Transcript reclaiming mental and sexual health after a cardiac incident

RECLAIMING MENTAL AND
SEXUAL HEALTH AFTER A
CARDIAC INCIDENT
Dr Marelize Swart
Psychologist and Sex Therapist
Helderberg Medi-Clinic
WELCOME HELDERBERG
CARDIAC SUPPORT GROUP!
How do I reclaim my sexual self after a
cardiac incident?
• Sexual activity is a major quality of life issue
for men and women with cardiovascular
disease and their partners.
• Sexuality, including sexual function and the
psychological aspects of sexual health, are
affected in almost everyone who has had a
cardiac incident.
• Expect that your body’s response to arousal
and stimulation will have changed.
How do I reclaim my sexual self after a
cardiac incident?
• Sexual activity frequency and satisfaction often decline
because of anxiety on the part of the patient or partner
that sexual activity will worsen the underlying cardiac
condition or cause death.
• Changes in sexual activity after a cardiac event may impair
the patient's quality of life, negatively affect psychological
health, and strain marital or other important intimate
relationships, which in turn may lead to depression and
anxiety.
• The resultant depression may be an important contributing
cause of ED in men and of female sexual problems,
including decreased libido, difficulty with arousal and
orgasm, and dyspareunia.
How do I reclaim my sexual self after a
cardiac incident?
• After a diagnosis of cardiovascular disease, it
is reasonable for patients to be evaluated by
their physician or healthcare provider before
resuming sexual activity.
• Patients should be assessed to see if their
sexual dysfunction is related to underlying
vascular or cardiac disease, anxiety,
depression or other factors.
RECLAIMING SEXUAL HEALTH (cont)
• Patients with severe heart disease who have
symptoms with minimal activity or while at
rest should not be sexually active until their
cardiovascular disease symptoms are
stabilized with appropriate treatment.
SEX AND INTIMACY AFTER CARDIAC
INCIDENT
• The insecurity, fear and doubt that can arise from
this can throw even the most open and loving
couples into a tangled web of conflicting
emotions.
• The most common concern for survivors and
caregivers alike is fear of causing another cardiac
incident.
• Experts agreed that research indicates that it is
very unlikely that lovemaking will cause another
cardiac incident.
RECLAIMING SEXUAL HEALTH (cont)
• The absolute rate of cardiovascular events
during sexual activity, such as heart attacks or
chest pain caused by heart disease, is
miniscule because sexual activity is usually for
a short time.
RECLAIMING SEXUAL HEALTH (cont)
• It is often the partner of the person who had a
myocardial infarction who is worried about
having sex and causing another MI.
RECLAIMING SEXUAL HEALTH
- Decreased sexual activity and function are
common in patients with cardiac incidents and
are often interrelated to anxiety and
depression.
• Cardiovascular events — such as heart attacks or
chest pain caused by heart disease – rarely occur
during sexual activity, because sexual activity is
usually for a short time.
• Some patients will postpone sexual activity when
it is actually relatively safe for them to engage in
it.
• On the other hand, there are some patients for
whom it may be reasonable to defer sexual
activity until they’re assessed and stabilized.
RECLAIMING SEXUAL HEALTH (cont)
• As long as someone can walk two flights of
stairs and has the okay from the doctor they
are good to go for having sex.
• Men and women with stable CVD who have
no or minimal symptoms during routine
activities can engage in sexual activity.
SEXUALITY
• According to a new scientific statement issued
by the American Heart Association, it is
probably safe to have sex if your
cardiovascular disease has stabilized.
SEX AND INTIMACY AFTER CARDIAC
INCIDENT
• Sex is a sensitive subject amongst cardiac patients
and their partners as it can cause big changes in
the lives of couples who are sexually active.
• Cardiac related physiological and psychological
changes may affect both sexual desire and
performance.
• When to have sex? Neither partner should force
the issue. You will know when you are ready.
WHAT HAPPENED TO DESIRE
• Many survivors find that they don’t have
much desire for sex because they are so
involved in their recovery process.
• Or erection difficulties. A number of antidepressants and blood pressure medicines can
reduce libido (sexual desire) and performance
(ED).
WHAT ABOUT DEPRESSION
• Depression often reduces libido, and drugs for
depression may also reduce libido.
• Careful grooming and attractive clothes can
help you feel good about yourself. While this
may take extra effort at first, you’ll feel
attractive.
THE IMPORTANCE OF INTIMACY
• Intimacy is very important and we need to get
away from the model of heterocentric penisvagina penetration.
• Men with heart problems may have difficulty
with erections both due to problems like
artherosclerosis and high blood pressure, and the
meds used to treat them.
• They need to hear that they can still be intimate
and not to get discouraged if they are having
difficulty with erections. It's common, talk to
doctor.
Grieve changes as often as you need to
• You will want to take time and grieve:
1) changes in how your body feels &
functions,
2) changes in your energy, and
3) changes in your desire, arousal and sensation.
• Let go of how you were, and embrace how
you are now - a “new normal”.
Re-Connect with your Body
•
•
•
•
Get a manicure or pedicure
Get a full body massage
Move breathe and eat mindfully, noticing every sensation
Connect consciously with the things you love about your
body
• Find clothing or lingerie that is comfortable and makes you
feel sexy and attractive
• Learn what feels good now and what kind of touch works
best for you.
• Do something physical (yoga, walking, sitting in the
sunshine and focus on how your body feels as you do it.
Communicate with your partner
• Sometimes it takes something as life-altering
as a cardiac incident to help one realize how
important it is to have clear and loving
communication in order to keep intimate
relationships healthy.
FATIGUE
• Fatigue is a common problem for survivors
and partners. The best time for sex may be
after resting or in the early morning.
• Perhaps, just to reestablish the relationship,
couples should spend time together cuddling
and sleeping quietly.
“Die Burger” front page article today
• A survey by Pharma Dynamics in South Africa reported
that the average man in SA has sex 52 times per year
versus 100 in other countries.
• 22% of the men reported that they only had sex every
3 months.
• 16% reported that they were in a sexless (no sex)
relationship.
• The majority of the men that took part in this survey
stated that they had experienced erectile disorder for
the previous 5 years without getting treatment for it.
ED can be a sign of cardiac problems, high blood
pressure, diabetes, etc.
• YOU HAVE A CHOICE TO BE MORE INTIMATE
THAN EVER BEFORE--
MOVING FORWARD: INTIMACY TIPS
• Take the time and do some work to make sure
that you’re both fully communicating with
each other: talk, listen, and intentionally move
through life together as a team.
• Grieve the changes together.
• Help your partner get to know your body as it
is now as s/he might be afraid too ask.
MOVING FORWARD: INTIMACY TIPS
• Get to know each other again
• Ask what s/he loves about you, mind, body
and spirit.
• Move forward together and further develop
your sense of being a team in this life.
• Make time for intimate closeness even if you
don’t have the energy for sex.
MOVING FORWARD: INTIMACY TIPS
• Take some time with your partner to cuddle,
touch, and be close in intimate, but not
necessarily sexual, ways when you don’t have
energy for sex.
• This will keep your bond strong, and provide
healing touch and comfort for both of you.
Permission for self-pleasure
• If you are feeling less sexual than your partner,
it’s important to give your partner permission
to enjoy self-pleasure as part of him or her
life.
• It is not your responsibility to provide sexual
opportunities or release for your partner but
is is helpful for to to explicitly give permission
for her or him to maintain their own wellness
through orgasm and self-pleasure
Permission for self-pleasure
• One way to provide this kind of permission is to
give your partner a pleasure toy, or an erotic
book or DVD, with instructions to “PS Enjoy
yourself, with love.”
• There will be a time when you will want to
explore you own pleasure, alone, as you learn
how your body has changed and what feels good
now, so setting the stage early for healthy selfpleasure can make that more comfortable when
it’s your turn.
Get to know your sexual “new normal”
• Because a cardiac incident can change how
your body responds to touch and stimulation,
once you feel reunited with your body, it is
time for you to explore to see how it works,
what feels good, what is not-so-pleasurable,
and what kind of touch and mental
stimulation work best for sexual arousal and
sensation.
Be Loving
• As a couple you need to be patient, loving and
keep humour in the relationship. It is good to set
aside a special time for intimacy and sex. Do
things that make both of you feel sexy and
attractive. Create a loving atmosphere with
music, soft lights, candles and by giving
compliments to each other.
• Having sex is not just about vaginal penetration
as much as touching, caressing, kissing, and just
showing appreciation for your mate.
TALK WITH EACH OTHER
• When do you have the energy for sex?
• If you have pain or discomfort, what do you need
to accommodate that?
• What does it take to have an orgasm now?
• Take time to explore with yourself so you can
share what you learn with your partner.
• Create a pleasure map for your partner (and have
him/her do the same for you) showing what kind
of touch you like and where, and showing where
the “no go” zones are now.
Practice communicating and
negotiating around sex
• It’s always a good idea to be able to
communicate explicitly about what you like
and want; but after a cardiac incident it is
even more important to do so.
• Practice asking for what you want, planning
together to enjoy intimacy at times when you
have the most energy and interest.
• Make conscious “sex dates” so intimate play
doesn’t get left out of your life altogether.
Explore new ways to make love
• It won’t be the same as it was before, and with
some creativity and learning, it can be even
better and more intimate than before the cancer.
• Pleasure each other without having intercourse.
• In stead, become accustomed to Outercourse.
Enjoy the sensations. Take your time. Be less
goal-oriented. Get creative and experiment with
new positions and places.
Use tools and enhancements when
you need them
• Lubricant
• Vibrator for helping with arousal, sensation
and orgasm
• Vibrating massage wand for vaginal health and
renewal
• Kegel exercises to help keep your pelvic floor
strong and flexible
• Penile rehabilitation devices for erectile
dysfunction
Facts about Intercourse
• Cultural attitudes have led most people to think
of intercourse -- ending in orgasms for all parties - as the be-all-and-end-all of sexual activity, in
spite of the fact that most women can’t orgasm
through that method alone.
• This leaves many people who are unable to
participate in that activity feeling cheated or
downright defective because they cannot provide
what is viewed by many as the ultimate act of
love and pleasure. It also negates the intimacy
non-penetrative acts provide.
Outercourse
• Fortunately, for couples who cannot have
intercourse, whether it’s caused by health
issues, like erectile dysfunction or painful sex, ,
there are plenty of alternative activities that
simulate the feel and closeness of intercourse.
• We call that Outercourse.
Outercourse -- What is it?
• Outercourse is creative sex play that is not
limited to, or focused on intercourse. It can
include any sexual activities you and your
partner enjoy, and can lead to anything you
both agree to. It can be “the first course,” “the
last course,” “the main course,” or “the only
course!”
Outercourse: a good choice if you or
your partner…
• has trouble maintaining an erection
• has pain with penetration, or do not enjoy
penetration
• has trouble reaching orgasm/ejaculating
during intercourse
• has performance anxiety
• want to postpone intercourse, and still enjoy
intimate play together .
GETTING STARTED
• Start slowly, perhaps just be being close and
cuddling. Explore what feels good to you now.
Tell your mate what pleases you – he or she
cannot read your mind.
• Intercourse may not happen at first, so just
relax and focus on the intimacy that you are
building together
• Add intercourse only if and when you both
feel ready.
• A playful attitude and adventurous spirit are
the best assets you have when it comes to sex,
second only to a genuine affection for your
partner. The right attitude can make any
activity or technique full of pleasure and fun.
• Sex can easily become serious business if you
see it as a race to the finish line, or a
performance that must play out in a particular
way each time.
• We all experience busy or stressful times,
illnesses, and other circumstances that force
changes in intimacy or physical response.
• Flexibility and a sense of humor can help you
weather these changes.
• Broadening your idea of what good sex
consists of, and exploring ways to create as
much pleasure as possible for you and your
partner, will take the focus off of what you
can’t, or choose not to do.
• Instead you can keep your attention on
creating pleasure and deepening your
intimate connection with each other. As an
added benefit, expanding your sexual
repertoire will increase the fun you can enjoy
during sex play.
Getting Started and Building
Anticipation
• Agree that neither of you will aim for orgasm; your
only goals will be giving/receiving pleasure and having
fun together.
• You can decide some activities are off-limits, or set no
limits, but DON’T set orgasm as the end point.
• One or both of you may have an orgasm, but it’s not
required. This can relieve performance pressure while
allowing you to explore activities you might have
otherwise missed, If you enjoy this, you can make try it
whenever you want to build your connection and
anticipation.
Getting Started and Building
Anticipation
• Make out during a movie with no pressure to
go any further, or skip the movie and revisit
heavy petting on the couch.
• Keep your clothes on much longer than you
want to, or keep them on all evening.
• See how much fun you can have undressing
slowly when the time comes, or touching each
other through your clothing.
Add some more advanced
communication skills
• Try asking your partner for permission before
every action or touch. Only touch when and
where your partner allows.
• After asking "may I touch your...?”Follow it up
with “Did you like that? Would you like me to
do it some more?" If so, try “May I kiss
your...?".
Hand or Foot Massage
• Another version is to give a hand or foot
massage but only touch in the exact manner
your partner requests. Your goal is that you
are both able to ask for specific kinds of touch
in specific places. Then you’re ready to move
on to other erogenous zones.
Communicate more about intimacy
• Practice talking about intimate play more
often, explicitly asking for what you want as
well as asking your partner what she or he
would enjoy doing.
• By improving your non-sexual intimacy –
hugging, laughing, having fun – can really
improve your sexual intimacy
• It is important to focus on what you have, not
what you have lost.
Become more creative
• Start a date by meeting in the produce
department of your local grocery store. If you
are tempted by fruit, what body part would
taste nice with raspberries on it? Peaches?
Whipped cream? Champagne?
More ideas for increased intimacy
• Find out how much fun a man can have without
an erection, or without engaging in penetration
of his partner.
• Buy a nice lubricant (or compare several) and try
stimulating him with a variety of different parts of
your body.
• Some ideas: hands, mouth, breasts, or between
the thighs. Try a masturbation sleeve if your skin
is not up for the contact. Remember that men
can have orgasms without ever having erections,
so keep going even if he isn’t hard.
More ideas
• Find a movie or book on erotic massage, and
try out the techniques. There are books and
movies on vulva massage, penis massage, and
whole body erotic massage.
• You can also explore touch using feathers, silk
scarves, strands of pearls or fur, and get
creative with some of the kitchen
utensils/gadgets.
Be creative
• See if you can discover some erogenous zones
you didn’t know about before by observing
your partner’s responses carefully and
experimenting with different areas and
different strokes and touches. Explore
everywhere, not just the genitals.
More things to try
• Try sexy phone talk, or explicit notes via email,
SMS, or sexy notes tucked into pockets or
lunch bags.
• You can tease, tempt, and arouse your partner
all day long from a distance.
• Anticipation can make your next date extraspicy.
Mutual self-stimulation
• Mutual self-stimulation in its many forms is both
sexy and safe.
• It can be extremely arousing to watch a partner
pleasure him or herself to orgasm.
• Settle yourselves into comfy positions and decide
if you want to take turns, go solo, or stimulate
yourselves simultaneously.
• You can impose rules like “You can’t touch me" or
let your partner play a supporting role in your
pleasure, e.g. by putting his arm around you
whilst you are lying on your bed.
KISSING
• Many people enjoy giving and receiving
pleasure of all kinds with their mouths.
• If you love kissing, devote some time to it
rather than seeing it as just an appetizer.
• You can take kissing to another level by
exploring your partner’s entire body with your
mouth.
SELF-PLEASURING
• Self-pleasuring is healthy. Studies have found that
orgasms boost your immune system and help fight
depression. Plus, the more orgasms you have, the
easier it will be for you to orgasm in the future.
• Orgasms are one of the most effective ways of
strengthening your pelvic floor muscles, which can
reduce the risk of urinary incontinence.
• Self-pleasure is also the best way to learn what you like
so you can teach these techniques to your partner. For
many women, it is easier to have an orgasm with a
partner after having discovered what works by
themselves.
NEW TO ORAL PLEASURE??
• If stimulating your partner’s genitals with your
mouth is new to you, consider rending an
instructional movie or book on oral sex to
debunk myths and offer sexy tips, or just dive
in and enjoy discovering what you and your
partner both enjoy.
ORAL PLEASURE
• If you are experienced in giving and receiving
oral pleasure, experiment with using flavors or
ice, and explore different positions, adding
additional stimulation with your hands or a
vibrator.
“Focus your attention” tips
• Take turns focusing attention on one another.
One day, have a date that’s all about pleasing
your partner.
• The next day, switch places.
• Sometimes knowing you won’t be
reciprocating right away can allow you to relax
at a deeper level and sink into the sensations
you’re experiencing.
Schedule time
• If you have trouble finding time for being
intimate in your busy lives, make a date and
put it on the calendar.
• Turn off the phone.
• If you’ll be distracted by your to-do list during
a date at home, get a motel room.
Go on a date
• Pack a romantic picnic, or order in. Even if all
you can manage is a an hour or two, you can
have a lot of fun in that time, and anticipating
the upcoming date can help get you both
through the week.
Sit closer and touch more
• If you’re overwhelmed with stress, try sitting
on your partner’s lap while you catch up on
the day’s events and see if the mood shifts.
• Or allow yourselves to begin gently touching
and pleasuring each other, and follow the
sensations.
• If you become more aroused, you can pursue
more intense touch. If not, enjoy the contact
and intimacy.
Above all, have fun!
• There are so many ways to enjoy intimacy
without ever engaging in intercourse or
penetrative sex play.
• Start with the ones we’ve listed here, and
then expand your list to whatever you wish to
add to your repertoire.
• You have nothing to lose, and a lot of pleasure
and closeness to gain.
Thumbs up for the new normal!
• Remember to take time for pleasure and
intimacy, and know that while things will not
be the same as they were, they may be even
better!
Ask for professional help from a
therapist if you need it
• Sometimes it’s just too hard to deal with it all
on your own pace. Find someone you’re
comfortable working with and ask for the help
you need, as an individual or as a couple.
MALE PENILE RINGS
SEX AND INTIMACY AFTER CARDIAC
INCIDENT
HOW TO SPICE UP YOUR LOVE LIFE
HOW TO SPICE UP YOUR LOVE LIFE
• 1. Make a conscience effort to be more
sensual and more sexual (if unsure, look on
internet for sexual flirting tips)
• Set aside time for “date and /or sex” nights
• Devise sexual games to play together
• Arrange an out of town trip at east twice a
year
• Be adventurous and change! Hair style,
clothing, make-up, cologne/perfume
HOW TO SPICE UP YOUR LOVE LIFE
• Have fun with personal hygiene: have a
shower or bath together
• Update or change your wardrobe (out with
the “granny panties” and in with a few new
sexy items. If you want your partner to look at
you in a more sexual light, you have to give
him/her something more/different
• Change your bedroom: new paint, artwork,
statues, candles and new bed linens.
HOW TO SPICE UP YOUR LOVE LIFE
• Engage in erotic entertainment. Watch an
erotic soft-core porn movie.
• Read erotic literature – either read that
together as a couple or alone. They can often
spur the imagination even better than films
• Experiment with sex toys (can be purchased in
adult shop or on internet)
• Attend or visit a clothing optional resort or a
nudist beach (Sandy Bay!).
MEDICATIONS AND SIDE EFFECTS
MEDICATIONS AND SIDE EFFECTS
• Some medications that cardiac patients are on may
change the way that your body functions sexually.
• Statins have erectile dysfunction as a possible side
effect (small, but reported frequently enough that it
needs acknowledging) and beta blockers slow down
sexual arousal and response so that orgasm is harder
(or impossible) to attain.
• This means you may need to adapt your sexual
interaction style to find intimate activities that are
rewarding and pleasurable in the absence of one or
both of these events
MEDICATIONS AND SIDE EFFECTS
• In addition to medication effects, coronary
artery disease can affect the blood vessels in
the penis and clitoris that fill with blood to
create the penile and clitoral erections.
MEDICATIONS AND SIDE EFFECTS
• Rehabilitation activities should help reverse
some of this damage, but the person with the
cardiac incident should understand that
arousal may take longer, erections may or may
not happen and be full, and that it may well
take more time to achieve orgasm because of
the length of time it takes to become fully
engorged and aroused.
MEDICATIONS AND SIDE EFFECTS
• Vibration will help this process for both men
and women, as it facilitates blood flow directly
to the appropriate vessels.
• PDE-5 inhibitors may or may not be safe for
the person to use, depending on what other
medications they are on and their risk factors.
MEDICATIONS
• It is reasonable for post-menopausal women
with cardiovascular disease to use estrogen
that’s topically or vaginally inserted for the
treatment of painful intercourse.
Erection Dysfunction: Treatment
• Vacuum device therapy (suction pressure)
• Penile stimulation ring (i.e. Pixie)
• Constrictor band (a round elastic device that
help trap the blood flow in the penis once an
erection is obtained. Especially for those that
have difficulty maintaining their erection.
Should only be worn for a max of 30 min’s
• Masturbation accessories.
Erection Dysfunction: Treatment
• PDE5 inhibitors
• Intracavernosal Injections: self-injection
therapy
• MUSE (very small pellet of prostaglandin is
inserted into urethra and erection occurs
within 15 to 30 minutes).
MEDICATIONS
• Women with cardiovascular disease should be
counselled on the safety and advisability of
contraceptive methods and pregnancy based
on their patient profile.
RECLAIMING SEXUAL HEALTH (cont)
• Cardiac rehabilitation and regular physical
activity can reduce the risk of cardiovascular
complications related to sexual activity in
people who have had heart failure or a heart
attack.
MEDICATIONS
• Drugs that can improve cardiovascular
symptoms or survival should not be withheld
due to concerns that such drugs may impact
sexual function.
MEDICATIONS
• Drugs to treat erectile dysfunction are generally
safe for men who have stable cardiovascular
disease.
• These drugs should not be used in patients
receiving nitrate therapy for chest pains due to
coronary artery disease (blockages in the arteries
that supply the heart with blood), and nitrates
should not be administered to patients within 2448 hours of using an erectile dysfunction drug
(depending on the drug used).
TOYS AND ACCESSORIES
Magic Wand, Water Sprite, Liquid Silk
MALE STIMULATION SLEEVE
BOOKS & PARTY GAME
AND FINALLY,…
• THE HUMAN SEXUAL RESPONSE SLOWS
DOWN WITH AGE, BUT IT NEVER COMPLETELY
DISAPPEARS.
THANK YOU!
Dr. Marelize Swart
[email protected]
Tel: 060 737 8837
www.femalethoughts.com