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How To Talk To Your Doctor About Sex When You Have Cancer

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More people are surviving cancer than ever before, but at least 60 percent of them experience long-term sexual problems post-treatment.

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So you’ve survived cancer. You’ve endured brutal treatments that caused hair loss, weight gain, nausea, or so much pain you could barely move. Perhaps your body looks different, too—maybe you had a double mastectomy with reconstruction, or an orchiectomy to remove one of your testicles. Now you’re turning your attention back to everyday life, whether that’s work, family, dating, school, or some combination of all of those. But you probably aren’t prepared for the horrifying side-effects those life-saving measures will likely have on sex and intimacy, from infertility and impotence, to penile and vaginal shrinkage, to body shame and silent suffering.

More than 15.5 million Americans are alive today with a history of cancer, and at least 60 percent of them experience long-term sexual problems post-treatment. What’s worse, only one-fifth of cancer survivors end up seeing a health care professional to get help with sex and intimacy issues stemming from their ordeal.

Part of the challenge is that the vast majority of cancer patients don’t talk to their oncologists about these problems, simply because they’re embarrassed or they think their low sex drive or severe vaginal dryness will eventually go away on their own. Others try to talk, but end up with versions of the same story: When I went back to my doctor and told him I was having problems with sex, he replied, ‘Well, I saved your life, didn’t I?’ And many oncologists aren’t prepared to answer questions about sex.

“Sex is the hot potato of patient professional communications. Everyone knows it’s important but no one wants to handle it,” says Leslie Schover, a clinical psychologist who’s one of the pioneers in helping cancer survivors navigate sexual health and fertility. “ When you ask psychologists, oncologists and nurses, ‘Do you think it’s important to talk to patients about sex?’ they say yes. And then you say, ‘Do you do it routinely?’ They say no. When you ask why, they say it’s someone else’s job.”

Schover spent 13 years as a staff psychologist at the Cleveland Clinic Foundation and nearly two decades at the University of Texas MD Anderson Cancer Center. After retiring last year, she founded Will2Love, a digital health company that offers evidence-based online help for cancer-related sex and fertility problems. Will2Love recently launched a national campaign called Bring It Up! that offers three-step plans for patients and health care providers, so they can talk more openly about how cancer treatments affect sex and intimacy. This fall, the company is collaborating with the American Cancer Society on a free clinical trial—participants will receive up to six months of free self-help programming in return for answering brief questionnaires—to track the success of the programs.

Schover spoke to Newsweek about the challenges cancer patients face when it comes to sex and intimacy, how they can better communicate with their doctors, and what resources can help them regain a satisfying sex life, even if it looks different than it did before.

NEWSWEEK: How do cancer treatments affect sex and intimacy?
LESLIE SCHOVER: A lot of cancer treatments damage some of the systems you need to have a healthy sex life. Some damage hormone levels, and surgery in the pelvic area removes parts of the reproductive system or damages nerves and blood vessels involved in sexual response. Radiation to the pelvic region reduces blood flow to the genital area for men and women, so it affects erections and women’s ability to get lubrication and have their vagina expand when they’re sexually excited.

What happens, for example, to a 35-year-old woman with breast cancer?
Even if it’s localized, they’ll probably want her to have chemotherapy, which tends to put a woman into permanent menopause. Doctors won’t want her to take any form of estrogen, so she’ll have hot flashes, severe vaginal dryness and loss of vaginal size, so sex becomes really painful. She’ll also face osteoporosis at a younger age. If she’s single and hasn’t had children, she’s facing infertility and a fast decision about freezing her eggs before chemo.

What about a 60-year-old man with prostate cancer?
A lot of men by that age are already starting to experience more difficulty getting or keeping erections, and after a prostatectomy, chances are, he won’t be able to recover full erections. Only a quarter of men recover erections anything like they had before surgery. There are a variety of treatments, like Viagra and other pills, but after prostate cancer surgery, most men don’t get a lot of benefit. They might be faced with choices like injecting a needle in the side of the penis to create a firm erection, or getting a penile prosthesis put in to give a man erections when he wants one. If he has that surgery, no semen will come out. He’ll have a dry orgasm, and although it will be quite pleasurable, a lot of men feel like it’s less intense than it was before. These men can also drip urine when they get sexually excited.

Why are so many people unprepared for these side-effects?
If you ask oncologists, ‘Do you tell patients what will happen?’ a higher percentage—like in some studies up to 80 percent—say they have talked to their patients about the sexual side-effects. When you survey patients, it’s rare that 50 percent remember a talk. But most of these talks are informed consent, like what will happen to you after surgery, radiation or chemotherapy. And during that talk, people are bombarded by so many facts and horrible side-effects that could happen, they just shut down. It’s easy for sex to get lost in the midst of this information. By the time people are really ready to hear more about sex, they’re in their recovery period.

Why is it so hard to talk about sex with your oncology team?
It takes courage to say, ‘Hey, I want to ask you about my sex life.’ When patients get their courage together and ask the question, they often get a dismissive answer like, ‘We’re controlling your cancer here, why are you worrying about your sex life?’ Or, ‘I’m your oncologist, why don’t you ask your gynecologist about that?’ Patients have to be assertive enough to bring up the question, but to deal with it if they don’t get a good answer. Sexual health is an important part of your overall quality of life and there’s nothing wrong with wanting to solve or prevent a problem.

What’s the best way for people to prepare for those conversations?
First, because clinics are so busy, ask for a longer appointment time and explain that you have a special question that needs to be addressed. At the start of the appointment, say, ‘I just want to remind you that I have one special question that I want to address today, so please give me time for that.’ Bring it up before the appointment is over.

Second, writing out a question on a piece of paper is a great idea. If you feel anxious or you’re stumbling over your words, you can take it out and read it.

Also, some people bring their spouse or partner to an appointment. They can offer moral support and help them remember all the things the doctor or nurse told them in answering the question.

So you’ve asked your question. Now what?
Don’t leave without a plan. It’s easy to ask the question, get dismissed, and say, I tried. Have a follow-up question prepared. For example, ‘If you aren’t sure how to help me, who can you send me to that might have some expertise?’ Or, ‘Does this particular hospital have a clinic that treats sexual problems?’ Or, ‘Do you know a gynecologist or urologist who’s good with these kinds of problems?’ If you want counseling, ask for that.

What happens if you still get no answers?
I created Will2Love for that problem! It came out of my long career working in cancer centers and seeing the suffering of patients who didn’t get accurate, timely information. When the internet became a place to get health info, it struck me as the perfect place for cancer, sexuality and fertility. Sex is the top search term on the Internet, so people are comfortable looking for information about sex online, including older people or those with lower incomes.

Also, experts tend to cluster in New York and California or major cancer centers. I only know of six or seven major cancer centers with a sex clinic in the U.S. and there are something like 43 comprehensive cancer centers!

We offer free content for the cancer community, including blogs and forums and resource links to finding a sex therapist of gynecologist. We also charge for specialized services with modest fees. Six months is still less than one session with a psychologist in a big city! We’re adding telehealth services that will be more expensive, but you’re talking to someone with expert training.

What can doctors do better in this area?
For health care professionals, their biggest concern is, ‘I have 40 patients to see in my clinic today and if I take 15 extra minutes with four of them, how will I take good care of everybody?’ They can ask to train someone in their clinic, like a nurse or physician’s assistant, who can take more time with each patient, so the oncologist isn’t the one providing sexual counseling, and also have a referral network set up with gynecologists, urologists and mental health professionals.

 

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The Science of Passionate Sex

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How to have hot sex, according to science

By Scott Barry Kaufman

Our culture is obsessed with sex. Everywhere you look is another article on how to have hot sex, harder erections, mind-bending orgasms, and ejaculations that go on for days. What people seldom realize, though– and which the latest science backs up– is that this is exactly the problem.

There’s nothing wrong with desiring sex. I’m extremely sex positive. Rather, I believe it’s the obsessive focus on the pragmatics and mechanization of sex– in isolation from the rest of the person— that is making us actually less satisfied with sex. We aren’t integrating our sexual desires into the totality of our being, and our whole selves are suffering as a result.

In a series of clever studies, Frédérick PhilippeRobert Vallerand, and colleagues studied a concept they refer to as harmonious sexual passionpassion for sex that is well integrated and in harmony with other aspects of the self, creating minimal conflict with other areas of life. Harmonious integration of ones sexual desires frees one up to fully engage and enjoy sexual activity in an open, spontaneous, and nondefensive manner. Items measuring harmonious sexual passion include: “Sex is in harmony with the other things that are part of me,” “Sex is well integrated in my life,” and “Sex is in harmony with the other activities in my life.”

In contrast, those who have obsessive sexual passion have not well integrated their sexuality into the totality of their being. Their sexual desires remain detached from other areas of their self as well as other domains in life. This leads to more narrow goals, such as immediate sexual gratification (e.g., orgasm), and leads to more of an urgent feeling of sex as a goal, compelling us to perform, instead of us being in control of our sexuality. This can significantly limit the full enjoyment of sex as well as life. Items measuring obsessive sexual passion include: “I have almost an obsessive feeling for sex,” “Sex is the only thing that really turns me on,” and “I have the impression that sex controls me.”

Across a number of studies, the researchers found that these two forms of sexual passion– obsessive and harmonious– differ remarkably in the way sexual information is processed, and how sexual activities are experienced. During sexual activities, obsessive sexual passion was related to negative emotions. Outside of sexual intercourse, obsessive sexual passion was related to intrusive thoughts about sex, conflict with other goals, attention to alternative partners, and difficulty concentrating on a current goal when unconsciously viewing pictures of sexually attractive people.

Obsessive sexual passion was also related to the biased processing of information. Those scoring higher in obsessive sexual passion were more likely to perceive sexual intent in ambiguous social interactions as well as to perceive sexuality in words that don’t explicitly have a sexual connotation (e.g., “nurse”, “heels,” “uniform”). Obsessive sexual passion was also related to violent actions under threat of romantic rejection, as well as greater dissolution of romantic relationships over time.

In contrast, harmonious sexual passion showed much greater integration with more loving aspects of the self, as well as other life domains. For instance, participants were asked to list as many words as they could in 1 minute related to the word “sex”. Those scoring higher in harmonious sexual passion were still sexually passionate beings: they listed quite a number of sexually-related words. However, they had a more balanced profile of purely sexual representations (e.g., “penis”, “breasts”, “vibrator”) and sexual-relational representations (e.g., “intimate,” “caress,” “intercourse”). In fact, the magic number seemed to be a ratio of 2: once the number sexual words outweighed the number of sexual-relational words by a factor of 2, there was a substantial increase in obsessive sexual passion and a marked decrease in harmonious sexual passion.

Those scoring high in harmonious sexual passion also showed greater control over their sexual drive. Whenever a sexual stimulus was subconsciously encountered (e.g., a beautiful person), they were able remain on task (which was to identify natural vs. artificial objects). Harmonious sexual passion was also related to less sexually intrusive thoughts and was unrelated to attentiveness to alternative partners. This greater integration and absence of conflict led to higher relationship quality over time.

It’s important to note that obsessive sexual passion is not the same thing as sexual compulsivity, or even sex addiction (although it is still hotly debated whether sexual addiction really exists). Even though obsessive sexual passion was correlated with negative emotions during sexual activity, it did not lead to greater feelings of distress. Also, both harmonious and obsessive sexual passion were related to loving and enjoying sex-related activities.

In fact, both harmonious and obsessive sexual passion were equally correlated with sexual desire. This is a really important finding, because we have a tendency to stigmatize those with greater sociosexuality in our society. Those with a more unrestricted sociosexual orientation are more willing to engage in casual sex, and report greater sexual desire and frequency of fantasizing about sex. These results suggest that sociosexuality itself is not the problem; rather, it’s how your sociosexuality is integrated into your identity and other areas of your life that really matters.

Perhaps instead of our cultural obsession with sexual performance, we should shift more towards helping people accept and feel comfortable with their sexuality, embrace sexual passion, and help them harness that passion in ways that bring joy, vitality, and openness to all areas of their life.

Complete Article HERE!

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I’m not that sexually experienced. How can I be more confident in bed?

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Buck up, champ: Feeling a little anxious about your sexual history (or lack thereof) is totally normal. Here are 10 ways to improve your sexual performance without having to have sex first.

by Vanessa Marin

Everyone has anxiety about being great in bed, but when you don’t have much sexual experience that anxiety can feel sky high. For some guys, that concern about experience turns into a horrible cycle: You don’t feel confident about your sexual experience, so you end up not having sex, and your experience level remains the same.

Here’s the good news: Experience is a good teacher, but you can still learn how to be great in bed without it. Here’s how.

1. Put it in context

As a sex therapist, I can tell you that just about everyone has self-confidence issues when it comes to sex—even people with a lot of experience. The insecurities are different from person to person, but they’re insecurities nonetheless. And keep in mind that many of the women you’re intimate with may be inexperienced or insecure as well. You’re certainly not alone.

2. Do your research

You can school yourself on how to have great sex without having any experience whatsoever. I also recommend Guide To Getting It On: Unzipped by Paul Joannides or The Big Bang by Nerve for general sex education topics like STIs and pregnancy prevention, anatomy, communication, and consent. She Comes First by Ian Kerner is a fantastic guide to the art of pleasuring a woman, and I recommend it to almost every man in my sex therapy practice. Come As You Are by Emily Nagoski is a great book about female sexuality in general.

One caveat: Don’t get your sex education from porn! Porn is meant to be entertainment, not education. Porn sex has very little resemblance to real sex. It’s all about angles, lighting, and editing. Most of the moves you see in porn simply won’t go over well in the real world.

3. Take care of your body

One of the best things you can do to improve your confidence is to take great care of your body. Sex is a physical act. Not only do you need endurance, but you also have to feel comfortable and confident in your own skin. You already know what you should be doing—eat right, get enough sleep, and exercise regularly. Exercise, in particular, can also have added sexual benefits, like increasing your sex drive and improving your erections and your orgasms.

Grooming is important too. Wear clothes that flatter your body and make you feel good. Get your hair cut and your beard trimmed. The better you feel about yourself and your body, the more confident you’ll feel in bed.

4. Masturbate

Yes, masturbation can improve your partnered sex life! Most men masturbate pretty thoughtlessly, zoning out to porn while they try to get the job done as quickly as possible. This actually serves to disconnect you from your body, and decreases your control over your erection and orgasm.

Instead, you can use masturbation to help increase your stamina. First, think of how long you’d like to last with a partner. That becomes your new masturbation session length. During that time, really pay attention to your body. Notice what it feels like when you start getting close to orgasm, and train yourself to back off when you’re on the edge.

You can also practice purposefully losing your erection, then getting it back again. This will help decrease anxiety about losing your erection with a partner.

5. Go slow

When you’re feeling anxious about sex, you’re more likely to rush. Lots of inexperienced men have the tendency to jump right to intercourse, but it’s so much more fun to take your time and go slow. Spend plenty of time on kissing, touching, and performing oral sex, and even slow down your physical movements. A slower pace will help dramatically decrease your anxiety levels.

Plus, keep in mind that most women feel more physical pleasure from oral sex and fingering than from intercourse, and a lot of women love being teased. She’ll appreciate your pace, too.

6. Focus on her pleasure

Being fantastic in bed means genuinely caring about your partner’s pleasure. It’s arguably the most important quality in a great lover. If you spend time specifically focusing on her body—taking your time with her, kissing her all over, fingering her, going down on her—you’re going to impress her way more than the guy who has a ton of experience but is selfish in bed. Plus, seeing the pleasure that you bring her will naturally help you feel more confident.

7. Treat her like an individual

I’m all about sharing sex tips and techniques, but the reality is that every woman likes different things. No one technique is going to work for every woman. This is great news for you because it shows that experience only goes so far. We’re all beginners when we have sex with someone brand new. Try to explore her body with openness and curiosity. Pay attention to how she responds to your touch. Does she moan? Does she start breathing more heavily? Does she arch her body toward you? Don’t be afraid to ask her what she wants or likes! One super-simple way to ask for feedback is to try two different things on her, and ask her, “Do you like it better when I do this or this?”

8. Keep it simple

So many men overly complicate sex, especially when they’re feeling anxious. Technique is important, but you don’t need to go crazy trying out a million different things on her. The key to female orgasm is actually consistency, not complicated tongue maneuvers or finger gymnastics. Switching things up usually throws her off and distracts her. Find something simple that seems to be working for her, and stick with it. Increase your pace and pressure gradually, but stick to the same basic technique.

9. Don’t think of it as a performance

One of the biggest mistakes that sexual newbies make is thinking of sex as a performance. They get overly fixated on the idea of maintaining a perfect erection, having the utmost control over their orgasms, and mastering their technique. But the truth is that no one likes feeling like they’re having sex with a robot. She doesn’t need you to perform for her like a circus animal. She wants to feel connected to you, and she wants to have fun. You can do that, even without any prior sexual experience.

10. Have a sense of humor

Sex is never perfect, no matter how much experience you have. Sex can be awkward, weird, and sometimes downright hilarious. You’re bound to try out a position that doesn’t work, bump foreheads, or get a cramp in your leg. Having a sense of humor is so important in those moments. If you can laugh it off, you’ll get back to the fun much faster.

Complete Article HERE!

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I thought that everything was completely normal down there, but then…

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Name: Shaon
Gender: Male
Age: 20
Location:
I am a 20-year-old male and recently on a forum I post on someone was talking about how they had to get a circumcision as an adult because they had a condition called phimosis. Up until a couple of days ago I thought that everything was completely normal down there, I have been able to masturbate normally for as long as I’ve been doing it. I’ve been doing a lot of reading on the internet about the condition and I think I might have it but I’m not really sure and I can’t bring myself to go to a doctor about it. I don’t have any picture now but I can take some and I’m wondering if you would be able to tell me if I have phimosis simply by looking at pictures. Thanks for your help.

So you’re reading around on the internet…that’s a good thing. What’s not so good is that your casual reading around has brought you to the conclusion that you have a medical condition called phimosis. Even though, up to this point, you believed everything in your nether regions was working perfectly fine.

That’s the problem with having just a little information. It tends to lead to more questions then answers.

For those in our audience unfamiliar with the term phimosis, it’s a condition in which the foreskin of the penis cannot be pulled back past the glans.

Shaon, you’re welcome to send me photos of your unit, but I can’t promise that I’ll be able to tell you for sure if you have phimosis or not. (Remember, I’m not a medical doctor, so don’t expect a medical diagnosis.) If you do send photos, you will have to include some of your erection with your foreskin pulled back as far as it goes.

So, let me ask you a couple of questions.  Can you retract your skin over the top of your dickhead? Are you able to retract your foreskin while your dick is hard as well as soft? When you shower or bathe, do you clean out under your foreskin?

Also, you should know that there are lots of ways to stretch your foreskin, so you shouldn’t ever have to worry about circumcision.

May I suggest that you take your time and read around my site for all the posting and podcasts that I’ve done under the topic “foreskin”? To do that, simply use the CATEGORIES pull-down menu in the sidebar of my site. Look for the heading Body Issues. Under that you will find the word “foreskin”. Every thing is alphabetized for your convenience.

And there’s more under the topic “Uncut”.

Good luck

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What happens when you find the idea of sex daunting

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Some people find physical intimacy difficult – here’s what to do

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We’ve all been there, feeling shy, bashful or even self-conscious due to a sexual encounter. But for some men and women, the idea of sex can be so daunting they’ll avoid it altogether.

Tara*, a 42-year-old who married young and divorced in her 30s, found herself a ‘practical virgin’ on the dating scene after finding herself single. For years, she avoided dating out of fear that she would eventually have to have sex.

“I simply couldn’t imagine stripping naked in front of a total stranger. I’d be too embarrassed,” Tara says. “My body was okay the last time I was dating, but now I’m older and I’ve had two children.”

Lacking the confidence in bed

Tara isn’t alone in finding the thought of sex incredibly intimidating. Whether it’s due to a bad experience in the past, body confidence issues, sexual dysfunction or anticipation about future sexual encounters, this is a common issue that many of us face.

According to Krystal Woodbridge, a psychosexual therapist at the College of Sexual Relationship Therapists (COSRT), finding sex intimidating can be centred around body image issues, especially for women, and how they perceive their partner wants them to look.

“Many women also don’t have the confidence to initiate sex,” says Krystal. “It’s quite common, particularly for women who struggle in this area, that they haven’t actually explored their own body through things like masturbation or understood their own sexual fantasies, sexual desires or urges.”

Many men feel that they need to perform and this constant worry over their ability in bed can lead to performance anxiety. “Men often feel like they need to act in a certain way, maintain an erection and take charge of the situation – and for some men this can be really intimidating.”

Very often people who suffer with a sexual issue, such as erectile dysfunction, premature ejaculation, vaginismus or low sexual desire, will also have problems with sexual confidence.

“Often these issues can put people off getting into a new relationship because when it comes to initiating sex, which would be something they normally do, they hold back because they don’t want their partner to know that there’s some kind of sexual problem,” says Krystal.

6 ways to overcome your sexual fear

Feeling unconfident and daunted by sex can be overcome. We spoke to Tracey Cox, sex and relationships expert about what you can do to turn this around.

1. Only have sex when you’re ready

“Forget any preconceived notions you have about having to climb into bed on date three. Have sex when you feel ready – when you know, trust and feel comfortable enough to sleep with them. Also remember, unless you’re planning on dating an 18-year-old supermodel, your new lover’s body isn’t going to be perfect either. While you’re frantically sucking in your stomach or worrying about how big your bum is, he’s nervous about the light hitting that not-so-well-concealed bald spot or wondering if the arms you’re grabbing on to aren’t as muscular as your ex’s.”

2. Think back to when you were a teenager and take your cue from there

“Start off slowly with foreplay. When you both really like each other, and are both nervous, this is the sexual equivalent of getting into the freezing swimming pool slowly rather than diving in at the deep end. The thought of having full sex after a few foreplay sessions together will feel a lot less scary.”

3. Stick to the basics at first

“Another big concern for people who find sex intimidating is: what if I don’t know what to do? Aren’t people doing stuff in bed I don’t know about? Both sexes worry about this one – and unnecessarily.
The way we meet people to have sex with might have completely changed
but once you’re having it, it’s pretty much the same scenario. After all, there are only so many physical sex acts you can perform and most people stick to the basics first time around. Requests for ‘kinky stuff’, if it’s going to happen, tend to happen a few months in so you’re safe for now. If they do suggest something you’re not comfortable with, simply say ‘I don’t think I’m ready for that now. Can we stick to basics until we know each other better?’.”

4. Explore your body with some solo sex

“If you’re not already doing this, start having some solo sex sessions to get your body used to the feeling of orgasm – perhaps by experimenting with sex toys. There are some good beginners’ toys you can try here. The more you explore your body and know what feels good and what doesn’t, the more confident you’ll be in bed with someone else. Sex toys are a great way to discover how your body works and what it responds to, making you sexually happier and more confident.”

5. Get your attitude right

“Sex isn’t an exam. You’re not going to be graded pass or fail (and if it feels like you are, you’re with the wrong person). So, stop stressing and thinking: ‘this has got to be perfect’. Perfect sex happens to people in movies; normal people muddle through the first time.”

6. Don’t be scared to dim the lights

“Lighting is crucial – especially if you’re body conscious. Don’t be scared to say what you need. If you want it really dark for
the first time, say so. You can start turning up the dimmer switch when your confidence increases.”

Complete Article HERE!

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