Transcript Sexual distress in Oncology patients

Is this
how it
needs to
be?
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 of
cancer!
To be discussed:
• Female / male differences
• Quality of life issues
• Sexuality in the palliative / terminal phase of cancer
• Assessment tools
Typical female-male differences
Male
More orientated
towards
The “act of SEX”
Female
More orientated
towards
relationships
physical contact
sensuality
The
erogenous
zones
Just
Some case histories
“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 patients
is in the range of 35 - 50%
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
Reasons for sex?
Love
Intimacy
Relationship
(relation)
Reasons for sex?
Lust
Fun
Pleasure
(recreation)
Reasons for sex?
Childwish
(procreation)
Relation
Recreation
Procreation
Habit / custom
That sounds neither
very romantic
nor very creative!
It makes ‘the next time’
rather sad when sex
has become impossible
(for instance by cancer)
However, continuing the habit
is 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
Are there
advantages to having sex?
In women:
Ongoing sexual activity is related
to less postmenopausal vaginal atrophy
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%
1.
Giles ea BJU International 2003; 92: 211
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.
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)
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
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
The importance of sexuality in cancer care
Sex is also a way
• to cope with anger & confusion
• to stick to life
• to say farewell
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!
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)
Basic Lube
(only if there is nothing else!)
•
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.
Better
•
•
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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.
Best
•
•
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.
Unknown as yet
(awaiting report from users!)
• 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.
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????
HRT
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Pros and cons
Consultation with oncology specialist
Controversial
Routes & administration
Alternatives – no evidence
Vaginal dilators
• 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.
Kaplan’s Assessment
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Main complaint
Sexual status
Masturbatory status
Medical assessment
Psychiatric assessment
Family and psychosexual history
Relationship history
Evaluation of current relationship
Summation
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 –
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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).
Age does not protect you from love.
But love, to some extent, protects you from age!
Jeanne Moreau
born 1928
Einde
presentatie
woet @ gianotten . com
Thank you!