Sexual relationships in trauma and disease

1. 51 1 Sexual relationships in trauma and disease  Elsa Almås and Esben Esther Pirelli Benestad Specialists i klinisk sexologi NACS Assistant professors Agder University College.

2. 51 2 WHO, 1974: Sexual health is the integration of somatic, emotional, intellectual, and social aspects of sexual being, in ways that are positively enriching, and that enhance personality, communication and love.

3. 51 3 Sexual health and somatic disease Somatic, emotional, intellectual and social aspects Positively enriching Communication Love

4. 51 4 Somatic aspects What does cancer do to your body? What does treatment do to your body? How is your sexual function affected? How is your body changed?

5. 51 5 Emotional aspects Shock Fear Adaptation Relief Hope

6. 51 6 Intellectual aspects Change Coping Understanding New knowledge Flexibility Positive focusing

7. 51 7 Enrichment? Deeper understanding of life and perhaps the reality of death Change in value systems Bodily awarenes Self care

8. 51 8 Communication Sexuality is commmunication Being emotionally open and honest Communication of needs Sharing experiences Having time together

9. 51 9 Love Show affection Care Physical and emotional contact Pleasure Sharing Affirmation

10. 51 10 Social aspects Entering a new social category: cancer patient Cancer as stigma Cancer as punishment for…..? Economy Dealing with the health care system Disability Sustain belonging as a sexual person

11. 51 11 The responsibility of the health care person

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13. 51 13 What is it all about? ????????????????????????

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15. 51 15 Talk about it with clients? When the question: Does people with cancer have a right to a sexual life, is forwarded. The need to talk on many levels is imminent Including the client level

16. 51 16 Some needs Networks, multidiscliplinary approaches Understand motives for sexuality Description of sexual dysfunctions How can sexuality be preserved? Prevention of sexual complications

17. 51 17 How does this become a problem to you? What do you think about your sexuality and your relationship?

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20. 51 20 Empathy The ability to take another person´s perspective… …without losing one´s own

21. 51 21 The experience of the cancer patient: TRAUMA! Trauma of function Trauma of self perception Trauma of presentation

22. 51 22 But: What happens when our total surface to the world around us changes… … for instance by constant pain? …. or by the persistant need to take drugs? When we no longer fit our selfperception… …which is healthy and well. Only superficial people concider the surface to be without significance.

23. 51 23 The individual´s perspective

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29. 51 29 What is a ”no”? You are destroyed You are not one of us You are ill You are wrong Yo re contageous You are non-existant because we cannot understand what it means to be you.

30. 51 30 Can disease be positive? Disease and pain alter the perception of self. How is one affirmed as gender when in hospital bed, when in wheelchair, when bodily molested?

31. 51 31 Belonging Is to be perceived by others the same way as we perceive ourselves. The belonging is positive when that which is being perceived is given a positive value both by oneself and by the others.

32. 51 32 Belonging As healthy As ill As ruined or destoyed As beautiful As ugly and repulsive As forbidding, contageous -- As incapasitated or handicapped --- As ----------------

33. 51 33 How does this become a problem to you? What do you think about your sexuality and your relationship?

34. 51 34 Sexual dysfunction Sexual dysfunction is a deficiency of organic, psychic or mixed character that in a negative, unpleasant or/and painful way interferes with the sexual motives and need of the individual.

35. 51 35 The horse of Troy

36. 51 36 Motives for sexuality “It makes me feel attractive” The added percentage of those that answered very important or rather important: Total: 48% (1987) 65% (1997) Men: 35% 51% Women: 60% 76%

37. 51 37 Sexual dysfunction Dysfunctionin in relation to the experience of attractiveness is a deficiency of organic, psychic or mixed character that in a negative, unpleasant or/and painful way interferes with individuals experience of being attractive.

38. 51 38 Motives for sexuality “It gives me physial satisfaction” The added percentage of those that answered very important or rather important: Total: 75% (1987) 79% (1997) Men: 77% 82% Women: 73% 78%

39. 51 39 Sexual dysfunction Sexual dysfunction is a deficiency of organic, psychic or mixed character that in a negative, unpleasant or/and painful way interferes with physical satisfaction.

40. 51 40 Motives for sexuality “It is an expression of love” The added percentage of those that answered very important or rather important: Total: 89% (1987) 91% (1997) Men: 85% 86% Women: 92% 94%

41. 51 41 Sexual dysfunction Sexual dysfunction related to the need for love and for loving is a deficiency of organic, psychic or mixed character that in a negative, unpleasant or/and painful way interferes with the experience of loving and to be loved.

42. 51 42 Motives for sexuality “It creates sexual excitement” The added percentage of those that answered very important or rather important: Total: 55% (1987) 72% (1997) Men: 59% 75% Women: 51% 70%

43. 51 43 Sexual dysfunction Dysfunction in relation to the need for excitement and relaxation, is a deficiency of organic, psychic or mixed character that in a negative, unpleasant or/and painful way interferes with sexual tension and relaxation.

44. 51 44 Motives for sexuality “It gives contact and intimacy” The added percentage of those that answered very important or rather important: Total: 92% (1987) 92% (1997) Men: 92% 91% Women: 91% 92%

45. 51 45 Sexual dysfunction Dysfunction in relation to the need for contact and intimacy is a deficiency of organic, psychic or mixed character that in a negative, unpleasant or/and painful way interferes with this sexual need.

46. 51 46 Motives for sexuality “It is to have children” The added percentage of those that answered very important or rather important: Total: 22% (1987) 27% (1997) Men: 18% 26% Women: 27% 28%

47. 51 47 Sexual dysfunction Sexual dysfunction in relation to reproductivity is a deficiency of organic, psychic or mixed character that in a negative, unpleasant or/and painful way interferes with the need of pregnancy including habitual abortions.

48. 51 48 How to get on and going? You can start with: Almås and Benestad: ”Sexologi i praksis” Tano Aschehoug, 1997. P.O. Lundberg: ”Sexologi” - 2002. Liber utbildning. Allgeier and Allgeier ”Sexual interactions” 1995, D.C. Heath and Company.

49. 51 49 Reminders: Be open to yourself and to your partner You may always, if possible… …bring with you to bed whatever you need to have good sex. …take a painkiller before sex, most of them do not interfere much in clinical doses. Large meals, alchohol, and heavy bodily strain may take energy you could have used for sex.

50. 51 50 Reminders: Enjoy your body and the sexual pleasures it can offer you also when you are alone. See your self as attractive to your partner. She/he is there because of you. In sexual relationships: Let the one with the best health and/or the one with the greatest physical capasity take the heaviest loads. Don´t fear technical aids or erotic toys Don´t hurry!

51. 51 51 Characteristics of long lasting happy relationships: Respect for each other Respect for the relationship Shared values Ability to play Good sex!

52. 51 52 Thank you for the attention!

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