23rd Congress of the World Association for Sexual Medicine e283

No major complications, no circumcision, overall satisfaction 98%. Intraoperative Citations:

correction of the curvature was achieved in 100%, significant relapse occurred in 2%. Nagoski, E. (2015). Come as you are. New York: Simon & Schuster.
Conclusion: This original technique is associated with low morbidity, a low recurrence Ogden, G. (2013). Expanding the practice of sex therapy. New York: Routledge.
rate and excellent aesthetic results. Ogden, G. (2017). Exploring desire and intimacy. New York: Routledge.
Keywords: penile curvature, erectile dysfunction, corporoplasty Keywords: desire, intimacy, women’s sexual health
Conflict of Interest and Disclosure Statement: None. Conflict of Interest and Disclosure Statement: None.

DOES ACCEPTANCE MEAN PERMISSION? USING

IDIOPATHIC PENILE EDEMA TREATED WITH ACCEPTANCE AND COMMITMENT THERAPY TO
ESWT e A NEW TREATMENT OPTION? “TREAT” EGO-DYSTONIC MASTURBATION IN A
Lars LUND DEVOUT JEWISH MAN
Department of Urology, Denmark Tal PELEG-SAGY
Background: Idiopathic penile edema is a rare condition. There is almost nothing in Be’er-Sheva Mental Health Center, Be’er-Sheva, Israel
the present dermatologic or urological literature about treatment of this condition.
Introduction: Jewish religion does not allow male masturbation, because of the prohi-
Patients and Methods: Four were referred to the department of Urology, Viborg
bition against ‘spilling’ semen in vain (ejaculation outside the context of intercourse).
Hospital and Odense University Hospital men between 1999 and 2014. Diagnosis was
Action: A 45 year old, religious, married man, sought sex therapy because of ego-
made on the basis of clinical criteria after ruling out potential differential diagnosis.
dystonic masturbation. He asked the therapist to help him refrain from masturbation,
The demographic, clinical and laboratory data were collated from patient files. After
an act he considered to be sinful. The therapist used Acceptance and Commitment
ruling out other causes all four were treated with steroids for 2 months. In 2 patients
therapy (ACT, Hayes, 1982) in order to help him accept masturbation as part of
the condition did not subside and they were treated with weekly shockwave therapy
natural human sexual behavior, and to be less punitive towards himself when
(ESWT) at the affected area. ESWT was applied at the root of penis and in the
masturbation occurred. At the same time, the client’s religious and moral positions
preputial area. Treatment was performed without local anaesthesia with 0.15 mJ/mm2,
were examined in therapy, in order to help him re-commit to his own values.
frequency of 5 Hz, 3000 shock waves with a total energy of 12.8 J per treatment. The
Outcome: After twenty sessions, the client reported being more accepting of himself
men received one treatment per week for five weeks.
after masturbation had occurred. He also was more able to take responsibility for his
Results: Mean age 32 years of age (range 24e42). They completed the treatments and
life, and to examine the factors in his life, which contributed towards making
there were no observed side effects or pain during or after treatment. After treatment
masturbation a solution to deeper feelings of emptiness and distress. As intended in
the two men did not observe any swelling or edema of the penis and they were able to
ACT, his ability to be mindful to certain aspects of his sexuality has improved.
obtain erection and have sexual intercourse without the use of medication.
Discussion: ACT is a “third wave” cognitive-behavioral therapy, which has been
Conclusion: ESWT showed to have an immediate effect of idiopathic penile edema in
found to be successful in reducing symptoms of various disorders including depression
some patients and was without any complications.
(Forman et al., 2007), pain (Dahl, 2004; Wetherell et al., 2011), anxiety (Forman et
Keywords: ESWT, treatment, genital edema
al., 2007) and schizophrenia (Hayes, 2002). In sex therapy, as in general psycho-
Conflict of Interest and Disclosure Statement: None.
therapy, patients seek help because they wish to reduce (or avoid) behaviors that they
judge as problematic (e.g. fantasies and masturbation). Although sex therapy is often
about permission for those physical and mental behaviors, therapists should not omit
THE FOUR-DIMENSIONAL WHEEL: A CLIENT- consideration of the patient’s moral, religious and cultural values. ACT allows thera-
CENTERED APPROACH FOR EXPANDING pists to accept the dialectic tension between non-judgmental acceptance of different
aspects of human behavior, and commitment to the clients’ own values.
WOMEN’S SEXUAL HEALTH
Keywords: third wave CBT, masturbation, ACT
Gina OGDEN Conflict of Interest and Disclosure Statement: None.
Adjunct Professor, California Institute of Integral Studies, United States
Lindsay JERNIGAN1, Tina NEVIN2
1
Private Practice, Burlington, VT, United States; 2Sexologist, Vaxjo Central RETROSPECTIVE ANALYSES OF FEMALE SEXUAL
Hospital, Vaxjo, Sweden HEALTH CARE AT A PUBLIC HOSPITAL
Introduction, rationale: We introduce the Four-Dimensional Wheel of Sexual Sandra SCALCO
Experience (4-D Wheel), an integrative template that invites women to explore body, Public Hospital Presidente Vargas e HMIPV, Porto Alegre, Brazil & Epidemiology e
mind, heart, and spirit, along with its core dynamics of movement, ritual, concreti- PPGEPI e UFRGS e University of Rio Grande do Sul, Porto Alegre, Brazil
zation, and safe space. This approach is based in systems thinking and sex survey Anna BICCA1, Daniela KNAUTH2, Aline MONDIN1, Tatiana SIVIERO1,
research, is compatible with both medical ethics and contemporary neuroscience, and Filipe RENCK1
is used effectively with other sex therapy techniques. 1
Public Hospital Presidente Vargas e HMIPV, Porto Alegre, Brazil;
Action: We present three innovative applications of the 4-D Wheel: 2
Epidemiology e PPGEPI e UFRGS e University of Rio Grande do Sul,
1) Moving Beyond Trauma: To locate negative blocks—past and present; physical,
Porto Alegre, Brazil
emotional, mental, and spiritual, and “re-member” sensation, power, connection, and
joy. Introduction: Female sexual dysfunction consists of the inability to participate in the
2) Addressing Low Sexual Desire: To develop self-acceptance, release old, mini- sexual relationship with satisfaction for more than six months and it causes distress to
mizing stories, and ignite desire on women’s own terms rather than on external the patient.
expectations. Objectives: 1e Evaluate the visits performed at the Ambulatory of Sexology, in the
3) Rehabilitating Vaginal Function after Cancer: To expand mind-body options as Public Hospital, through the retrospective analysis of medical records, from January to
women explore each quadrant: Mental (“I should be content just to be alive.”), December, 2015. 2 e Define the profile of patients referred for treatment with
Emotional (“I’m angry—I have a right to be sexual!”), Physical (“Oh—there are ways complaints of sexual dysfunction. 3 e Prepare a specific and brief questionnaire e the
to get there!”), and Spiritual (“Now I can reconnect with myself and my partner.”) Rapid Test for Female Sexual Dysfunction.
Outcome: Women who engage in 4-D sex therapy generally report increased desire, Methods: Retrospective analysis of medical records. All women above 18 years of age
intimacy, and function, and decreased avoidance, partner resentment, and dysfunction. who had at least one consultation with the complaint of sexual dysfunction regardless of
Positive themes include curiosity, gender-role fluidity, self-respect, and more mean- marital status, sexual orientation or schooling were included. For categorical variables:
ingful relationships. Pearson’s chi-square test or Fisher’s exact test was employed. To compare means, Analysis
Discussion, recommendations: The 4-D Wheel is a simple but profound practice of Variance (ANOVA). In asymmetry, the Kruskal-Wallis test. The Receiver Operating
designed to help women discover crucial elements of desire and intimacy that lie Characteristic (ROC) curve determined the cutoff point for the score (p0.05).
beyond the focus of behavioral sex therapies. The 4-D Wheel approach is safe, moving, Results: The profile of the 124 patients showed an average of 39.3 years; 95% had a
collaborative, integrative, inspiring, and often life-changing. fixed partner. Depression (45.3%) and gynecological surgery (27.4%) were the most

J Sex Med 2017;14:e211ee350