Category Archives: Health Concerns

Sexuality and Illness – Breaking the Silence


(This is a Companion piece to yesterday’s posting. You’ll find yesterday’s posting HERE!)

By: Anne Katz PhD

Sexuality is much more than having sex even though many people think only about sexual intercourse when they hear the word. Sexuality is sometimes equated with intimacy, but in reality, sexuality is just one way that we connect with a spouse or partner we love (the true meaning of intimacy). Our sexuality encompasses how we see ourselves as men and women, who we are attracted to emotionally and physically, what turns us on (eroticism), our thoughts and fantasies, and yes, also what we do when we are sexually active, either alone or with a partner. Our sexuality is connected to our image of ourselves and it changes over the years as we age and face threats from illness and disability and, eventually, the end of life.seniors_men

Am I still a sexual being?

Illness can affect our sexuality in many different ways. The side effects of treatments for many diseases, including cancer, can cause fatigue. This is often identified as the number one obstacle to sexual activity. Other symptoms of illness such as pain can also affect our interest in being sexually active. But there are other perhaps more subtle issues that impact how we feel about ourselves and, in turn, our desire to be sexual with a partner or alone, or if we even see ourselves as sexual beings. Think about surgery that removes a part of the body that identifies us as female or male. Many women state that after breast cancer and removal of a breast (mastectomy), they no longer feel like a woman; this affects their willingness to appear naked in front of a partner. Medications taken to control advanced prostate cancer can decrease a man’s sexual desire. Men in this situation often forget to express their love for their partner in a physical way, no longer touching them, kissing them, or even holding hands. This loss of physical contact often results in two lonely people.  Humans have a basic need for touch; without that connection, we can end up feeling very lonely.

Just talk about it!

seniors_in_bedCommunication lies at the heart of sexuality. Talk to your partner about what you are feeling, how you feel about your body, and what you want in terms of touch. Ask how you can meet your partner’s needs for touch and affection. The most important thing you can do is to express yourself in words. Non-verbal communication and not talking are open to misinterpretation and can lead to hurt feelings. Our sexuality changes with age and time and illness; we may not feel the same way about our bodies or our partner’s body that we did 20, 30 or more years ago. That does not mean we feel worse – with age comes acceptance for many of us – but we do need to let go of what was, and look at what is and what is possible.

The role of health care providers

Health care providers should be asking about changes to sexuality because of illness or treatment, but they often don’t. They may be reluctant to bring up what they see as a sensitive topic and think that if it’s important to the patient, then he or she will ask about it. This is not good. Patients often wait to see if their health care provider asks about something and if they don’t, they think that it’s not important. This results in a silence and leaves the impression that sexuality is a taboo topic.senior intimacy02

Some health care providers are afraid that they won’t know the answer to a question about sexuality because nursing and medical schools don’t provide much in the way of education on this topic. And some health care providers appear to be too busy to talk about the more emotional aspects of living with illness. This is a great pity as sexuality is important to all of us – patients, partners, health care providers. It’s an important aspect of quality of life from adolescence to old age, in health and at the end of life when touch and love are so important.

Ask for a referral

If you want to talk about this, just do it! Tell your health care provider that you want to talk about changes in your body or your relationship or your sex life! Ask for a referral to a counselor or sexuality counselor or therapist or social worker. It may take a bit of work to get the help you need, but there is help.

Complete Article HERE!

Sexuality at the End of Life

By Anne Katz RN, PhD

In the terminal stages of the cancer trajectory, sexuality is often regarded as not important by health care providers. The need or ability to participate in sexual activity may wane in the terminal stages of illness, but the need for touch, intimacy, and how one views oneself don’t necessarily wane in tandem. Individuals may in fact suffer from the absence of loving and intimate touch in the final months, weeks, or days of life.head:heart

It is often assumed that when life nears its end, individuals and couples are not concerned about sexual issues and so this is not talked about. This attitude is borne out by the paucity of information about this topic.

Communicating About Sexuality with the Terminally Ill

Attitudes of health care professionals may act as a barrier to the discussion and assessment of sexuality at the end of life.

  • We bring to our practice a set of attitudes, beliefs and knowledge that we assume applies equally to our patients.
  • We may also be uncomfortable with talking about sexuality with patients or with the idea that very ill patients and/or their partners may have sexual needs at this time.
  • Our experience during our training and practice may lead us to believe that patients at the end of life are not interested in what we commonly perceive as sexual. How often do we see a patient and their partner in bed together or in an intimate embrace?
  • We may never have seen this because the circumstances of hospitals and even hospice may be such that privacy for the couple can never be assured and so couples do not attempt to lie together.

intimacy-320x320For the patient who remains at home during the final stages of illness the scenario is not that different. Often the patient is moved to a central location, such as a family or living room in the house and no longer has privacy.

  • While this may be more convenient for providing care, it precludes the expression of sexuality, as the patient is always in view.
  • Professional and volunteer helpers are frequently in the house and there may never be a time when the patient is alone or alone with his/her partner, and so is not afforded an opportunity for sexual expression.

Health care providers may not ever talk about sexual functioning at the end of life, assuming that this does not matter at this stage of the illness trajectory.

  • This sends a very clear message to the patient and his/her partner that this is something that is either taboo or of no importance. This in turn makes it more difficult for the patient and/or partner to ask questions or bring up the topic if they think that the subject is not to be talked about.

Sexual Functioning At The End Of Life

Factors affecting sexual functioning at the end of life are essentially the same as those affecting the individual with cancer at any stage of the disease trajectory. These include:go deeper

  • Psychosocial issues such as change in roles, changes in body- and self-image, depression, anxiety, and poor communication.
  • Side effects of treatment may also alter sexual functioning; fatigue, nausea, pain, edema and scarring all play a role in how the patient feels and sees him/herself and how the partner views the patient.
  • Fear of pain may be a major factor in the cessation of sexual activity; the partner may be equally fearful of hurting the patient.

The needs of the couple

Couples may find that in the final stages of illness, emotional connection to the loved one becomes an important part of sexual expression. Verbal communication and physical touching that is non-genital may take the place of previous sexual activity.

  • Many people note that the cessation of sexual activity is one of the many losses that result from the illness, and this has a negative impact on quality of life.
  • Some partners may find it difficult to be sexual when they have taken on much of the day-to-day care of the patient and see their role as caregiver rather than lover.
  • The physical and emotional toll of providing care may be exhausting and may impact on the desire for sexual contact.
  • In addition, some partners find that as the end nears for the ill partner, they need to begin to distance themselves. Part of this may be to avoid intimate touch. This is not wrong but can make the partner feel guilty and more liable to avoid physical interactions.

Addressing sexual needs

senior intimacyCouples may need to be given permission to touch each other at this stage of the illness and health care providers may need to consciously address the physical and attitudinal barriers that prevent this from happening.

  • Privacy issues need to be dealt with. This includes encouraging patients to close their door when private time is desired and having all levels of staff respect this. A sign on the door indicating that the patient is not to be disturbed should be enough to prevent staff from walking in and all staff and visitors should abide by this.
  • Partners should be given explicit permission to lie with the patient in the bed. In an ideal world, double beds could be provided but there are obvious challenges to this in terms of moving beds into and out of rooms, and challenges also for staff who may need to move or turn patients. Kissing, stroking, massaging, and holding the patient is unlikely to cause physical harm and may actually facilitate relaxation and decrease pain.
  • The partner may also be encouraged to participate in the routine care of the patient. Assisting in bathing and applying body lotion may be a non-threatening way of encouraging touch when there is fear of hurting the patient.

Specific strategies for couples who want to continue their usual sexual activities can be suggested depending on what physical or emotional barriers exist. Giving a patient permission to think about their self as sexual in the face of terminal illness is the first step. Offering the patient/couple the opportunity to discuss sexual concerns or needs validates their feelings and may normalize their experience, which in itself may bring comfort.

More specific strategies for symptoms include the following suggestions. senior lesbians

  • Timing of analgesia may need to altered to maximize pain relief and avoid sedation when the couple wants to be sexual. Narcotics, however, can interfere with arousal which may be counterproductive.
  • Fatigue is a common experience in the end stages of cancer and couples/individuals can be encouraged to set realistic goals for what is possible, and to try to use the time of day when they are most rested to be sexual either alone or with their partner.
  • Using a bronchodilator or inhaler before sexual activity may be helpful for patients who are short of breath. Using additional pillows or wedges will allow the patient to be more upright and make breathing easier.
  • Couples may find information about alternative positions for sexual activity very useful.
  • Incontinence or the presence of an indwelling catheter may represent a loss of control and dignity and may be seen as an insurmountable barrier to genital touching.

footprints-leftIt is important to emphasize that there is no right or wrong way of being sexual in the face of terminal illness; whatever the couple or individual chooses to do is appropriate and right for them. It is also not uncommon for couples to find that impending death draws them much closer and they are able to express themselves in ways that they had not for many years.

Complete Article HERE!

Chlamydia at 50… Could it be you?

by Jenny Pogson

senior intimacy

If you think only young people are at risk of sexually transmitted infections, think again – rates could be on the rise in older adults.

With more of us living longer and healthier lives, and divorce a reality of life, many of us are finding new sexual partners later in life.

While an active sex life comes with a myriad of health benefits, experts are warning those of us in mid-life and beyond not to forget the risk of contracting a sexually transmitted infection from a new partner.

Figures suggest rates of infections have been on the increase among older people in the US and UK in recent years and there is a suggestion the same could be happening in Australia.

Chlamydia, a common bacterial STI, is on the up among all age groups in Australia, and has more than doubled in those over 50 since 2005; going from 620 cases to 1446 in 2010.

Gonorrhoea, another bacterial infection, has seen a slight increase in the over 50s, rising from 383 infections in 2005 to 562 in 2010.

While these increases could partly be attributable to more people being tested, the trend has caused concern in some parts of the medical community here and overseas.

Cultural shift

Older people are increasingly likely to be single or experiencing relationship changes these days, according to the UK’s Family Planning Association, which last year ran its first sexual health campaign aimed at over 50s.

It’s much easier to meet new partners, with the advent of internet dating and the ease of international travel. Plus, thanks to advances in healthcare, symptoms of the menopause and erectile dysfunction no longer spell the end of an active sex life.

But despite this, education campaigns about safe sex are generally aimed at younger people; not a great help when it’s often suggested that older people are more likely to feel embarrassed about seeking information about STIs and may lack the knowledge to protect themselves.

And, as noted by Julie Bentley, CEO of the UK’s Family Planning Association, “STIs don’t care about greying hair and a few wrinkles”.

Risky sexual practices

Dr Deborah Bateson, medical director at Family Planning NSW, started researching older women’s views and experience of safe sex after noticing a rise in the number of older women asking for STI tests and being diagnosed with STIs, particularly chlamydia.

The organisation surveyed a sample of women who used internet dating sites and found, compared with younger women, those aged between 40 and 70 were more likely to say they would agree to sex without a condom with a new partner.

Similarly, a telephone survey commissioned by Andrology Australia found that around 40 per cent of men over 40 who have casual sex do not use condoms.

While the reasons behind this willingness to engage in unsafe sex are uncertain, Bateson says older people may have missed out on the safe sex message, which really started to be heavily promoted in the 1980s with the advent of HIV/AIDS.

In addition, older women may no longer be concerned about becoming pregnant and have less of an incentive to use a condom compared with younger women.

“There is a lot of the information around chlamydia that relates to infertility in the future, so again for older women there may be a sense that it’s not relevant for them,” she says.

However, the Family Planning survey did find that older women were just as comfortable as younger women with buying condoms and carry them around.

“There’s obviously something happening when it comes to negotiating their use. Most people know about condoms but it’s just having the skills around being able to raise the subject and being able to negotiate their use at the actual time,” Bateson says.

As with most things in life, prevention is better than cure – something to remember when broaching the topic of safe sex and STIs with a new partner.

“If you’re meeting a new partner, they are probably thinking the same thing as you [about safe sex],” says Bateson.

“So being able to break the ice [about safe sex] can often be a relief for both people.”

Stay safe

Anyone who has had unprotected sex, particularly with several people, is potentially at risk of STIs, says Professor Adrian Mindel, director of the Sexually Transmitted Infections Research Centre based at Westmead Hospital, Sydney.

“People who are changing partners or having new partners, they and their partner should think about being tested,” he says.

“Also think about condom use at least until [you] know [the] relationship is longer lasting and that neither of [you] are going having sex with anyone outside the relationship.”

The UK’s Family Planning Association also stresses that STIs can be passed on through oral sex and when using sex toys – not just through intercourse.

It also notes that the signs and symptoms of some STIs can be mistaken as a normal part of aging, such as vaginal soreness or irregular bleeding.

And remember that often infections don’t result in symptoms, so you may not be aware you have an STI. However, you can still pass an infection on to a sexual partner.

So if you are starting a new sexual relationship or changing partners, here is some expert advice to consider:

  • If you have had unprotected sex, visit your GP to get tested for STIs. This may involve giving a urine sample to test for chlamydia, examination of the genital area for signs of genital warts, or a swab of your genitals to test for STIs such as herpes or gonorrhoea. A blood test may also be required to test for syphilis, HIV and hepatitis B.
  • If you are starting a new relationship, suggest your partner also gets tested.
  • Use a condom with a new partner until you both have been tested for STIs and are certain neither of you is having unprotected sex outside the relationship.
  • If you have symptoms you are concerned about, such as a urethral discharge in men or vaginal discharge, sores or lumps on the genitals, pain when passing urine or abdominal pains in women, see your GP.

Complete Article HERE!

New Mommy Woes

Name: Megan
Gender: Female
Age: 29
Location: Toronto
I’m a new mother and this is my first child. He was born 3 weeks ago, but I am still enthralled with the miracle of it all. So far motherhood has been pretty wonderful. Sure I’m tired, but just holding my son in my arms makes me so happy I sometime cry with the joy. There is a problem, however, my husband wants to resume our sex life, but I have absolutely no interest. I love him dearly and I know I owe him this, but I have no libido. What can I do?

Yep, this is common enough complaint. This is precisely the place where new parents experience the most strain on their relationship. And when you think about it, it’s not all that surprising. Most new mothers are exhausted by the expectations of motherhood. And first babies are the most challenging. Added to these burdens her partner eagerly awaits the resumption of the sort of sex life that was in place before the pregnancy. New mothers often feel like their husband is just one more person to service, one more person with needs and demands that are keeping her from much-needed sleep.

New Mother LoveNew mothers can find sex unappealing for reasons both physical and emotional. If you’re breastfeeding, your breasts are sore, heavy, and leaky. Your body just doesn’t feel sexy, with its stretch marks, cellulite, dark nipples and dark line down the abdomen, not to mention the weight gain and varicose veins. Then there is lochia, the discharge after the birth, which lasts for 3 to 4 weeks and does not smell very good. If you had an episiotomy, the stitches are very uncomfortable and you may worry about infection. Your hormones may still be in a state of flux, so you feel moody or depressed. And you may not have a good method of birth control, so sex is the last thing on your mind!

Some doctors recommend that new mothers refrain from sex until their first post partum examination, usually about 6 weeks after the birth.NewMother

So if you and your husband weren’t warned about all this, you’re probably both totally unprepared. And if you can’t talk about it, there will be trouble ahead. Many new fathers labor under the misconception that once the baby is born, their sex life will return to normal. Besides this being completely unrealistic; it mostly puts pressure on the wife to do, as you suggest, her ”duty”. This is no way to pursue a sex life together.

Of course, new fathers can help their partner move beyond those feelings of sexual disinterest by being an involved parent and helping around the house.

There are loads of sex things new mothers can do that will pleasure their partner that don’t involve full-on fucking. Hand jobs and blowjobs are always welcome. Reading erotica aloud to each other can be fun. Mutual masturbation, or even watching him and cheering him on as he squeezes one out is also an option. But probably the thing that will get your libido back is a lot of touching, massaging, hugging, kissing, and snuggling and not as a prelude to sex, but just for the joy of it. These things, without the pressure to perform will help reestablish the pair-bond between you and your old man, which will inevitably lead to the long awaited fuckfest.

Good luck

One Of The Willie Worrisome

Name: lup92
Gender: Male
Age: 15
Location: England
I’m 15 and masturbate often but have had no form of sex although my girlfriend wants to start. However my penis and scrotum have extremely small lumps all over. I also have a purple red large lump on the rim of my bellend. What do I do? Should I start? Or do I risk giving something to my girlfriend?

A quick note before we begin. I’m a Ph.D. kind of doctor. not MD type of doctor. You know that, right? While I know my way around the human body, I never offer medical advice of any sort. And, just so you know, no self-respecting physician, MD kind of doctor, is gonna offer you medical advice online either without seeing you in person first. Which, if you ask me, is a real good thing.

teen intimacy

Here’s the thing about lumps and bumps and discolorations of the skin anywhere on your body, especially on your precious willie, pup. They are signs that all is not well. Do us all a big favor and have your johnson looked at by a physician. Your health is nothing to fool around with. Everything you describe could be completely harmless, but you don’t want to take the chance that it isn’t, right? And here’s a tip: don’t do it for your girlfriend. DO IT FOR YOU! It’s your dick, you gotta lean how to take care of it. And there’s no time like the present to start properly lookin’ after it.

willy_worryJust so you know, I’m not suggesting that your have a STI (Sexually Transmitted Infection). I mean, how could you? You’ve only been wanking, right? Still, if you’re concerned enough to write to me about it, you should take yourself in for a look-see. Since you are underage, you’ll probably need one of your parents to arrange the appointment. But if you are typical teenager, you’ll probably be embarrassed to discuss this with your parents. Still, there’s no getting around this. I think your parents will be proud of you for being proactive about your health and wellbeing. Besides, there’s nothing to be ashamed about.

Another option is to contact a sex-positive resource near you. Check out the folks at FPA. Surely they’ll have a resource for you.

Please take care of this ASAP.

There is one more thing. And I’m gonna be as blunt as I know how. If you think you’re old enough to fuck, you’re old enough to know all about condoms and how to use them. If ya don’t, you’re just a dumb kid who may function like a grown-up, but doesn’t know how to behave like one. And I don’t want to believe that about you.

What it is with young people (old people too) who are still fuckin’ clueless about unprotected sex in this day and age? I have nothing against younger people being sexual. That pretty much is to be expected. But I am totally opposed to kids having kids! Like I said, if you’re old enough to swing it around, you’re old enough to know how to swing it responsibly.

Good luck

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