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Sexual Healing After Cancer

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Sexual Healing After Cancer

Presented by Clinical Sexologist Dr. Martha Tara Lee of Eros Coaching for breast cancer survivors at Breast Cancer Foundation , Singapore on Sat, 9 April 2016.

Dr Martha Tara Lee is Founder and Clinical Sexologist of Eros Coaching since 2009. She is a certified sexologist with ACS (American College of Sexologists), as well as a certified sexuality educator with AASECT (American Association of Sexuality Educators, Counselors, and Therapists). Martha holds a Doctorate in Human Sexuality as well as Certificates in Sex Therapy, Practical Counselling and Life Coaching. She was recognised as one of ‘Top 50 Inspiring Women under 40′ by Her World Singapore in July 2010 and ‘Top 100 Inspiring Women by CozyCot Singapore in March 2011. Website: http://www.eroscoaching.com.

Presented by Clinical Sexologist Dr. Martha Tara Lee of Eros Coaching for breast cancer survivors at Breast Cancer Foundation , Singapore on Sat, 9 April 2016.

Dr Martha Tara Lee is Founder and Clinical Sexologist of Eros Coaching since 2009. She is a certified sexologist with ACS (American College of Sexologists), as well as a certified sexuality educator with AASECT (American Association of Sexuality Educators, Counselors, and Therapists). Martha holds a Doctorate in Human Sexuality as well as Certificates in Sex Therapy, Practical Counselling and Life Coaching. She was recognised as one of ‘Top 50 Inspiring Women under 40′ by Her World Singapore in July 2010 and ‘Top 100 Inspiring Women by CozyCot Singapore in March 2011. Website: http://www.eroscoaching.com.

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Sexual Healing After Cancer

  1. 1. PRESENTATION NAME Sexual Healing after Cancer 9 April 2016
  2. 2. Dr. Martha Tara Lee Clinical Sexologist • Doctorate in Human Sexuality • Masters in Public Policy and Management • Bachelor of Arts (Comm) • Certificate in Sex Therapy • Certitificate in Practical Counselling • Cert in Life Coaching
  3. 3. Agenda 1. Sex Myths 2. Misconceptions about sex and intimacy after surgeryTreatments 3. Effects of Treatment 4. Tips for healthy and safe sexual activity 5. Conclusion
  4. 4. Sex Myths 1. Sex is a sensitive topic. 2. Sex is only for making babies. 3. There is a cut-off age for sex 4. He knows what he is doing. 5. There is a “best” way to have sex 6. More sex is better. 7. Faster is better. 8. Sex is incomplete without the orgasm. 9. Need desire for sex. 10.Need emotional connection for sex to happen.
  5. 5. Misconceptions about Sex and Intimacy After Surgery 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
  6. 6. Can Sex During Chemo or Radiation treatment hurt your Partner? • A few chemo drugs can come out in small amounts in vaginal fluids. You may want to tell your partner to use condoms while you are getting chemo and for about 2 weeks afterward. • Having sex will not expose your partner to radiation unless you have an implant that gives off radiation. • Do not get pregnant during treatment. Ask your doctor about birth control.
  7. 7. When should a Person with Cancer not have Sex? • Ask your doctor if sex would cause a problem any time during or after treatment. • After surgery, sex might cause bleeding or pull the stitches. Sex may also raise your chance of infection. • Some types of cancer may cause bleeding in the genital area. • During chemo or radiation treatment, your immune system may not work very well and you can get all kinds of infections. • Urinary tract infections can be a problem, but there are things you can do to help prevent them. • If you notice any sores, bumps, or warts on your partner’s genitals, or any kind of discharge, find out what’s going on.
  8. 8. Treatments that Affect Sexual Health Radiation Side effects such as fatigue, nausea, vomiting, and diarrhea, often decrease sexual desire. Radiation treatment to the pelvis can cause vaginal soreness for a few weeks after treatment. Scar tissue can form, narrowing or shortening the vagina, making sex painful. Women who have not been through menopause before radiation therapy can experience a sudden stop of their menstrual periods. This is called early-onset menopause and may lead to reduced sex drive, vaginal dryness, itching, or irritation. Any and all of these side effects can result in painful sex.
  9. 9. Chemotherapy Weight gain or loss, nausea, vomiting and diarrhea, can affect sexual desire and self-image. Temporary or permanent menopause Breast cancer surgery Losing part or all of a breast to surgery can change a woman’s body image. Breast surgery can also change how your breast feels or cause a loss of feeling when touched. Treatments that Affect Sexual Health
  10. 10. Endocrine therapy Anti-estrogen treatments may cause symptoms seen with menopause, including hot flashes, vaginal dryness, pain with intercourse, and lowered sex drive. Other drugs Some medications, such as certain painkillers or antidepressants, may decrease desire or interest in sexual activity. Treatments that Affect Sexual Health
  11. 11. • Sickness or feeling sick • Tiredness (fatigue) • Irritability • Sadness or depression • Frustration, anxiety or tension • Pain • Bowel problems such as diarrhea • Breathing, Mouth and Bladder problems • Skin changes or scarring • Changes in your sex hormones • Concerns about changes in the way you look Having Cancer or its Treatment can Cause
  12. 12. • Decrease or loss of sexual desire • Negative thoughts and feelings during sex • Difficulty feeling sexual excitement and pleasure during sex • Difficulty reaching climax • Decreased or absent Vaginal dryness and tightness • Pain when your genital area is touched or from sexual intercourse • Increased unpleasant sensations or numbness in the genitals Fears around Sexual Health After Cancer Treatment
  13. 13. • 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 - some of these same challenges and concerns that you do. He or she may avoid intimacy due to fear of causing you pain. • Stress in the relationship with your partner Emotional Effects of Treatment on Sexual Functioning
  14. 14. Sexual Functioning Concerns and How to Find Help Loss of desire for sex after cancer • Ask a member of your health care team to check your medications for possible side effects. • Get medical treatment for pain during sex that will not go away or fatigue that may be affecting your energy and desire for sex. • If you are in menopause, see a gynecologist or an endocrinologist. • If there are no physical causes, see a licensed mental health professional to find out if your loss of desire could be related to feelings of depression, anxiety, low self-esteem, or relationship conflict.
  15. 15. Sexual Functioning Concerns and How to Find Help Negative thoughts and feelings during sex • Women often find themselves distracted during sex by negative images and thoughts, for example about losing a breast or being infertile. • Try focusing on pleasurable feelings in your body or on a sexy thought or fantasy. If that does not help, ask for a referral to a mental health professional who can help you change negative feeling and thinking patterns
  16. 16. Sexual Functioning Concerns and How to Find Help Vaginal dryness and tightness, making sexual activity uncomfortable or painful • Talk with a gynecologist • Ask your gynecologist, for advice on using over-the-counter vaginal moisturizers for before and during sexual activity. • You also may benefit from learning to control the muscles around the vaginal entrance. • Some women can benefit from low-dose vaginal estrogen in a cream, tablet or ring form. Such hormones can help the vagina regain moisture and ability to stretch with less getting into the general blood circulation.
  17. 17. Vaginal Renewal 1. Moisturizing the skin of vulva and vagina 2. Massaging your vulva 3. Internal massage
  18. 18. Sexual Functioning Concerns and How to Find Help Difficulty feeling pleasure during sex • If you have lost feeling in an area of your body that gave sexual pleasure you may need to find new caresses that you enjoy. Communicate with your partner. • Ask for a referral to a sex therapist who specializes in treating cancer survivors.
  19. 19. Sexual Functioning Concerns and How to Find Help Difficulty reaching orgasm • Ask your health care team to check your medications. Antidepressants or anti- anxiety medicines may make it more difficult for you to have an orgasm. • Give yourself time. Try not to pressure yourself to have an orgasm. Try to have a goal of enjoying sex and getting as much pleasure as possible. The nerves that help a woman feel pleasure around the clitoris and in the vagina are rarely damaged by cancer treatment.
  20. 20. Pros Cons Low-dose vaginal estrogen replacement (such as Estring, Vagifem) The Estring releases a small dose of hormone over three months. Some oncologists still worry about breast cancer survivors using these products. The Vagifem suppository is used a couple of times a week. A small study found that some women using suppositories still had levels of estrogen in their blood high enough to interfere with the benefits of aromatase inhibitors. Both Estring and Vagifem produce a low dose of estrogen. This is considered to be helpful treating vaginal dryness with very little hormone released into the bloodstream. Generally thought to be safer than pills, patches, or creams. Treatments for Sexual Functioning Concerns
  21. 21. DHEA (didehydroepiandrostero ne) Vaginal DHEA may help treat vaginal dryness and/or painful sexual intercourse, without increasing estrogen levels. Vaginal lidocaine Lidocaine, applied to the vaginal opening just before sexual activity, may decrease pain and increase satisfaction. Pelvic floor physical therapy Pelvic floor physical therapy is useful for women with tight, tender muscles. It helps with relaxation, and if needed, strengthening of the pelvic floor muscles. Working on pelvic floor muscle health can help keep muscles relaxed and reduce pain during sex.
  22. 22. Pros Cons Learn to relax muscles around the vaginal entrance Learn methods of relaxation to avoid pain during intercourse. Try “Kegel” exercises. Can help minimize pain, but may not relieve pain if tissue scarring is present in the vagina.Women can use silicone vaginal dilators to practice muscle control, starting with a smaller size and going up to larger ones. Always use a water-based lubricant on the dilator and be gentle inserting the dilator. Treatments for Sexual Functioning Concerns
  23. 23. Kegel Exercise •Frequency •Duration •Intensity
  24. 24. Sensate Focus Stage 1 •Without genital touch Stage 2 •With genital touch Stage 3 •Go with the flow
  25. 25. • Enjoying being close to each other • Touching and stroking • Kissing • Massaging • Talking • Holding hands Focus on Showing your Feelings for One Another in Other Ways by
  26. 26. Communication • Code Words • Red, Yellow, Green • Open Ended Questions • Closed Ended Questions • Scale 1 to 10
  27. 27. • Be sure to use a reliable form of birth control to prevent pregnancy- even if you think your periods have stopped or your fertility has been affected. • Think outside the box about sexual activity - it does not have to involve intercourse or oral sex. Use kissing, touching, caressing to satisfy each other. • Keep communication open. Talk about what feels good and what doesn't; communicate with your partner when you are tired or uncomfortable. • Cancer surgery may result in a particular position being painful. Try different positions to find what is best for you and your partner. For example, if lying on your back during penetration is painful, having both partners lying on their sides may be more comfortable. Tips for Healthy and Safe Sexual Activity
  28. 28. • Cancer surgery may result in a particular sexual position being painful. Try different positions to find what is best for you and your partner. For example, if lying on your back during penetration is painful, having both partners lying on their sides may be more comfortable. • Talk with your healthcare team about coping with changes in your body image and sexual health. • For some, talking with other women in a support group can help. • While others may find more intensive help from a mental health provider, with expertise in working with women with cancer, useful. Tips for Healthy and Safe Sexual Activity
  29. 29. • Some practical tips for body image concerns include exercise, maintaining a healthy weight, dressing in clothing that makes you feel attractive, wearing pretty undergarments or learning beauty techniques to manage side effects such as facial coloring, eyebrow loss, etc. Tips for Healthy and Safe Sexual Activity
  30. 30. 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
  31. 31. 1. Sex Is Bigger Than Any Body Part 2. Even If You’re Afraid To Ask — Ask 3. Don’t Wait, Act Now 4. You Are Not Alone 5. Don’t Give Up Takeaways
  32. 32. More! We need 1. Self knowledge 2. Facts 3. Options 4. Techniques 5. Honesty
  33. 33. Thank you! Martha Lee Clinical Sexologist Eros Coaching Pte Ltd Website: www.eroscoaching.com Email: drmarthalee@eroscoaching.com

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