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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 extraordinary case of the Guevedoces

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Catherine and his cousin Carla, Guevedoces in the Dominican Republic

Catherine and his cousin Carla, Guevedoces in the Dominican Republic

The discovery of a small community in the Dominican Republic, where some males are born looking like girls and only grow penises at puberty, has led to the development of a blockbuster drug that has helped millions of people, writes Michael Mosley.

Johnny lives in a small town in the Dominican Republic where he, and others like him, are known as “Guevedoces”, which effectively translates as “penis at twelve”.

We came across Johnny when we were filming for a new BBC Two series Countdown to Life, which looks at how we develop in the womb and how those changes, normal and abnormal, impact us later in life.

Like the other Guevedoces, Johnny was brought up as a girl because he had no visible testes or penis and what appeared to be a vagina. It is only when he approached puberty that his penis grew and testicles descended.

Johnny, once known as Felicita, remembers going to school in a little red dress, though he says he was never happy doing girl things.

“I never liked to dress as a girl and when they bought me toys for girls I never bothered playing with them – when I saw a group of boys I would stop to play ball with them.”

When he became obviously male he was taunted at school, and responded with his fists.

“They used to say I was a devil, nasty things, bad words and I had no choice but to fight them because they were crossing the line.”

We also filmed with Carla, who at the seven is on the brink of changing into Carlos. His mother has seen the change coming for quite a while.

“When she turned five I noticed that whenever she saw one of her male friends she wanted to fight with him. Her muscles and chest began growing. You could see she was going to be a boy. I love her however she is. Girl or boy, it makes no difference.”

Child on swing

 

 

So why does it happen? Well, one of the first people to study this unusual condition was Dr Julianne Imperato-McGinley, from Cornell Medical College in New York. In the 1970s she made her way to this remote part of the Dominican Republic, drawn by extraordinary reports of girls turning into boys.

When she got there she found the rumours were true. She did lots of studies on the Guevedoces (including what must have been rather painful biopsies of their testicles) before finally unravelling the mystery of what was going on.

When you are conceived you normally have a pair of X chromosomes if you are to become a girl and a set of XY chromosomes if you are destined to be male.

For the first weeks of life in womb you are neither, though in both sexes nipples start to grow.

Then, around eight weeks after conception, the sex hormones kick in. If you’re genetically male the Y chromosome instructs your gonads to become testicles and sends testosterone to a structure called the tubercle, where it is converted into a more potent hormone called dihydro-testosterone This in turn transforms the tubercle into a penis. If you’re female and you don’t make dihydro-testosterone then your tubercle becomes a clitoris.

Foetus at 12 weeks

When Imperato-McGinley investigated the Guevedoces she discovered the reason they don’t have male genitalia when they are born is because they are deficient in an enzyme called 5-alpha-reductase, which normally converts testosterone into dihydro-testosterone.

This deficiency seems to be a genetic condition, quite common in this part of the Dominican Republic, but vanishingly rare elsewhere. So the boys, despite having an XY chromosome, appear female when they are born. At puberty, like other boys, they get a second surge of testosterone. This time the body does respond and they sprout muscles, testes and a penis.

Imperato-McGinley’s thorough medical investigations showed that in most cases their new, male equipment seems to work fine and that most Guevedoces live out their lives as men, though some go through an operation and remain female.

Another thing that Imperato-McGinley discovered, which would have profound implications for many men around the world, was that the Guevedoces tend to have small prostates.

This observation, made in 1974, was picked up by Roy Vagelos, head of research at the multinational pharmaceutical giant, Merck. He thought this was extremely interesting and set in progress research which led to the development of what has become a best-selling drug, finasteride, which blocks the action of 5-alpha-reductase, mimicking the lack of dihydro-testosterone seen in the Guevedoces.

My wife, who is a GP, routinely prescribes finasteride as it is an effective way to treat benign enlargement of the prostate, a real curse for many men as they get older. Finasteride is also used to treat male pattern baldness.

A final interesting observation that Imperato-McGinley made was that these boys, despite being brought up as girls, almost all showed strong heterosexual preferences. She concluded in her seminal paper that hormones in the womb matter more than rearing when it comes to your sexual orientation.

This is still a controversial topic and one I explore later in the film when I meet Mati, who decided from the earliest age that though “he” looked like a boy, Mati was really a girl.

As for Johnny, since he developed male genitalia he has had a number of short term girlfriends, but he is still looking for love. “I’d like to get married and have children, a partner who will stand by me through good and bad,” he sighs wistfully.

Complete Article HERE!

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Why I’ll miss Candida Royalle – the feminist porn queen

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Candida Royalle – the legendary feminist porn director and animal rights activist – has died after long battle with ovarian cancer. Fellow porn director Petra Joy explains what she did for women everywhere

By Petra Joy

Candida Royalle former porn star and film-maker in her New York flat in 1997

Today is a very sad day for many women, feminists and erotic artists around the world. As the news spread that yesterday morning Candida Royalle died at her New York home aged just 64, her Facebook page is being transformed into a colourful kaleidoscope of an amazing life. Every few minutes someone new leaves a tribute for this truly exceptional woman that paved the way for porn from a female perspective and opened doors to the many feminist pornographers – myself included – that followed in her footsteps. All the pictures posted show a radiant woman with a smile that said “I love live, will live it to the full, let’s go and have an adventure!”

Candida was born Candice Vadala on the October 15 1950 in New York. The daughter of a jazz musician, she too was drawn towards a creative lifestyle. She studied music, art and dance and was a flamboyant and beautiful young woman. Experimenting with her sexuality and being drawn to filmmaking, she decided in the seventies to become a porn performer. In the ‘Golden Age’ of porn she starred in over 25 adult films, including titles such as “Kinky Tricks” and “Hot & Saucy Pizza Girls”.

Candida prioritised women’s pleasure and orgasms

As time went on, she grew tired of portraying female sexuality through the eyes of the men that directed her and craved taking the reins of production. In 1984, at a time where the first feminist porn movement was at its peak and when “feminist porn” was also the ultimate oxymoron, she founded her own adult film company, Femme Productions. The old boys club that ran the porn industry at the time was bemused and did not expect what was to come: Candida produced and directed 17 award-winning films, including her debut “Femme”, the “Eyes of Desire” series and “Stud Hunters”. She was way ahead of her time and proved to be right – women were voyeurs too and the moment was ripe and ready to produce porn from a female perspective.

So what made her porn different from mainstream porn, created by men and for men? Put simply – Candida prioritised women’s pleasure and orgasms. And she didn’t end every scene with the male ejaculation – the so called “money shot”. She featured a variety of sensual and sexual play rather than shooting what she used to call “predictable and soulless porn painted by numbers”. Her films showed hot men who were skilled lovers, ran credible storylines that were full of humour and spoke to a large audience who were tired of soulless wham-bam-thank you-mam porn. She was a very skilled business woman but was never motivated by financial gain. She created her films because she had a burning desire to put female sexuality on the map, inspire other women to live out their fantasies, and bring pleasure to people’s bedrooms.

As an activist for feminism and female sexual liberation, she branched out in 1999 when she developed the “Natural Contours” line of body massagers. Candida brought innovation to the sex toy market that was then saturated with giant plastic phallic rods by developing ergonomically shaped toys that hit just the right spots to make a woman orgasm. In 2004 Candida moved into writing – penning “How To Tell A Naked Man What To Do”, encouraging women to ask for what they want long before Nicki Minaj said women should demand orgasms.

Candida Royalle was all about female pleasure long before Nicki Minaj

That was also the year I started shooting my version of porn from a female perspective. In Europe back then, feminist porn was still unheard of. My style is different from Candida’s as I do not feature dialogue, but we shared the vision of porn as art and using is as a vehicle of sexual empowerment for women. It was through the legendary ‘ecosex’ artist Annie Sprinkle that I met Candida Royalle in 2008. Candida kindly viewed my first full length feature “Female Fantasies” and was full of praise. I was humbled by the amount of time she gave me and genuine support when she suggested publishing my films under her coveted “Femme” line in America. Our professional co-operation continued over the years. I published some of Candida’s classic films on my “Her Porn” anthology series and was chuffed when she agreed to be a jury member for the Petra Joy Awards I had set up for up- and coming filmmakers. To discover and mentor new talent was very close to her heart.

We shared many magic moments such as in 2009 when we were both honoured with the first Poryes award in Berlin and then two years ago when we met at the Dusk Porna Award in Amsterdam. I was baffled to win it and asked Candia onto the stage to join me. After I handed her a bunch of flowers to thank her for all she had done for the sisterhood, I walked off stage, only to be called back by her with these words: “I am very happy to step aside and just honour you and all these wonderful filmmakers who are picking it up and doing it now.” I was speechless and we hugged to thundering applause – a moment I will never forget. She was, as someone said on Facebook, the Grace Kelly of porn – a sophisticated and beautiful woman of incredible integrity, big enough to allow others to shine.

Candida was not just a colleague but became a close friend. In September 2013 I was very happy to entertain her in my home for several days where we shared beach walks, cream teas, and spoke at length about nature and environmental issues, issues close to both of our hearts which served to strengthen our bond even further. Her last post on Twitter was: “Icelandic whalers are about to start harpooning endangered fin whales again but we can stop them! Act now”.

Snettisham Bird Reserve lies on the edge of 'The Wash', one of the most important bird estuaries in the UK, supporting over 300,000 birds. A few times every year higher than average tides force thousands of waders including Knot, Oystercatchers, Sanderlings, Black and Bar Tailed Godwit and Plover to take flight, and advance up the mud flats in search of food. The event is one of the most incredible wildlife spectacles in the UK

She loved her wildlife too and was a passionate animal rights campaigner

We also both loved to feed the wildlife in our gardens and that was always a big concern to her – who would feed her birds when she was gone? She did not want to go and fought over five years a very hard fight against ovarian cancer. Only two weeks ago she was full of optimism and we emailed about her bringing my new film to America and she loved a picture of the starlings in my garden I had sent her.

So how to pay tribute to the feminist icon, animal rights activist and inspirational woman that was Candida Royalle?

Maybe it could be an apt one to start feeding your local wild birds. Alternatively, simply enjoy one of her films or toys and have an amazing orgasm in her name. I think she would like that.

Complete Article HERE!

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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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20 Interesting Facts You Never Knew

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Everyone took a sexual education course in middle or high school to learn about the “birds and the bees.” However, there are a lot of facts that sex ed teachers leave out. These facts are sometimes the most interesting and the most useful in real-life situations. Here are 20 little known facts about “doing it.”

Patterns In Sexual Desire

Most women have an increase in sexual desire around the time that they ovulate each month. This is nature’s way of making sure the Earth stays well-populated.

It Sounds Gross But…

Semen can be great for the facial pores and can even help with acne. The male-produced “facial cream” can also prevent wrinkles.

Headache

A Headache Is A Bad Excuse

We’ve all heard the cliche “my head hurts” excuse for turning down sex. However, sex often helps with pain, especially with headaches.

We’re Not Judging

Many straight men enjoy having their anal areas stimulated, and that is totally okay! Sexual experts say that the anal areas are packed full of nerves and can make a male orgasm so much better.

1, 2, 3…And They Keep Coming!

Women can orgasm an unlimited amount of times. Men generally need a period of time after orgasming to recover. However, women need barely any time and are ready to go as many times as they please.

Men Are Erect…A Lot

It is said that many men experience about 11 erections every single day. While they may not be raging every single time, it does happen pretty often.

Celery Can Arouse

Yes, celery. The pheromones in celery can cause arousal in men. In addition to the arousal, the vegetable also makes men who eat it more attractive to women.

The Left Side Is The Best Side

A group of scientists found the upper left quadrant of the clitoral head is the most pleasurable spot to touch. So, it’s okay to tell him to go “a little to the left.” It’ll be sure to make the sex even more enjoyable.

Orgasms Are Different

A man’s orgasm lasts about 22 seconds while a woman’s lasts about 18. It is also very common for it to be uncomfortable to pee after having sex because of an antidiuretic hormone that prevents urine from freely flowing.

Sex Can IMPROVE With Age

Sexual attraction is a life-long drive. The reason most older people don’t have sex very often is that there is a lack of opportunity to have sexual encounters.

Get Your Heart Going

Sex is a great way of getting in your daily cardio exercise. During an orgasm, heart rates can reach between 140 and 180 bpm.

spunklube

Lube Can Make A Difference

While lube is considered a sex tool for older people, many sexual experts say that a little lubricate can make the difference between pain and pleasure during sex. This doesn’t mean the woman is not turned on. Natural “lube” can come and go without any warning.

Penetration Is NOT The Secret

Most women do not orgasm from penetration alone. The majority of women need some type of clitoral stimulation to reach their climax. It has nothing to do with size or penetration.

Everything Expands

The penis is not the only thing that grows during a sexual encounter. In fact, the testes grow by 50% and the vagina can double in size when aroused.

More Sex Makes You More Appealing

After having sex, a woman’s estrogen levels double. When estrogen levels are higher, a woman’s hair can look shinier and her skin can even feel softer.

Not Only People Can Be Arousing

Some people have sexual attraction to objects instead of specific people. There is a woman known to be sexually aroused by the Eiffel Tower.

Have Sex, Live Longer

Scientists have found that orgasms can actually prolong your life. That’s right, the more sex you have, the longer you can live.

Humans & Dolphins Alike

As far as sex is considered, dolphins and humans have one key fact in common. The two mammals are the only animals in the world that have sex for pleasure.

Sex Everyday Keeps The Doctor Away

Sex can actually help you stay healthy. Many doctors believe this is because sex can lower blood pressure and greatly decrease stress levels.

It’s Like Two Puzzle Pieces

Not every penis, or vagina, is the same. If a guy is too large, women can control penetration by changing positions. If he is too small, there are many toys, etc that couples can invest in.

 

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