This presentation provides an overview of sexuality issues for patients undergoing chemotherapy and/or radiation therapy. It discusses how a cancer diagnosis can impact a patient's sense of identity, self-image and intimacy. It outlines the PLISSIT model for discussing sexuality with patients, emphasizing the importance of creating a private, comfortable environment and addressing myths, providing accurate information and specific suggestions or referrals for intensive therapy. The goal is to help patients process their experience and find ways to maintain or regain intimacy and a sense of self through their treatment journey.

1. Welcome to Intimacy 101
aka: Sex – Chemo – and Rock n’ Roll
Starting the conversation………
Presented by Penny Daugherty, RN, MS, OCN
Oncology Nurse Navigator
Northside Hospital Cancer Institute
Atlanta, Georgia

2. Our Target Audience
This presentation is intended for:
• Oncology Nurse Navigators (ONN) involved
in the care of patients undergoing
chemotherapy with or without radiation
therapy
• Clinicians working with patients receiving or
having received chemotherapy/radiation
therapy

3. Educational Objectives
This presentation is designed to provide a multifaceted patient
centered approach to sexuality issues in the nursing care of
chemotherapy/radiation therapy patients via the following:
• A comprehensive overview of sexuality and sexual self-image
• Exploration of issues related to sexual side-effects of
treatment and effective methodology for assessment and
intervention
• Provision of therapeutic strategies for the clinician to employ
in the care of patients experiencing sexual dysfunction
• Formulation of a successful therapeutic patient/clinician
dialogue

10. The
beginning
of
intimacy

14. Touch is the mother of all senses
Isolation
affects
the
mind of the skin…………….
Davis,PK, 1999

15. It’s not a coincidence that
the human nervous system
is derived from the
embryonic skin, the
human counterpart of the
cell membrane……
Lipton, 2008

18. Simply the effect of tactile experience upon
human behavioral development
Montagu, 1986

19. Intimacy
is seen
through
the prism
of
culture……….
Galanti, 2008

20. ………..and love

21. And touch………..

22. We love that warm
fuzzy touch…….

23. …and our brain

24. The seat of our emotions……

28. To the beat of your brain

29. See yourself sexy
Courtesy of Photbucket.com

30. intimate music………
Courtesy of Photobucket.com

31. and “spirit” intimacy……………..

33. Private Expressions of Intimacy

34. Courtesy of Photobucket.com

35. We’ve all
created
Our own
Personal
Sexuality
theme song

36. And then without warning…….

37. the world as you knew it explodes!!!!!!!

38. So Sorry….you have cancer

39. And your world
will never
be the same
again

40. Treatment Choices??????????
 Surgery? Robotic? Open?
 Paracentsis? Thoracentesis?
 Chemotherapy? IV? IP?
 Radiation? Colostomy?
 Testicular Implants?
 Impotence
 No breast(s)???????
 Baldness?
CO-PAYS$$$$$$$$$$
REALLY???????????

42. The Hospital Stay #@!%*X$$$$$$$

43. Powerless and Naked!
• Blue and white hospital gown – opens in the rear
• Not very comfortable bed – just sayin’
• Nurses in and out 24/7……..
• Labs/BP at really weird times
• Noises……
• Really not great food
CANCER!!!!!!!!!!!!!!!!!!!!!!!!!!
• Naked face /Bird nest hair
• Who are YOU?! What the heck is a “Nurse Navigator??”
REALLY?????????????????????????????
~ ~ ~ ~ ~
Welcome to Loss of individuality/identity/intimacy and
LOSS OF CONTROL of your LIFE!!!!!!!!!!!!!!!!!!!!!!

44. Where did my music

45. Personal Impact of Cancer
A cancer diagnosis can instantly (and forever…) create:
 A profound sense of grief and loss
 Myths and fears about resuming sexual activity (if at all..)
 Global changes in self-concept and body image
 An impact of social roles and relationships
 Surgical alteration and function of structures important to
sexual function
 Dramatic hormone shifts
 Infertility
 Impotence

46. We can’t put a bandaid on this
one so……
Let the patient/family react* as they
need to (only they know what that is
for them)
*PTSD: People who have not been able to
go through the reaction to traumatic
stress**
**Traumatic stress: A normal
response/reaction to an abnormal event
Patients have short attention span, impaired
concentration, confusion, vulnerability,
disorientation….self blame and or
blaming others

47. The physical reality of PTSD induced
STRESS…..

49. HPA axis component
Hypothalamus:
~~~~~~~~~~~~~~
Pituitary :
~~~~~~~~~~~~~~
Adrenal:
Regulating Factors
Cytokines and growth factors (+/-)
Neural in-puts (+/-)
SEX HORMONES (+/-)
Prostaglandins (+)
Leptin (+/-)
Neuropeptides (+/-)
~~~~~~~~~~~~~~~~~~~~~~~~~~
Cytokines and growth factors (+/-)
Vasopressin (-)
Prostaglandins (-)
Opiates (-)
Catecholamines (+)
~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Cytokines and growth factors (+/-)
Prostaglandins (+)
SEX HORMONES (+/-)
Neural input (+/-)

50. For the men………..
 Interference w/erection by damaging
pelvic nerves
 RT can damage arteries that carry blood to
the penis/internal tissues become scarred
 Certain chemo drugs cause permanent
damage to part of nervous system
(Cisplatin/Vincristine)
 Colostomy/Tracheostomy/Ileostomy
smells, feelings of disfigurement
 Orchiectomy/Amputation/Redistribution of
fat
 Feelings of loss of manhood
 Hair loss/skin changes
 Emotion surges –hormone induced/guilt
Schover, 2006
For the ladies………
 Loss of reproductive organs/breasts
 Disfigurement from surgical scars
 Hair loss/redistribution
 Mucositis/vaginal dryness/sudden menopause
w/hot flashes
 Worry/guilt that sexual behavior caused cancer
 PPE/alteration in body odor
 Extreme fatigue
 Inability to discuss sexual needs/fears
 Vaginismus (vaginal spasms)
 Pain during intercourse
 Weight gain/loss/feelings of new
unattractiveness
 Embarrassment at looking at/touching their
own ‘private parts
Schover, 2009

51. But WE can “fix” the issues…..
Are you worried/depressed/anxious??????????
We have SHUT UP drugs for you!
Let’s whip out the antidepressants
(especially SSRI’s)
• Anti-estrogens/Anti androgens
• Sedatives/tranquilizers/anti-fungals
ALL of these are associated with sexual
dysfunction, silence the body’s
symptoms and ignore personal
involvement with their onset
Lipton, 2008.

52. This is our opportunity as Navigators to help
open that door and help our patients
Talking about sex can rank right up there with talking to the
principal

53. So why is it such a big deal?
For us as navigators:
 Will we have answers to all
their questions??????
 Personal issues: age, sexual
orientation, religious
background
 Comfort with the topic
 Professional issues:
resources, space, education
 All of the above?
Katz, 2012
For patients /caregivers:
 Thought patterns:
 It’s too trivial
 It’s embarrassing
 This is just part of the process
 I fit into a “weird” category…

54. Look too familiar?????????????
Memecrunch.com

55. And their family…………..
randyallbright.net

56. A “prelude” to PLISSIT ~
aka avoiding THIS…………………………..
clipart.pal.com

57. Ambience is everything – or at least a
good start
Get a room..PRIVACY RULES!!!
Do NOT sit behind a desk ~
patient/partner on a small couch is
ideal
Aromatherapy is helpful…possibly
lavender and eucalyptus
If possible have music in
background…can use very light
jazz/acoustic guitar ~ music
without words
Find common ground
OBSERVE! OBSERVE! OBSERVE! and
abort if it looks too painful….

58. Putting the pieces together
PLISSIT
Permission – Always.
Openers: It’s not uncommon for
people with ----- cancer to
experience changes with sexual
function …or …physical intimacy
 How’s your sex life/physical
relationship during all this
change?
 Then ask if it’s Ok to discuss…
Now what???
Receptive..
Move on to a general statement as the
next step in the PLISSIT model
Not Receptive..
Provide reassurance and comfort and
leave the door open

59. PLISSIT
Provide general and accurate information to dispel myths
 Will my partner catch cancer?
 Will my partner be harmed from chemo?
 Will I harm myself?
 Can we sleep in the same bed? (do they sleep in the same bed?)
 Can we use the same bathroom?
 Am I radioactive?
 Do I smell different?
 Am I still me????????
Benigno, 2013

60. PLISSIT
Specific Suggestions:
Offer some options to work
around or with issues
Support group activities (to be
continued..)
A planned get away, special dinner
Romantic movies
Music in the bedroom or
just………………………….
Mars, 2002

61. PLISSIT
Intensive Therapy
Give patient a follow up plan:
Support group Activites:
Laughter Yoga
Touch,Caring and Cancer program*
Sensuality program
Couple-Specific Counseling session
Drum Circle Session
Labyrinth
Individual Counseling
Couples Therapy
Pelvic Floor rehab
Collinge, 2009
Katz, 2007

62. Sex Chemo and Rock n’ Roll
Cancer changes a life forever
Theday of diagnosis is the day the music died
As Navigators we have an opportunity to:
Connect (with patients exactly where they are)
Ground ( the patient to help them grasp the reality of their situation)
Support ( factual discussions and simplify choices)
Normalize (and validate their experience)
Prepare (for future choices and events)
We can help our patients write a new
song for their lives
Lerner, 2012.

63. Life isn’t about
waiting
for the storm to pass.
It’s about
learning
to dance
in the rain
Vivian Greene

64. No matter what your ribbon is we’re all in
this together

65. Questions?
Penny.daugherty@northside.com
404-459-1657

66. References
Davis, P. (1999). Infants and the Need for Touch. In The Power
of Touch (Reprint ed., Vol. 6, p. 40). Carlsbad, CA: Hay
House USA.
Rathus, S., Nevid,J., & Fitchner-Rathus, L. (2000). What is
human sexuality? In S. Rathus, J. Nevid, & L. Fitchner-
Rathus (Eds.), Human Sexuality in a world of diversity(4th
ed., pp 4-33),Boston: Allyn and Bacon.
Hughes, M. K. (2000). Sexuality and the cancer survivor: A
silent coexistence. Cancer Nursing, 23, 477 - 482.
Wagner, G., Bondil, P., Dabees, K., Dean, J., Fourcroy, J.,
Gingell, C., & et al., C. (2005). Ethical aspects of sexual
medicine. Journal of sexual medicine, 2, 163-168.
Montagu, A. (1986). Touching: The human significance of the
skin. (3rd ed., p. 18). New York: Harper & Row.
Schover, L. (2006). Sexuality and cancer: For the man who has
cancer and his partner. New York: American Cancer
Society.
Schover, L. (2009). Sexuality for the woman with cancer. New
York: American Cancer Society.
Lerner, M. (2012). Helping ourselves and others through a
health crisis: information, inspiration and hope.
Walgreens Clinical Updates, (39), 1-4.
Katz, A. (2007). Breaking the silence on cancer and sexuality; a
handbook for healthcare providers. (1 ed., Vol. 1, pp. 159-
161, 161 - 166). Pittsburgh: Oncology Nursing Society.
Mars, B. (2002). Sex, love and health: A self-help health guide to
love and sex. (1 ed., Vol. 1, p. 173, 209, 40911Basic Health
Publications). North Bergen: Basic Health Publications.
Lipton, B. (2008). The biology of belief: Unleashing the power of
conciousness, matter and miracles. (2 ed., Vol. 2, pp. 82-
83). Carlsbad: Hay House.
Benigno, B. (2013). The ultimate guide to ovarian cancer. (1 ed.,
Vol. 1, pp. 198-199). Atlanta: SherryBen.
Galanti, G. (2008). Caring for patients from different cultures. (4
ed., Vol. 1, p. 115, 117, 125). Philadelphia: University of
Pennsylvania Press.
Collinge, W. National Cancer Institute, (2009). Touch, caring and
cancer: simple instructions for family and friends (ISBN
978-0-9823360-0-7). Kittery Point, ME: Collinge and
Associates
Clip Art:
See Yourself Sexy, Pink Floyd, Fifty Shades of Gray: Courtesy of
Photobucket.com
Deer in Headlights: Courtesy of www.memecrunch.com
2 deer: Courtesy of allbright illustrations
(www.randyallbright.com)
Shook Up deer: Courtesy of www.clipart.pal.com
Boy in Fog: Courtesy of cool-animal-children-photography by
Elena Shumilova
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67. Books worth reading:
 The Power of Touch - Phyllis R. Davis, PhD – Hay House
 Touching – The Human Significance of the Skin 3rd ed - Ashley Montagu – (Harper & Row)
 Women Cancer Sex - Anne Katz, RN, PhD ( Hygeia Media)
 This Should Not Be Happening – Young Adults with Cancer -Anne Katz, PhD – (Hygeia
Media)
 Breaking the Silence on Cancer and Sexuality -Anne Katz, RN, PhD ( Hygeia Media)
 Women’s Mental Health -Joan C. Urbanicic/Carla J. Groh ( Lippincott Williams & Williams)
 Contemporary Issues in Women’s Cancers - Suzanne Lockwood ( Jones and Bartlett)
 After You Ring the Bell - Anne Katz ( Hygeia Media)
 Difficult Conversation (Cure Media Group)
 Whole Care for the Cancer Patient (Institute of Medicine)
 The Complete Guide to Complementary Therapies in Cancer Care – Barrie R. Cassileth
(World Scientific)
 Cancer – Step Outside the Box 5th ed – Ty Bolinger (Infinity 510 Partners)
 The Full Catastrophe – David Carkeet (Washington Square PRESS)
 Caring for Patients from Different Cultures 4th ed – Geri-Ann Galanti (Penn)
 The Review of Natural Products – 6th ed – (Wolters Kluwer)
 The Sexual Herbal – Brigitte Mars