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Sexuality at the End of Life

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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!

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The Virginity Myth

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Name: Tia
Gender: Female
Age: 19
I have a problem. I’m still a virgin, but my bf thinks I’m not. It’s really my fault he thinks this, cuz I told him I was all experienced and everything. We’ve been going together for about 8 months already and I really want my first time to be with him, but how am I going to act all experienced when I don’t know what I’m doing.
HELP ME PLEASE!!!

That sure enough is a pickle you got yourself into darlin’. You’ve got some ‘splanin’ to do Lucy!

Funny, because I’m more likely to hear from young women who are not virgins, who want to know how they can fool a new partner into thinking, they are. I guess we can chalk up all this deception and confusion to the powerful associations every culture imposes on virginity…female virginity, that is.

virginityLike most things sexual there is a huge double standard between the cultural and personal importance of virginity between the sexes. The cultural expectations about virginity are also tied to age as well as gender. For example, our society expects its 16-year-old girls to be virgins. To be otherwise, at that tender age, would be a scandal in most communities. But a 35year old woman who is still a virgin is considered an old maid — or worse, a dyke — in our society.

Of course, things are more fluid when it comes to boys and men. On the one hand, a 16year old boy, who is not a virgin, may raise some eyebrows in most communities. But many others in those same communities would praise him for being a stud. On the other hand, a 35year old man who is still a virgin is not only the butt of jokes — or worse, a queer — but he’s also more of a disgrace to his gender than an old maid is to hers. Funny how that works, huh?

I hasten to add that there is a lot to argue with in terms of these arbitrary cultural norms, and I encourage ya’ll to argue away. God knows I do! And you don’t have to buy into them either. God knows I don’t! But till things change these norms are the norms, like it or lump it.

I’d love to know why you felt the need to deceive your BF in the first place? Do the people you hang with, prize sexual experience over sexual innocence for a woman of 19? And what are the expectations of your group regarding a 19year old guy? I’ll bet the expectation is that he not be a virgin. Right?

Well you can see why a lot of people, not just you Tia, find this whole thing just too damned complicated. And rather than adding to the confusion or the deception, I encourage you to come clean with the BF about your cherry.Sign-Virginville-VillageOf

Here’s why I think this is the best policy. First, if the BF is sexually experienced, it will be very difficult for you to hide the fact that you’re not. Besides, like you said in your message to me. “I really want my first time to be with him.” Tell him that, sweetheart! No man is gonna turn that down…ever. Simply put, that is the most sexually charged and treasured sentence in any language.

Begin the big talk with your man like this. “Baby, I got something real special to tell you. You know how I’ve been sayin that I’ve been with other guys and shit? Well that was just my way of keeping all the other guys from pestering me for my junk. Baby, the truth is that I haven’t had sex before now. And the best part of this is I’ve decided that I really want my first time to be with you. My cherry belongs to you, baby”

Like I said, Tia, no man is gonna turn that down. The BF will be so flattered you won’t have to pretend to be something you’re not. Clearing the air like this will also allow you to relax when the magic moment finally happens. And relaxation is the key to enjoying yourself. And you should enjoy yourself.

Good luck

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Casa Rodrigo, Yee-ha!

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Hey sex fans,

The summer holidays are over and we’re all back at the old grind. Bummer, I know. But I have what I think is the antidote.  It’s a little something that, I believe, will brighten your day.

  • Ya’ll know how fond I am of smart and smutty erotica, right?
  • Ya’ll know that for nearly seven years I produced a podcast series, The Erotic Mind, right?
  • Ya’ll know that each and every one of these marvelous shows, that feature conversations with erotic artists of every stripe, literary and graphic, are archived right here on my site, right?
  • Ya’ll know that all you have to do is use the pull-down PODCAST menu in the header to find them, right?

Good, I thought so.

Anyhow today I have something that will sure enough make you sit up and say; “oh boy howdy!”Casa Rodrigo cover

I want to introduce you to Casa Rodrigo, the 12 person audio play written and directed by award nominee, and my new friend, Johnny Miles.

Like I said, Casa Rodrigo, an audio play featuring 11 characters and a narrator, as well as an extensive sound engineering that transport us, the listening audience, back to Spain and the Caribbean during the mid-1600s, allowing us to feel the dangers and excitement the era had to offer. Four and a half hours of pure aural experience awaits us. The story is richly layered and textured, with effects to help stimulate our senses. It’s an immersive experience not to be missed.

The good folks at Mania Media, the producers of audio play, believe it is important to provide their audience with a great entertainment experience and Casa Rodrigo certainly fits that bill.

Johnny Miles began his writing career in 1985, when his first erotic short story was published by Numbers magazine. Since then, his work has appeared in various adult magazines. After several decades of working in various careers, Johnny re-entered the world of erotica in 2008 with the release of his first full-length novel, Casa Rodrigo. Published by Loose Id, the controversial story was followed by Lauderdale Hearts, Learning To Samba, The Rosas of Spanish Harlem, Yuletide Knights, and Yuletide Knights: A Spring Frost, and The Last Stop: USA, all of which you can find on Johnny’s site.

Johnny has asked me to share with you the first two chapters of the book. You’ll find the links below. And when you’ve finished the sampler, you can mozie on over to Audible to pick up the whole audio play, or Johnny’s site.to snap up the e-book.

Have a ball, ya’ll!

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Chlamydia at 50… Could it be you?

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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!

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A Farewell to a great man

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Dear sex fans,

I realize this is a bit off topic for this blog, but I want to acknowledge the death of famed British neurologist and author, Oliver Sacks.

1993: Portrait of British-born neurologist and author Dr Oliver Sacks standing in the admittance driveway of Beth Abraham Hospital with his arms crossed over his chest, New York City. (Photo by Nancy R. Schiff/Hulton Archive/Getty Images)

1993: Portrait of British-born neurologist and author Dr Oliver Sacks standing in the admittance driveway of Beth Abraham Hospital with his arms crossed over his chest, New York City.

In February, he wrote an op-ed in The New York Times revealing that he was in the late stages of terminal cancer, after earlier melanoma in his eye spread to his liver.

“It is up to me now to choose how to live out the months that remain to me,” he wrote. “I cannot pretend I am without fear. But my predominant feeling is one of gratitude. I have loved and been loved; I have been given much and I have given something in return; I have read and traveled and thought and written. I have had an intercourse with the world, the special intercourse of writers and readers.”

Earlier this summer I read Dr Sacks’s memoir, On the Move.  I love it.  It’s an interesting memoir by a fascinating personality.  And while reading I discovered that we had a dear friend in common, Thom Gunn.  What a small world!  So I decided to send him a note.

Dear Dr Sacks,

I just finished reading your memoir, On The Move.  What an amazing life you’ve lived.on-the-move-by-oliver-sacks

Of all the marvelous things you’ve done and all the fascinating people you mentioned in your book nothing surprised me more than your close friendship with Thom Gunn.  I was a friend of Thom too and I lived directly across Cole Street from him.  I moved to the flat at 1207 Cole Street in 1979.  At the time I was working on my doctorate in clinical sexology at the Institute For The Advanced Study of Human Sexuality in San Francisco.

I didn’t know Thom well at first.  However, I would regularly see him walking both in our neighborhood and elsewhere in town.  He was always in his leathers, rain or shine, and used to think to myself, “What a mensch!”

It finally dawned on me that he lived across the street from me.

Once he saw me in my roman collar.  (I was ordained a catholic priest in 1975 at the age of 25 in Oakland, CA.  I had come out to my local superiors; I was a member of the Oblates of Mary Immaculate, before I was ordained.  Like I said, I was working on my doctorate to become a sex therapist and prepare for an upfront gay ministry.)  Thom smiled at me when he saw me; I blushed and told him what I just told you.  He was fascinated, but I also believe he thought I was a twit.  He probably was right.

I knew nothing about Thom other than he was my neighbor.  Then one day I was in a bookstore on Haight Street and there was a photo of Thom in the window advertising a reading.  That’s when I started asking around about him.  Despite his cult status within the gay community, he was the most unassuming person.  I was honored to have a personal connection with him.small_front

I finished my doctorate in 1981.  My dissertation, Gay Catholic Priests; A Study of Cognitive and Affective Dissonance was directed by Wardell Pomeroy.  A firestorm of media attention followed.  The media branded me as THE gay priest, as if.  I think Thom read about me in the New York Times because next time he saw me he clapped me on the back and said, “Well done.”

No sooner did I complete my doctorate, and because of the media attention my public coming out caused, the leadership of my religious community in Rome began a process of dismissal against me.  I was devastated and lost.  I was even getting death threats.  Thom was always so supportive and encouraging.

I fought the church for the next thirteen years in an effort to save my priesthood and ministry.  Alas, the writing was on the wall back in 1981 and it was only a matter of time till they had their way with me.  I wrote about the travail in a book that was published in 2011, Secrecy, Sophistry and Gay Sex In The Catholic Church: The Systematic Destruction of an Oblate Priest.

Thom was always so solicitous about my wellbeing.  He knew how difficult life had become for me.  And both of us found ourselves on the forefront of caring for friends who were dying of AIDS.  One of my landlords died in 1986.

Thom introduced my housemate and I to Augie Kleinzahler and his girlfriend, Caroline Lander, who lived only a few blocks from us in Cole Valley.  We all became great friends and copious amounts of strong drink were consumed.  I wonder, do you know Augie?

When Thom turned sixty I surprised him with a homemade German chocolate cake.  I told him he was the oldest person I knew.  This made him laugh and he called me a whippersnapper.

In 1992 the surviving landlord sold the Cole Street duplex and I and my housemate moved to Oak and Ashbury.  Sadly, I didn’t get to see Thom as much as before.  I move up here to Seattle in 1999 because I could no longer afford to live in SF.  I was deeply saddened to learn of Thom’s death in 2004.  He was such a great guy, what a marvelous soul.

Again, thank you for your memoir; it was grand getting to know you on a personal level.  I read The Man Who Mistook His Wife for a Hat when it came out in the mid-eighties and loved it.  But I never guessed you and Thom knew each other or that you actually visited him when I lived across the street from him.  What a small world.  I wish I had known you back then.

Anyhow, thank you for the bringing me this unexpected flood of memories of Thom.  I wonder what he would have made of yesterday’s Supreme Court decision (Obergefell v. Hodges).  I contend that we got marriage equality only because we walked through AIDS first.  I think Thom would have agreed with me.

All the best,
richard

Richard Wagner, M.Div., Ph.D., ACS

To my astonishment, Oliver wrote back; I mean that literally, a handwritten note.  Apparently, he never used a computer.

Dear Dr. Wagner (can I say Richard?),                                                          6/60/15

I am greatly interested and greatly moved, by your letter — your courage in being honest and forthright, at a time and on a subject bound, sooner or later, to cause your ejection from the priesthood. In another few years perhaps, with Pope Francis at the helm, these last bastions of Catholic bigotry may have fallen.

I like to think of you as living across the street when I visited Thom, and glad to know that he appreciated you and your works. I still miss him deeply — there were not too many people with whim I could be entirely open — and I like to think that his ghost is pleased that my title came from his poem. (I find it a huge relief being open now to all and sundry {Oliver came out earlier this year} — I am so glad I completed my book before I became ill).

And what a liberation, an affirmation for us all that the Supreme Court voted as it did. I suspect that Ruth Bader Ginsberg, quite ill now, stayed on to ensure the 5/4 decision.

Thanks for your letter and my very best wishes,

Oliver

Oliver Sacks01     Oliver Sacks02

Click on this link to see a copy of Oliver Sacks’s note.

Thank you Dr Sacks and farewell!

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