Sex and intimacy after Prostate Cancer treatment

1. PRESENTATION NAME Sex and Intimacy after Prostate Cancer Treatment Tan Tock Seng Hospital Mon 11 June 2018

2. Dr. Martha Tara Lee Clinical Sexologist • Doctorate in Human Sexuality • Masters in Public Policy and Management • Bachelor of Counselling • Bachelor of Arts (Comm) • Certificate in Sex Therapy • Certitificate in Practical Counselling • Cert in Life Coaching

3. Agenda 1. What Might Be Happening 2. What Might Be Useful 3. Non Ejaculatory Orgasm 4. What Else to Take Note 5. Resources

4. What Might Be Happening

5. Misconceptions about Sex and Intimacy After Surgery (Mental) 1. Be grateful to be alive. 2. Things will get better. 3. Sex is about penetration. 4. Sex is about the orgasm. 5. Sex is all about him. 6. No need to think about sex if single. 7. Too old anyway Copyright 2018

6. Stages of Grief (Emotional) 1. Denial (This isn't happening to me!) 2. Anger (Why is this happening to me?) 3. Bargaining (I promise I'll be a better person if...) 4. Depression (I don't care anymore) 5. Acceptance (I'm ready for whatever comes)

7. • Difficulty with self-esteem because of feeling ill and being unable to fill all your usual roles in the family and at work • Body image changes from surgical scars or openings that affect how you feel about your body • Affected by what your partner may experience. • Stress in the relationship with your partner Emotional Effects of Treatment on Sexual Functioning Copyright 2018

8. 1. Sickness or feeling sick 2. Tiredness (fatigue) 3. Irritability 4. Sadness or depression 5. Frustration, anxiety or tension 6. Pain 7. Bowel problems such as diarrhea 8. Breathing, Mouth and Bladder problems 9. Skin changes or scarring 10. Changes in your sex hormones 11. Concerns about changes in the way you look Having Cancer or its Treatment can Cause (Physical) Copyright 2018

9. Preserving Fertility in Men with Cancer 1. Radiation shielding 2. Sperm banking Limitations • Fast-growing cancers • Infectious diseases • Costs 3. Other ways to collect sperm • From the urine (for males with retrograde ejaculation) • Electroejaculation • Sperm extraction and aspiration procedures Source: https://www.cancer.org/treatment/treatments-and-side-effects/physical-side-effects/fertility- and-sexual-side-effects/fertility-and-men-with-cancer/how-cancer-treatments-affect-fertility.html

10. Cancer Can Affect a Man’s Ability to Ejaculate 1. Surgery • Radical prostatectomy • Radical cystectomy • Abdominoperineal (AP) resection • Total mesorectal excision (TME) • Total pelvic exenteration 2. Dry orgasm 3. Nerve damage • The most common way surgery affects erections is by removing or injuring the nerves that help cause an erection. 4. Urine leakage during ejaculation Source: https://www.cancer.org/treatment/treatments-and-side-effects/physical-side-effects/fertility- and-sexual-side-effects/fertility-and-men-with-cancer/how-cancer-treatments-affect-fertility.html

11. Other Things that Affect Erections After Surgery 1. Age 2. Strength of erections before surgery 3. Other conditions, such as Peyronie’s disease Source: https://www.cancer.org/treatment/treatments-and-side-effects/physical-side-effects/fertility- and-sexual-side-effects/fertility-and-men-with-cancer/how-cancer-treatments-affect-fertility.html

12. Sexual Functioning Concerns 1. Loss of desire for sex after cancer 2. Negative thoughts and feelings during sex 3. Difficulty feeling pleasure during sex 4. Difficulty reaching orgasm Copyright 2018

13. What Might Be Useful

14. Issues of Intimate Sexual Relations at Advancing Age As men get older, erectile difficulties becomes more common.

15. Dealing with Sexual Desire and Arousal Problems Problem Side Effects Treatment Arthritis Joint pain due to arthritis can make sexual contact uncomfortable • Exercise, rest, warm baths, and changing the position or timing of sexual activity • Joint replacement surgery and drugs may relieve this pain. Chronic pain Can lead to sleep problems, depression, isolation, and difficulty moving around. Chronic pain can often be treated. Diabetes Many men with diabetes do not have sexual problems, but this is one of the few illnesses that can cause impotence. In most cases medical treatment can help.

16. Problem Side Effects Treatment Heart disease Narrowing and hardening of the arteries. Can lead to trouble with erections in men, and high blood pressure (hypertension). Always follow your doctor's advice. Incontinence Loss of bladder control or leaking of urine. The good news is that this can usually be treated. Stroke Problems with erections are possible Try using different positions or medical devices to help them continue having sex. Dealing with Sexual Desire and Arousal Problems

17. Goals of Penile Rehabilitation Penile Rehabilitation (PR) is the process of regaining erectile function, erectile length and girth, and hardness. The main goals of PR are to: 1. Increase daily oxygen exchange to the penis, and 2. Maintain length and girth of the penis such that full erection size and hardness are possible once the nerves have recovered. Source: Penile Rehabilitation Booklet www.sexualityresources.com/PR _booklet_2013

18. Techniques of Penile Rehabilitation 1. A low nightly dose of PDE-5 Inhibitor medication 2. Gentle stretching and massage of the penis 3. Use of a Vacuum Erection Device (VED) twice daily 4. Pelvic Floor Muscle Exercises Source: Penile Rehabilitation Booklet www.sexualityresources.com/PR _booklet_2013

19. Techniques of Penile Rehabilitation 1. A low nightly dose of PDE-5 Inhibitor medication, in combination with Vacuum Erection Devices to preserve girth and length. 2. Gentle stretching and massage of the penis - 10 minutes per day: • Select a personal lubricant • Holding the tip of the penis with one hand, use your other hand to gently squeeze and massage the shaft toward the body (removing blood from the penis) • Then, gently stroke and stretch the penis away from the body (allowing blood to flow back in). Source: Penile Rehabilitation Booklet www.sexualityresources.com/PR _booklet_2013

20. Techniques of Penile Rehabilitation 3. Vacuum Erection Device (VED) Vacuum erection device (VED) therapy has a very high rate of consumer satisfaction (92%), and most importantly, is the only therapy that preserves both the length and the girth of the clitoral body inside of the penis. Restorative pumping methods include: Double Pumping is easier to do—just be sure not to pump too quickly. The Pump-3-Release Method takes some counting, but this variation more effectively moves blood in and out of the penis. Source: Penile Rehabilitation Booklet www.sexualityresources.com/PR _booklet_2013

21. Techniques of Penile Rehabilitation 4. Pelvic floor muscle exercise The pelvic floor is a sling of muscles that surround and anchor the base of the penis, helping to hold blood in the penis during erections Source: Penile Rehabilitation Booklet www.sexualityresources.com/PR _booklet_2013

22. Products for Sexual Wellness and Pleasure 1. Basic Erection Pump - features a simple squeeze pump, a see- through chamber, and a hole in the side of the chamber to release vacuum pressure. 2. Finger Pull Pump - This erection pump has an ergonomic pump handle, a see-through chamber, and a vacuum-release button on the tubing. Source: Penile Rehabilitation Booklet www.sexualityresources.com/PR _booklet_2013

23. Products for Sexual Wellness and Pleasure 3. Power Pump - Vacuum strength, and quick pressure release as expensive medical pumps, but at an affordable price. 4. Lasso Erection Ring - Adjustable erection rings are a good choice for any man (regardless of ejaculatory capacity) who uses aVED, or who wants to quickly loosen or remove the ring before ejaculation Source: Penile Rehabilitation Booklet www.sexualityresources.com/PR _booklet_2013

24. Products for Sexual Wellness and Pleasure 5. Lasso Ring with Vibrator - An adjustable lasso ring combined with vibration adding sensation for the wearer and/or against a partner’s genitals during penetration. 6. Relaxed Fit Elastomer Erection Ring - Because of its stretchy comfort, this has become a store favorite because it is discreet while providing a strong grip. Source: Penile Rehabilitation Booklet www.sexualityresources.com/PR _booklet_2013

25. Products for Sexual Wellness and Pleasure 7. Elastomer Erection Ring - Sturdy but secure, and a good choice for non- ejaculatory men who want to prevent urinary incontinence during intercourse. 8. Elastomer Pump Sleeve - This simple, flexible sleeve is made to fit onto the end of a vacuum pump shaft to create a snug, comfortable fit. Source: Penile Rehabilitation Booklet www.sexualityresources.com/PR _booklet_2013

29. Link Between Pain vs Pleasure

31. 1.Kegels Super Duper Orgasms • Frequency •Duration •Intensity

32. Super Duper Orgasms 2. Intention

33. 3. Breath Super Duper Orgasms

34. 4. Sound Super Duper Orgasms

35. 5. Movement Super Duper Orgasms

36. 6. Touch Super Duper Orgasms

37. 7. Fantasy Super Duper Orgasms

38. 1.Kegels 2.Intention 3.Breath 4.Sound 5.Movement 6.Touch 7.Fantasy Super Duper Orgasms

39. What Else to Take Note of

44. Why Do Medical and Mental Health Care Professionals Need to Understand Sexual Problems? Sexual problems have an adverse effect on interpersonal relationships and the quality of life. Copyright 2012 Eros Coaching

45. Resources Man Cancer Sex http://amzn.to/2CNBR94 Intimacy With Impotence http://amzn.to/2E1iqsP

46. Resources Love, Sex and Intimacy after Prostate Cancer http://www.sexafterprostatecancer.com.au/e- book.html Sex and the Man With Cancer http://bit.ly/2oBLwXC

48. Thank You! Dr. Martha Tara Lee Clinical Sexologist Eros Coaching Pte Ltd Website: www.eroscoaching.com Email: drmarthalee@eroscoaching.com

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