Sexuality in Cancer Care: Understanding, Coping, and Healing

1. Is this how it needs to be? Here liesour faithfulSexlife 10 Jan 197820th Spetember 2009

2. the reaction of the average patient & partner Scared to talk sex! the reaction of the average oncology professional: Scared to talk sex! the reaction of the average Psychosex counsellor Scared ofcancer!

3. To be discussed: • Female / male differences • Quality of life issues • Sexuality in the palliative / terminal phase of cancer • Assessment tools

4. Typical female-male differences Female More orientated towards relationships physical contact sensuality MaleMore orientated towards The “act of SEX”

5. Theerogenous zones

6. Just

7. Some case histories

8. “Intimacy is a casualty in the battle against cancer” Extrapolating from the literature, the percentage of disrupted sexuality and intimacy both in male and in female cancer patientsis in the range of 35 - 50%

9. What is sex? • Intercourse (included oralcourse, analcourse) • Outercourse (included masturbation & petting) • Stroking, massaging, sensuality • Getting excited by fantasy, watching, etc. • Enjoying oneself being naked / being sexual • Feeling feminine / masculine

10. Reasons for sex? LoveIntimacyRelationship(relation)

11. Reasons for sex? LustFunPleasure(recreation)

12. Reasons for sex? Childwish(procreation)

13. Relation Recreation Procreation That sounds neither very romanticnor very creative! Habit / custom It makes ‘the next time’ rather sad when sex has become impossible (for instance by cancer) However, continuing the habitis probably a very good way physically ‘to stay in a good condition’and sexually ‘to keep things going’ The ‘use it or lose it’ principle

14. Are thereadvantages to having sex?

15. In women: Ongoing sexual activity is related to less postmenopausal vaginal atrophy

16. In men:High ejaculation frequency (whatever method) is related to: Less prostate cancer 1 Every increase of 1 ejaculation / week reduces the risk of prostate cancer by 5% • Giles ea BJU International 2003; 92: 211

17. In men:A higher ejaculation / orgasm frequency is accompanied by: ● Less male breast cancer 2 ● 50% less mortality risk (in the 45-59 yr age range) this is the same for frequent intercourse 3 2. Petridou et al. Br J Cancer, 2000; 83: 1234. 3. Davey Smith et al. BMJ; 1997: 315: 1641.

18. In women & men: depression and suicide: Celibacy is associated with increased levels of depression & suicidal tendencies in young males (he- / ho- / bi-sexual) Masturbation is associated with less depression (in heterosexual men & women)

19. Sex for QoL? In women strong associations were found between sexual interest and well-being Sexual desire increased dramatically in periods of well-being. A youthful appearance in women and men is enhanced by sex ● People whose age was regularly underestimated had an active (& high frequency) sex life Weeks & James. Secrets of the superyoung, 1998

20. The importance of sexuality in cancer care Sex can: relax emotionally console and comfort relax physically distract from pain reduce pain (in women) improve self esteem in both men and women

21. The importance of sexuality in cancercare Sex is also a way • to cope with anger & confusion • to stick to life • to say farewell

22. Sexuality in the palliative phase Continue to follow up progress at every visit When there is a partner, don’t forget him/her Don’t discuss serious matters without the partner being present except when he/she is a real burden (for the patient) Don’t forget that the partner is involved as well In case of a male partner: he too can have sexual problems!

23. Sexuality in the palliative phase • adequate pre-sex painkillers • adequate lubrication • Consider advice on: • proper timing in case of fatigue • adapted techniques in case of vaginal shortening or stenosis • adequate stimulation --- Take time • other erogenous zones or artificial vibration)

24. K-Y Lubricating Jelly is a water soluble personal lubricant.. Most doctors recommend K-Y Jelly, as water based K-Y Jelly is safer and more effective than other lubricants. Clear, non greasy K-Y Jelly is the perfect supplement to your own natural moisture, so that your lovemaking is instantly more pleasurable. K-Y is safe to use with condoms, unlike petroleum jelly or baby oil. K-Y is clear and clean-rinsing, easy and convenient to use, non-greasy and non-sticky, hygienic and pH balanced, fragrance free and alcohol free. Basic Lube(only if there is nothing else!)

25. Replens Vaginal Moisturiser replaces essential moisture lost through vaginal dryness (vaginal atrophy). Vaginal dryness is a result of the natural ageing process, and not only affects lovemaking, but often leads to itching, irritation and discomfort. Use Replens three times a week to provide continuous moisture and comfort. Pre-filled applicators enable you to place hygienically the right amount of Replens exactly where it is needed, high up inside the vagina. Replens is also hormone free and safe to use with condoms. Better

26. SYLK is derived from an extract of the kiwi fruit vine and contains no synthetic compounds, making it a natural substance. Every woman at some stage in her life experiences vaginal dryness which can be due to a variety of reasons. Hormone fluctuations and drug side effects can cause dryness. Having a pH the same as your skin means it is extremely gentle and non-irritating. It has no chemical base whatsoever, unlike most other supplements and lubricating gels, thereby making it fully natural in every respect and totally safe to use with tampons and condoms...it is a perfect substitute for the body's natural lubricating system. Best

27. Astroglide is fairly new to the UK, but it is the second best selling "lube" in the US. Astroglide is such a good lubricant, you need much less than you do with other types of lubricant, making it great value.This product is not a spermicide or contraceptive. Unknown as yet(awaiting report from users!)

29. Sexuality in the palliative phase • If the patient patient is “palliative” formerly ‘forbidden treatment’ may be discussed • adequate oestrogen replacement • adequate testosterone replacement • Note: The level of testosterone below which sexual symptoms usually occur is not known nor do we understand brain and genital receptor sensitivity to testosterone. • ‘serious’ pain relieving medication • unauthorised solutions????

30. HRT • Pros and cons • Consultation with oncology specialist • Controversial • Routes & administration • Alternatives – no evidence

31. Following radiotherapy to the vagina, cervix or pelvis, the woman may experience some internal scarring (adhesions) to the treated area, which can make the vagina narrower, drier and less elastic. Preventing the formation of scar tissue within the vagina helps ensure that it remains supple so that sexual intercourse and vaginal examinations can be performed without discomfort or pain. Vaginal dilators

32. Kaplan’s Assessment • Main complaint • Sexual status • Masturbatory status • Medical assessment • Psychiatric assessment • Family and psychosexual history • Relationship history • Evaluation of current relationship • Summation

33. PLISSIT MODEL The Ex-PLISSIT model is an extension of the much-used PLISSIT model. The PLISSIT model was developed by Annon (1976) for use by practitioners in meeting the sexuality and sexual healthcare needs of patients. The acronym PLISSIT signifies the four levels of intervention – • Permission, • Limited Information, • Specific Suggestions, and • Intensive Therapy. As the level of intervention increases, greater knowledge, training and skills are required (Seidl et al 1991).

34. Age does not protect you from love. But love, to some extent, protects you from age! Jeanne Moreau born 1928

35. Einde presentatie @ .com woet gianotten

36. Thank you!