagStephen Adamsag1epMicrosofCurrent UserBGSummaryInformation($&DLPowerPoint Document('^DocumentSummaryInformation8Jt PowerPointP@@@҄^ƕ@@҄^ƕGZ՜.+,0    ( eOn-screen ShowAdams Medical Services Pty Ltda^ Times New RomanPulse( / 0LDTimes New Roman$6bbv 0b( 0W ` .  @n?" dd@  @@`` 0( T5%@8B:2___PPT9/ 0? %O =Take-Home Messages   ask about sexual function in patients suffering from psychological disease ask about psychological symptoms in patients suffering from sexual dysfunction  ~*  0` ff33f` ffD3f` MMM` f3fD"Yf` f3f6f3f` 3f̙f>?" dd@,|?" dd@   " @ ` n?" dd@   @@``PR    @ ` ` p>> 0 &&^&(    H2,$@ 0>   0e0e     ?B)CDElFt @ 5% 8c8c     ?1 0u0@Ty2 NP'p<'p @A)BCD|E?||c $)6N_i> _4% #j +  y  p  d(78@ #  3 0e0e     ?BCnDEF @ 5% 8c8c     ?1 0u0@Ty2 NP'p<'p @A)BCD|E?||//  MoK0YVS_^tT, [v] T5  G r C  ]smm#h g:Y/x|!  L  _`@e   3 0e0e     ?BC DEF @ 5% 8c8c     ?1 0u0@Ty2 NP'p<'p @A)BCD|E?||44S.e'w : v   E n OV?5^B<Shjv  _UEf"X( w 8  lQ<e$<. il@  3 0e0e     ?BC%DEF @ 5% 8c8c     ?1 0u0@Ty2 NP'p<'p @A)BCD|E?||11_eskw$ h % U  m`*W`/kcy$yu:^V]I\& iWB0' cd@3   3 0e0e     ?BCDE`Fh @ 5% 8c8c     ?1 0u0@Ty2 NP'p<'p @A)BCD|E?||S>VO\Nb2h"n?}w; I i  Ij KtN14@j4(  3 0e0e     ?BC$DEpFx @ 5% 8c8c     ?1 0u0@Ty2 NP'p<'p @A)BCD|E?||##6Th DXncq u Cm ^w yr ^ho|9<@   3 0e0e     ?BCDEF @ 5% 8c8c     ?1 0u0@Ty2 NP'p<'p @A)BCD|E?||,,n/vg^L : "X B   ]_>^ 8ZI* 9 l ] )@8nJVbhncqnY\@X    0BD CDE@FH@? C u, <C !$@D    0z5 P 5 X Click to edit Master title style!!    s *]  5 RClick to edit Master text styles Second level Third level Fourth level Fifth level!    S    s *Z] `` ] R*    s *h\] `  ] T*    s *`E] `  ] T*  T  <޽h? ffD3f  Pulse '  0  && )&(    H2,$@ 0   3 0e0e     ?B)CDElFt @ 5% 8c8c     ?1 0u0@Ty2 NP'p<'p @A)BCD|E?||c $)6N_i> _4% #j +  y  p  d(78@ #  3 0e0e     ?BCnDEF @ 5% 8c8c     ?1 0u0@Ty2 NP'p<'p @A)BCD|E?||//  MoK0YVS_^tT, [v] T5  G r C  ]smm#h g:Y/x|!  L  _`@e   3 0e0e     ?BC DEF @ 5% 8c8c     ?1 0u0@Ty2 NP'p<'p @A)BCD|E?||44S.e'w : v   E n OV?5^B<Shjv  _UEf"X( w 8  lQ<e$<. il@  3 0e0e     ?BC%DEF @ 5% 8c8c     ?1 0u0@Ty2 NP'p<'p @A)BCD|E?||11_eskw$ h % U  m`*W`/kcy$yu:^V]I\& iWB0' cd@3   3 0e0e     ?BCDE`Fh @ 5% 8c8c     ?1 0u0@Ty2 NP'p<'p @A)BCD|E?||S>VO\Nb2h"n?}w; I i  Ij KtN14@j4(  3 0e0e     ?BC$DEpFx @ 5% 8c8c     ?1 0u0@Ty2 NP'p<'p @A)BCD|E?||##6Th DXncq u Cm ^w yr ^ho|9<@   3 0e0e     ?BCDEF @ 5% 8c8c     ?1 0u0@Ty2 NP'p<'p @A)BCD|E?||,,n/vg^L : "X B   ]_>^ 8ZI* 9 l ] )@8nJVbhncqnY\@X    0BD CDE@FH@? C u, <C !$@D    HDN]? ??p ] X Click to edit Master title style!!    BL]? ?? `   ] [#Click to edit Master subtitle style$$    s *Q] `` ] R*    s *_] `  ] T*    s *|c] `  ] T*  T  <޽h? ffD3f0 0 N(     0e] P   ] `*     0i]    ] b*   d  c $ ?  ]  0l]  @ ] RClick to edit Master text styles Second level Third level Fourth level Fifth level!    S   6] `P  ] `*     6o] `  ] b*   H  0޽h ? ̙334  0  @\(  x  c $ ] P  ]   c $ ![ <$ 0 ] H  0޽h ? ffD3frPUs.[ ]0Take-Home Messages  Fonts UsedDesign Template Slide TitlesOh+'0  4@ ` l x,SEXUAL DYSFUNCTION IN PSYCHOLOGICAL DISEASEDr Stephen AdamsNormalStephen Adams2Microsof      !"#$%&'()*+,-./0123456C:;<=>?@ABq^qw8et;>E[PH:ũN]J>9INr7Gs}P}Qn#^߽,dJ;N)dJ;#9|mVgy;۬JP[ YPZ*d+' PĔ(҉ZTȖ'O *LPj'KQ!H@Blib ٮ D!Vb *d D?-Ũ'P![8?B)q~NbN ن \T:Iuu'>dH@TBӤ TȪh"@![C'BbIU]$ H U,i~Qm*i~Wc!٠Vq*i~1: ⫱0ԖjnCt6}098Ҡ,\b3n0ekնa=c_oiٷف=عܹwrָ/;4?rw1)u6ZBWMfIu:ϭIt꜐y)usCԙvݹyX~վ.o[h{=ȞhwXm @C]˺l^Dw_YLǠ)xJ;Ҏ)xu hC pmǀO6' J:TµIyvN jQ ג' OʳOʳ@&OʳK%Jg'(pwI>?)NP4?)NP$Jg'(pH>?)NP4?)NP.(}~R$Q<;A d<;APIyvwD.I\' uOʳ@&OʳUOʳk$Jg'(pLg'(plOB@JM|E6%R+1)a5:_W4hP[qZ_oӢ>?Zz˩/1GАSZkxښifͪ[{ZkmكXw[mٿ+?Nc/a'8wNsIMwForI<3kβOw ._eˬ+wZ߭Y$k3f]gVg+oV*NH_Lg)lJ;Φ)lu͆΀}h;f% |9?͕PC6\KhuhP[ l4?ZT`/(}~&(k%JRT`4?]^*Q,7X%Q,7s2i~[P(}~lP`o(}~Q d,77{D{D\ l g %Jf$J\T`4?u+Q,7} ur @&rs *$Jf{Dܼ@&rs*lOB@JM|E6%R+1)a5:_W4hP[qZ_oӢ>?Zz˩/#Ӑo?%㍷yc>a3/cv/n w;FZ54nzO=eeoX$8{;uiGPvAiGP;QD1:_DOl|a%*cV uա2&\Kh1Ѡ1ZjQsD3_0AV/,EeL g 1J>?!(c(}~ 9T2i~ [P3'Q٠E/,FeL g 1K>?(cn(}~ QȤ/l@e̅| ʘ$J\T2i~ PsD3_)(c(}~ U d֠2fD3_H1P\#Q.BeL g 1l|@s4>?ZmJWb_Sjku(Ki_ѠWtsj(ަE}~S_D}7+yzT?ǩnGթoKSדTj9yŞ%з yMG^0g֮0cdcu9m^f7B3JHԽ̉c(J;Ҏc(+|5{ |Fcjwג' P!Eג'QYcD25K.?@&O CeiO }O [Gt ͨdeTָYt DW5^(]~15L@<s$J@X(k<&Qb<*k,?X%J@Ԡ2'\P֨(]~q-*k,?x5(]~њƳO fPYcDdcjg2P+O nEe 'uuOkh"Be P{5"5e ,?Dq˟Hn[7jls¸B{;K2͸C>w8#qb_ڱv,KiRڱv,zrxO?ۅ9'(5{7usP5k{\#Y)ύM](Qb] PI.?Ȣrd |Td%J@@|犦D(]~oCq1u8HD3P9d"DO @H(QIT!Q#OJ.?herFt )2Y~1#H.?g6rdDM[FO rdDV'Q9db *GlC;"O @w$J@ #s~TMMwpʑhPX"Td Q9?wǑ0YK:=ոl\OWr9f~TXhr=uڑ9 GuNĥD/%z)K^JRD?<'W`rF -?3h7?4>3„ߵ6|VEnV[5U"v{ud๨Fj2 drU󻌫Zإr3*>S g0?G1N[fΩ^ŌϔҐwxNGPS^  ;L>䔢;I2JY(3zVyH 5f.Qc'+]5㼆=S0?W^6ssEFo~me7j9W-7r> ׾ e5@'I[,/0VŚ~I0&!ASB;U\֑͘:NŘc:O Q.K2KV\<-`L•s4c$~u} 1vgcբ_^WWm9Oz8.H)^G;pN CL!1$`B ^H 7x!MPI|SZ%IC v_*T $$- Bd:T! 5$S o\P ^HoBb5I `B9 6x!$9hBQv+$I,RIY&$`BM1x!$bjB[$j IP ^H7I u $P3 ^H|JC.2x!с|P& @H}4$X$`2LȒ\P s@bI@V.1x!sUcm+Iϕ.5lUن9 PPs ^H " @ HhDIѰ5:e sC$_ gH~vanHNLh4}L2ZanHC 84kMuM ׊.s sF$`Bh4-# ձv/I2Jõ $hX{$`]=$/+. ׂD2'4d-^cmI@PkW ձv#IVUڑ$hX[CpWߒ ձ!IoCuA%Pk=Hl2C$Ɛ U5n4~c+/<>+g{ͽz}[ӹM9k$ 0µ)$^' x-Dy !Fkx$Co97BTM6x!&I Jf[$!*n m$o9/$l Q-?WcBm!U ^H x;D'D=IN:u/$v Q.5x!$`Wj&'{j7 ^HKa/$# x7D|$0x!I>oN#6x}Z{?Q|H+se' C:$ Q =$ QğH2gCT?mB#?nBb/IG!פ/$L7D ILlBbIBT _2x!@/D:U! hQ]_IfB"G05k OHr!% ^H' $D $Ԝ ^H|Jp D /$$.cB%P!+>2x!a's;/$l+D C`+T $ SWGJI5x'/$8IP ^; I|z!њ$|ŕz!ц$AKhK&_IJhG6_JhO._!K@>_KHtHWR/$:)BI@DŽ>JI@>=KL>KB9z!ѕ$KB)B n n$$;R/$tKwq^C nwZD/ N $]w}Hz';R/$I&J8$oBRi$&OI^H# 8-"+B?I@ $'R/$ HjK8$``B] R/$ J;^HA08Bz!1$QD5IRPꄾS0 }ר $BT,#H'ݰR/$FH;o^H" wJ8$`TBQ,B,3eIJ;^HM0:{١%=gOIOSz15\kϔ 8v@vOw>G"?y3YHIΔ!"JAOwT XR{3:zӝ)y=NDIj;SZGD7Hj;S@D%_y3:_͒Δ6W$;SzoVOwT絕NOwT絓 <ݙRD|z3:D<';Sp?|ݙR#p3:/ "UugJu^UD3:vD:3:Dz3:D3:D|3:!D|F3:QDIΔ!"iI}ݙRWO4_wT5ϔL_wT5_.}ݙRDjI]Δ꼮&" $ם)y- "K$ם)y-!"7JF_wTu#ER3:[mם)yFDWHj;SZAD/3:$;Sz?$|ݙRCD1I=Δ#"OJI_wT$FR3:gFImugJu^zם)y=OD_KL%"ugJu^ov:D=IΔ#"{$ם)y!" jugJu^ DV{Tȕ[o^Vv2Le'STv2̉N6YN6g:IO"e`zRVEO$&X 4SZVdJGO$IX9?c2P9?XA.RVDO$9 슜HdIDO$2H pQ9?nDERnHPx1r~"q=)=&\YDGM t'HXGO$9?%e Q D PXˣ'2jR. X 5?Nm,j~"$WPa$WXDbB%WhX[IqXZ=IĘJ̧p=nWF{k9rorr[o)/Pơ[q\:OF`s<>?k xKީ񇽗b˼e+3bxۡ]Hx`<{nj܋ &w;nqڸcn8?9Y9]lr"p:OeSTv<Oesw<ǯc l;\f' }R~1?NTʟcevR~Ch4$||-j~rRevR~BD|$'ىJ+ʜ\f'*R(s~rd2;Q)?P2;Q)BD|$'ىJ7+9?NTQevR>QDʜ\f'*oR(s~rd2;Q)BD eO.򑌚\f'**9?NT_P2;Q)ɨevR>+t W+S$”9?JLq,ZIh+q%WhX[IqXZ=I9?Z@VR1FT'S:gScfΩs;{zgC/A$__qqt65==ƻ3vnl7. y?NtN4Gb8?p8,_ss.:x:s·(+`ǩq89;|nctjNŝ4w~BKp:MegSTv6Megsw6ǯ3Pm: TIrYm":H)_ rBam%)kQڮ'ܕ ej{J ej{)"5?]BYmsP)wBΒR.QBJY2g=E- ejfRE2j~V/R ejJ/*9?I)ɨYmo"ʜvGr7)9?d7R2gpTݠPkI)ɨYm%Z2gT]P/%\$gr,\cZ͜r%6)Wb\cXHr5VF3\(FJ\:Ir])J:}! ߲g;v=vgo_!͟9?;C84:3g秱9O$]$+ xj?^v8OԕAeGPTvAeGpw:'OI>QI蓴˯"%:HI_ Bam%)ikQ3'% e\~J e\~)i#5?s]BsPI{B3ϒ6Q3BJY2g.?E%- e\fRF2j~/ e\J/*9?sIIɨo"%ʜ|G7)9?sd72g.pTޠPkIIɨ˯%%Z2g.T^P/%%m$g.,g.bZ͜r%6)Wb\cXHr5VF3\(FJ\:Ir])J:'3i$hɬKg'Ps >}]b+٣v.<ﰳ)?f;ZOz}QPk;N83aΥk}X k5|Y' D]RBs)Ii h뤴dSk=b2)?dSkIiKXqTע'I:'47~̛ Vu5ƺiŜ!R\SXwXϺmgYDkcq7v1?&EYع>֋d0%-,o[^&ػbWs`lac?f9bO\O{uxOKeRٱTv,Kerw,_v!ˎ_d};Y7Tڍ,ע,146l2)?77wlB/ӵjALDeHFO$,PDR-V(S~ӼȲ{ʔejr:QYVPDb,)ːHdHY6VLHYQ(S~"4)˾PDb7)˞V(S~"Aen2'IYdDeʔ5{,Q9eVkHYvB,[PDwQYUL@R!-?I2$X*)f*GHYU2'#e#9`)~fHʲѰ6eZSkKIYEO$eH2m`_gX[^6ξf/`_dcNg;ڱx' h+^IJWD?։~|_~LNsؒb-?hig1nz͖+qs4VN.mG]^SHmZi1,Qwm⮓k:}5 4_y gn_f}B[ڿ_R3뼥Z.+bo2ƱYTD1kn(?'>.8 3nA3V._{gehp|_{o*dLuz>UI]^yu躒ƿ>1rJa$G- kK].[T+}..NlSO6#{(5tJVνv2ƹ<=ٷ)Rcx-S_U~ۅ{8/d*~gNw ?>.RcH~^dQmL͕KМG=w8p\Ȯga5_kY4v^2&ܓp֑<~\çGx X5j,.| 53YS̢_>eW}X#{(c}|)]dUiUFW0 z5pFcR]pbܠ-^(~M+Th׏րG8o;EW,jZaեQ;kx}a>~[X~.YPWC~N)~;?-2֏3}u _dSUh*x?ч~WE;*ZG{-v^[تҚ͘#]J_8mDD7T1_L:M1=.mn*_d+N\UU0>|Ƀaq. i.ݳgmGqћ *:^1 cI zyR^i$T⅄")8͠/$FR *kB>T' )Ϡ:[BR jBbI:J.,^H$)@BhBb:IHnBu \bP=,^HKRUiB?I 5 $iP,^Hl4/$tQ Z a$HVC,^HL&)fP /$.&)lPZbkBn 5$w/1/$v`P,^HtP v`G Yx!1:ą$ j kH .4a/$\cPGYXER̠FXx`AmB$HT hPXHRdeB$5y$'q/$")8ϠX7 xAx!gBm 5DmP'Z8 u $g5S,^H|l $7YXARԠ&Yx`A-^Hl')xʠ&[pC5D$+ԩ/$#)cPS-^HARpAMx! nB$ j I nP3-^H7I5V6,^H|@RՠNx!S|`PgXh$)@B3H lc2hgZD2:2$ l?#)X96I&mou $Hױv*IveH')856־LR0|ܐ.Icaq]`/< kd627$H kCH X{kH XeeH4LH buIRpr\XMRpgl4=OR:V ysA"F) kHԱ6`P H &XUfd9w$n#):6Vc7$+cuKRXkA)x7VZ?IbYYh!)x?F~ /$JR8c 5Fyf%^ǩZ;IA)F 9{ ]$QCgiBb7I8u;/$> )e~JSx!!2(ux!'r;j_,^H$N>}IkP-/$|/N]WI+ dB"$)bԈyx!!I BeZZƩ/$R֕v{ki19 !)HǨ/*[D :tmgT=$:t.$pUDW.{tû άB@h^Ht#)8pq^Ht')趇j/$")$^H )8(ߵ8GCV{!ѓ 7B"GR3ER)SDo^>Ѫ IA ^H!)LOj/$!)W^H4W ^HJRАW;^HFRph_YU{!ї `+j/$Z; $3J $2 A$3 $2D O.^HARpxJBH#2YCH O^H %)4FR04?V{!qI ]p2z#H g@G]j/$F;^H4ݕj/$!)hj/$FF^HKR0*Fe>hc3|7 H Fg[cH ]j/$');^H@Rp|^V{!1 )BbI jq󸪞s`t?NOy@WȏSu+Zk#=3ڭ}"9]9V_|%WMk)eg+#r^w{5uo)%"kSyOD$zHSy&"k56r^k/5ˀSyHnԆSym "nO);""ISnO)絉H7nO)|GSܞR""SS;nO)絓H4U =WH:r{J9/'D")=ɮr{J9DDzܞRΫ죩>!CD$k)!r{J9!DDrFܞRk$1!CD$OI!:H5=WHԌSy "gj̐SyID$!:H^CnO)u1\!Z@D$/!󺜈H^CnO)u5^SׇܞRz""yn =MDDrܞRk)r{J9{4uO)!"i꾐SyGD$C!zH>GCnO)(|\SܞRq""NSBnO)絎H>CnO)4|NSυܞR9""^=DDr܊JD$[!zHԎSy "-j =W ,kr{J92 n q{J9P"N$=W'""MS$FD${kr^d_MܞRΫ/<\SKnO)u8Sy '"55Zr{J9DDrKnO)5HND)&ɩ*=T""yΐܞR ""yΕܞR\""9OS$GD$/%Rj\%b""yܞRnW4ur^4uCl7P-oHnO)7o[5ursHޥ$󺋈H.̗S-SA""RS+cZ$)涆H\S?sErܞRnn뉈3z&63T䋺rs{Hnh=VNH6zrsn&"ihQ-t}Wj`wcrh*zjt=#EdrғH6h!6Z"9Hꃨa>,VFHP-' RO "hhP-St}J>jbYTٺ~v~6"9Ws>S]DDRiJA&zkNWWcoiۺn sK6S|5X!n  Nrn |708i}2)9XeL^޿5<. L9:Y^n?C ȅ"rwbgq5;6΍OvkP{=33u?{v%?Rjw?9OΫvjw?9OΫvjw?9OΫvjw?9OΫvjw?9OΫvjw?9OΫvjw?9OΫvjw?9OΫvjw?9OΫvjw?9OΫvjw?9OΫvjw?9OΫvjw?9OΫvjw?9OΫvjw?9OΫvjw?9Okﻟjw?9~r^{P͡v'7~rs'7~rs仟ܜ?'w.|;'w 'vatOj#~ߊPvko 0)V+dk@$8 k IcֆH&`AM E`A}RV^HB*[L*-5 Ue["T$ XC*"nB"QXcP3,^HL%d5$n#`AnB5Rn33,^H AJH,!dk%$ `AcBB'ג 0OHS䥩狀:.:5ܞ~-)8<}\ѩ-/d)Zƿ@>& ppy7-^˽W<O}S_W<Ͼ_|z1ȅc uv'VSD™:ZH%O [bam)Ɽ)uvr2ىʅeO LRg'*.5({~J\͠)uvr!ISD¢ASDeO LRg'*^kP:;QYىʅH&O 0({~J\ޠ)uvr!ISDeO =?NT.D2i~J\dP:;QpASDB$ىʅHVSߡS\͞^KT秾8Z IߍiF2+u56w秾fP~1Fޖh1oso+o[o5{K} W1~Y?Ά_?GLLH5x8_wqOai ='voOpz0˛Lx_GhAϻݼם^+w%].?ۛ@}eS_W6M}eS_ͧht: 43I+.':ZH9%Fw-ѰXltI9Ar~A]JH&Fw)/5({~6Q3Iu+Y*/'eݙ:ZHY%Ryʺ-ѰuX,IYwATnAT^JʺH&Ry).5({~ʣ񄽿uo+b+a߯>'i}ud:n%ɱ:ֶKH uPygkl4]I;x,Y~"w4([~"EueO$fl';IyeO$zӠlčdDyR޹Ѡlġ>*) ,?xw7([~">) ^I;IydKd{kR1-?Pd{kkHyGXiTc$Mh}'4?ΛI|gs{F:WzC=e9I Ay0pC?/×d+Biq:&/0驳Esj,f`sA`p boz?{_ǽErO;OIqx?V{__W,K}R_W,z>^.ž~LBbG}pG'(XTx,Y~^/cam(sCG׾(6]U-eO$@2Y~"Ty'wbADQaP\SXgPSk`UeO$N$(N4([~"mRQ ʖH$64gy/|qS+>/vgDGNjѱ#GGW5!勤{3ֳ$gUh*4S1Cm:Q9M^4geM 4,(voV;ΪN0<~tf3}7?fαػDekw2E.\Ұr\ziYp:] Vb4鐽:\N.[þ~$?ޟ mLs}{LKt؛~_϶1;7KS뼎pǸWwJY'-Q\YW.^tYuwi[stM>ݧUXW(H`"Dd 0  # A2u";h%<m-pQ"1e`!I";h%<m-p@ p`ER4"x TՕyUA CDAZDTPQ@DǷ6Ҙ.1o12F|e G FH!0cQc| (W:DT{~m-v{+}нۧ{ޠ#RBx R%DOkbF z3\Y@=}ƌ^NX֏˧^SE=4=KW3g=+Y GWZ㣬`bN71_폇폣w 9X8HHõp;<۪)Q||bџ t>ۣ?($")oP2FyI 2 ER0۠/$FR *kB~T7 )ߠ[DR iBbI&J,^H!)@ 1| H T`P}-^H'I}x!? Vľ.JAA x!1.SI FT KH ԁ/$')ĠZzdBq{ j I 7-^Hl')xѠZl7C,^HJRdu $a/$.&)lP#,^H\CRpAx!:J5$+ $)xޠXBWG:$HvQc-^H@RpAx!qI u H .0/$*:ģ$bPYXGRAMx!I:hB" P 1-^HDRdu H 2I/$!)8ΠNx!s dKH `PXXNRĠXx`A-^Hl%)xڠZpC5$S-^HMR0[8h:$g _')ܠfZx5<`P[LR5G$ }%JGu z$x!1Ɏ:.#)iveHI .3-s@bIAѠαx!3ecmIόεl0,s@7ՠηx!1Ɏ:N%)ǺF2$H N4]h%)Jl4=IR]c,sCe'ca,sCbJѰ6cm I>22g$I Fu$:")pr-H")+6^ )XcmI \˵ Ml$]Kwձ6`hH &XUڑhX[ARp{ߐձIobuAXkH γHL$)@2KëjuZy^^;:~מԣDwЇɝگBebThN WH>F,^H')x%FA/$^%)XRLH ^QgXx#FemBb#Ik1[|H 6ƨkx!:Iy/$69h 7HzA -^HIRFE/$zV-1jîx!{ޱǨ># H ~$oŨܘoZxo/$%wck1j1Zme8,^H!F ?ĨO|6?ƨ'?fBO$1j)OXxO1jԟYNR~2m ?lQ H \gBCާŨCND+I1j-^H5Fzz%)K:쬍/$J$ۏSgox!7R~;H F $;Z`gy,^HI.5N]⅄ȠcoB!Olvxß-^H$N5CIkP/$|/N]I+ dB"$)bx!!I Ba񒙮S;-^HHm;:$)c,s@"CRQG+[D ֺtmWT9$t$wV $=vV}H z⫥ wYľ$. *ER.*MRkݕ^HGR;ï$^H!)/ïZ^HOR'ï^H%)?ïƕ^HH f ~$ 2^H') ϑYeB~WPDI~Rā$u~SA$fUI J cBb0N+BR08+8`HuWz!1 ïBn a$d;J/$%)*8 GVp2_#H g;J/$Fw^HNR02AWz!1 ^hQ3P$3| 1$GdG$c2|w #I 3|' $GfQGQ϶x!1 BhqVx3| cH gbǒỗ^HGRplVz!1 J 󄊞s`t'=B~rH"\Vɞ)'[[LiD"3~&SSwܙRN""y 3}DDM=pgJ9#z$Δr^UZpgJ9UDDrVܙRk5~pgJ9_uZpgJ9uDDw])~GD$7hjC)675f)$"j݀;SyKD$kj{)弶ɒJw*I'YvBL)HD4!w""SS=CL)ՓHT;Sy!"45 Δr^`M 3`""9\SCL)5HԘ;Sy!"55>Δr^㉈ :!Δr^'ɼ!wərgJ9DD,MrgJ9䅚0Δr^K4uIȝ).!" 4 Δr^ "Δr^Wɫ5uuȝ)弮&"k;Sy]OD$o!w󺙈H.Ԓ;Sy-!"wBL)""y 3׽DD~MrgJ9Úz8Δr^4Xȝ)#"Ojɐ;Sy=ID$hjMȝ)g4Lȝ)弞!"k;Sy=OD$_+!wzHnr^ۚz;Δr^omrgJ9mDDUS!wj%"eMCL)U&"ܩ!L)J$"MS$wFD${iΔr^dMܙRΫ?;Sy $"45LrgJ9aDDrFIL)5H8ɝ)ɉ(3D""9YS%wLD$kjΔr^Ӊ䙚:SrgJ93:_rgJ9\M͕ܙRk.>jlfɝ)LD$U;S*""yܙR:""ynFE ɝ) ""ynܙRnɻ5uΔr^weZ2E!]HrgJ9jjl&L)6I)]4[szBgKoe{6$V4v?=Bn,qC\|(|nAp}*!,C^]?9<˟o GφKr[0K oׄ6G>r!$z,ݞؙp@+X?&A׫QS2_ջ_[u?9OΫz伪w?9OΫz伪w?9OΫz伪w?9OΫz伪w?9OΫz伪w?9OΫz伪w?9OΫz伪w?9OΫz伪w?9OΫz伪w?9OΫz伪w?9OΫz伪w?9OΫz伪w?9OΫz伪w?9OΫz伪w?9OΫz伪w?9OΫzv͡zC'Onջw?9~rs'7~rs'7O~rw?kO~r!#̓;ixΤ">L!O5ڷIcURd{@$8 k Iǒ XE*Bl**:4Rv^HJ*4[H*5PUe"q9H&"8 *5tRL_CvR/$^'v:ġm"RLWB⧤,2s-^HUy/$f4/ ;HiP}o pAH iP}W d}I@4 ͖HN*H@ѵefa$O 56 uԱ_clU$w]p4R|1x?;8կ~NwYKkObߖA. q~"q-#s\8? \DJRI$I~!k' H&O$V LHD!q~"H*@$'+IhI R&O$% IK!i~"1TDbIƱdZ+IƩĔ4JƱѰWtWk-$ަ'3(ަwp)4= o8tͿ];/k~.d0?8'\ X,tro5 IԍrES`SAnMw K?<..uQpD` `l/wM?`DOܝhO^gwk;ڎxj;ڎ;Ϯc ;pv N®:;QpVVR.ǒىʅѰ )uvrRىʅ-eO LRg'*.1({~J\Š)uvr!ISD¢ASDeO LRg'*^kP:;Q9ىʅH&O 4({~J\֠)uvr!ISDeO W=?NT.D2i~J\hP:;QpASDB$ىʅHv^S\͞z%6Wb^SXZIz56F^(FR^]uzS^o5;hQYK\s69?_yzM&o-=LE0ʟN_ #;#=~ ܖ:&x+u~0)}CH2} #ӎ`j7"k{#O+^K 9ޜ`??Zp{N7,b+]ow:MmgSv6Mmgw6]gm {3P"Ozw)ϊձJXw8 kKI9Kn )/5({~ֻ]To1({~ֻKH9ɤYn!%ezw[ ʞnLzR/=?>*7({~ֻגr>I}5({~ֻTΠY^IH&zw-)_iPw֠Y. |$g=?HrjgHH&zw%)7=?rJg{.)#4?夜dW~:ˍZ^oSqʞz%&8[uWcc4{~8ҫql4-%8UZ I鸋=?ZAVS30Fڿ= _s܃7;[ݾ"o\^0^'ѳ}~OLwZ8: wյumGPvAmGPgwG]uݳwԥ,dݮ,Xk%RyʺѰuY*Rg*`PDRRA2Y~"cR޹ԠlΏ ʖHF;H&O$ ʖHl%; ʖH QygA/HyeO$zITyʠlądDAR޹РlćdGk'*|hfO$n!$'/u JhDBu=N;*VǚL>,?E҄'>Fqy3irNr>r&:7G;)oה)S~Ay(pŗ­bX.W48nWDRԉ%5D Jw31~b~0R8$?CL犷fޗ.uocݻ3y$~ ns%;__ݻXj;ڎcXj;=clUobOBBbgNzQcjRQc{Q\ kHE͖:EΠ&W9h5([~"'fRQ ʖHI*f睝ӠlEƠW.(Z ʖHO* $'RQoPDۤ(-?xT6([~"TO-?ᡊbAHEdDTG-?:VE`PW[ MeO$6bAG'#IEdD,RQ QڗIEq1-?xT_6([~"[RQ<vh'& k3HEuԱTXD_IE'D#FqX-*t79׈UbH./ ě%/# W*;OkwG\KZD%NEzWjtG7]nxNڞt^IRmp_(8S^Xwjcss%=솋;'=Ol'U8߁dSZz&~#G+fzЗvYG>J3Wu s^hn .^ԴpA]ӂ:հqqb8;7HJ扟3۶>>J5wO6/L-ZxY3]ܻWz\{W:Z_TWet{;=f{F u~|jˬkfc4͊{熵sWڎڳwu?{wkO>zFtEU=W^b3|ʷ_G}£#E1Table9SummaryInformation(*RDocumentSummaryInformation8Z`CompObj`qt Office Word@G@Ǖ@ǕdZ՜.+,00 hp   Adams Medical Services Pty Ltd)  ,SEXUAL DYSFUNCTION IN PSYCHOLOGICAL DISEASE Title@@@ NormalCJ_HaJmH sH tH R@R Heading 1$7$8$@&H$a$B*CJ,aJ,phf\@\ Heading 27$8$@&H$^`B*CJ aJ phT@T Heading 4L7$8$@&H$^`L B*phDAD Default Paragraph FontVi@V  Table Normal :V 44 la (k@(No List >B@> Body Textd B*ph*,-;&Iz { 67Aabcvefw00000000000000000000000I00000000000000000000^7A]_:::: _Hlt506540891 _Toc506540816 _Toc506540817 _Toc506540820 _Toc506540844 _Hlt506540896 _Toc506540847 _Toc506540848 _Toc506540849 _Toc506540850 _Toc506540852,wG@@ -vG Q \ HMKS Xa3333333-:&II{  &P*v̮vv`@CJ OJQJo(" خv @CJOJQJo(" ( '@p@UnknownGz Times New Roman5Symbol3& z Arial"qhmRFmRFdZ )dZ )%2td2QLP(?( 2+SEXUAL DYSFUNCTION IN PSYCHOLOGICAL DISEASEDr Stephen Adams Stephen Adams   FMicrosoft Office Word Document MSWordDocWord.Document.89q