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Cancer, Sexuality and the ‘Unattached’.

Cancer, Sexuality and the ‘Unattached’. Sue Lennon Macmillan CNS and Sex Therapist. It is not my intention to offend or hurt or upset anyone, but if I do, I wholeheartedly apologise. This is a serious subject which I will treat respectfully but with a dash of humour too....

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Cancer, Sexuality and the ‘Unattached’.

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  1. Cancer, Sexuality and the ‘Unattached’. Sue Lennon Macmillan CNS and Sex Therapist.

  2. It is not my intention to offend or hurt or upset anyone, but if I do, I wholeheartedly apologise. This is a serious subject which I will treat respectfully but with a dash of humour too.... If anyone is already cringing and you’d rather go off for a coffee for 40 minutes, go now.

  3. Background to this talk...

  4. Agenda • Talking about cancer with patients. • Setting the scene... • What is cancer? • What is sexuality? • Who are the ‘unattached’? • What does the research say? • What does clinical experience tell us? • What do we feel we can do differently, easily? • Is there bigger challenge?

  5. Talking about sex with patients. Staff say.....and I quote... Its hard. Depends on the age of the patient. If they’re like me, its easier...gender/culture/religion. Has something to do with trust and confidence. If I think that someone is gay but hasn’t told me, it’s really, really awkward. I’d rather talk about death! I pick it up if I know how to help, but mostly, I don’t.

  6. So that means that sometimes patients reveal something that’s really uncomfortable for them, and some staff still don’t hear....staff don’t hear... My vulva hurts How’s your bowels??

  7. But it’s really not that difficult.......

  8. P.LI.SS.IT Permission...offer the opportunity to talk about sex, sexuality, relationships, dreams and aspirations. Remember not only to give permission to talk about this, but to gain it too. 60% Limited Information...if there is something that can be easily straightened out, some education or signposting, do so. 15% Specific Suggestions...maybe you need help from another specialist, who is your best ally? 15% Intensive Therapy...know who were and how to refer those who need it. 10%

  9. Setting the scene What’s different about cancer versus other illnesses? What does this include? Who are the ‘unattached’?

  10. Cancer Lots of illnesses and disabilities affect sexuality, so in that respect, cancer is not different. But cancer comes with lots of fear, is not 1 disease, is not predictable, is a long term thing, has complex and often sequential treatments and difficult side effects. 40-100% of cancer patients will suffer some sexual impact from their cancer/treatment.

  11. Sexuality Is multidimensional Includes: Body image, intercourse, identity, confidence, gender, roles and responsibilities, choices, how we present ourselves to the world, communication, sexual knowledge. Is affected by: Culture, class, age, ability, education, economics religion, ethnicity, social group etc

  12. Relationships/being single May never have had a relationship May have had ‘serial monogamy..serial breakup’s’ May have several lovers but no one special person May have been divorced recently or many years ago May have been bereaved recently or many years ago May be a single parent May be a carer for someone else May be any age May be straight, may not be May be in a conflicted relationship break up right now

  13. What does the research say? In 2008 Macmillan survey : 68% of adult cancer patients had never been spoken to about sexual relationships. Lemieux 2010 : Patients want to be asked with little ‘beating around the bush’ ... Chamberlain 2010: Female cancer patients are 6 times more likely to be left by their partner than the other way around.

  14. Mahadi 2011 : Being married is associated with improved survival in women with ovarian cancer. Baine et al 2011: Marital status is a prognostic factor in pancreatic cancer. Similar outcomes across most cancer sites. But there is still much research to be done- in specific groups such as black/ethnic minorities, adolescents, divorced patients, bereaved patients, LGBT patients, those with existing physical/learning disability etc.

  15. What does reflective practice tell us? Take care...Reflecting on my own nursing practice made me a sex therapist! Since working in both roles, I am hugely aware of the continuing need to challenge myself, my practice, health care in general, my colleagues and my patients... and to keep on growing as a nurse, a therapist and a human being. We can’t pretend to offer holistic care if we pay no attention to sexuality throughout the cancer ‘journey’ and beyond.

  16. What do our ‘unattached’ patients say? How can I go and ask the doc for some Viagra when she’ll know I am using it to masturbate...it’s too embarrassing. Who’s going to want me anyway...a one breasted, dry, saggy, infertile woman, old before her time? I looked at the couples in the room and thought they were all in perfect relationships, I was so jealous... until one woman came for treatment and told me her husband had just walked out. He’d been violent for years but she said she was still desperately, desperately sad. I’d never thought that some of those relationships were poisonous.

  17. I get sad seeing all those sickly pictures in the cancer books of man and woman in supportive poses. Its all so invariably heterosexual. I pick guys up on the internet. My question is...Can I receive anal sex after prostate radiotherapy? If I asked my doctor, could they answer me? My marriage broke up years before my cancer came..yet I was acutely aware of the husband shaped empty space beside me each time I came to the hospital. And if our patients can’t talk to us about it, they can be exposed to less than useful advice from blogs and web-support...

  18. ‘I’m about to start chemo and radiation for lung cancer (and I don’t even smoke) I may be around for a long time but then again I may not have long. I don’t know, the doctors don’t know. Is it unreasonable to try to find a relationship or am I destined to face this lonely and alone?’ ‘Why would you want some chick around who is going to try to make everything about her, when you are fighting for your life?Women are a pain in the a$$ and 10 times worse when you don't feel that great.’ ‘You have a lot on your hands, and it would not be in your best interest that you get stressed out over dating right now. Getting stressed out is never good, and even less when you have cancer. Make getting better your top priority’.

  19. What can we do differently, easily? Be aware that being single means your patient is potentially more vulnerable and less supported. Give permission to talk about sex, relationships and the future, early. If they are not talking to you about sexuality, don’t assume that means they’re fine...stay curious but respectful. Leave the door open. Find out who, where and how to refer anyone who does raise a problem that you cannot ‘fix’.

  20. Is there a bigger challenge? If so, what is it?

  21. Contact.. sue.lennon@hdft.nhs.uk 01423 553318 For donations to the Nepal challenge... www.justgiving.com/walknepal

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