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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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How to Talk to Your Younger Sibling About Sex

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Since older siblings can sometimes be the best sex-ed teachers, here are four important topics to cover and a few links about how to get the conversation started.

Positive sexuality is at the forefront of conversations being had by student activists on college campuses. Dismantling the societal constructs of traditional masculinity and femininity and redefining campus sexual scripts are priorities aiming to decrease sexual assault rates and increase discussion about what perpetuates them.

As a result, college students are in a prime position to be instigators of conversations amongst younger groups, because they are at the core of the rapidly changing dialogue prompting social changes that support young adults in expressing their sexuality and promoting safe sexual climates for everyone.

Being a mentor to the younger kiddos in your life, and more specifically the youngsters in your family, can be a tricky yet invaluable role to fill. If you decide to open up a conversation about sex with younger siblings, some awesome topics to include are consent, gender identities and expressions, contraceptives, birth control and the construct of virginity. There are certainly other categories to include, and questions will likely arise about the many nuances of sex, but starting with broad ideas essential to healthy sexuality will set up the conversation to be productive and meaningful.

1. Consent

It’s never too early to start introducing principles of consent into children’s lives, nor is it ever too late. If your siblings are elementary school-aged, having a conversation with them about consent does not have to centered around sex, because consent is applicable to any and all interactions, whether sexual intentions are present or not.

Teaching young kids to ask for permission to hug someone or to sit close to someone plants the seed for healthy habits of asking for and offering consent to grow. If younger individuals become accustomed to asking for consent in small, everyday ways, they will be more aware and respectful of others’ boundaries. As they grow into adolescents and college students, the concepts of consent will be second nature and clearly understood when they do enter into sexual contexts where consent is required.

Regardless of the age of your siblings, consent is applicable to everyone and should be a frequent, continuing conversation. For siblings that are old enough to dive deeper, unpacking the mechanics of genuine and enthusiastic consent can include information about how things such as power dynamics, substances, coercion and intimidation can all influence the improper acquisition of consent. This is also a great time to emphasize that despite the common tactics used to unfairly obtain someone’s consent, the right to enthusiastically consent to sexual activity without the influence of outside factors is omnipresent, powerful and absolute.

Consent is a quintessential component of healthy sexual encounters! For more info on consent, and the “Yes Means Yes” campaign advocating for enthusiastic consent, check out https://www.yesmeansyes.com and have your siblings take a look, too for the scoop on all things consent and respect. As quoted in an article on everydayfeminism.com “conversations about consent—especially if those conversations are with children—are not always easy to have. They are, however, necessary if we’re trying to create a society in which consent is understood and respected by adults and children alike.”

2. Gender Identities

Another frequently skipped-over chapter in the sparse book of sex education in America is the section on gender identity. Thanks to celebrity stories in recent years such as Caitlin Jenner, Jazz Jennings and many other Hollywood young adults openly identifying as gender fluid, bisexual and indicating other identities along the gender-nonconforming spectrum, gender identity and gender rights have become popular topics. While many school sex education programs are a bit behind the times and have yet to add conversations about various gender identities into their curriculum, older siblings can try to fill some of the gaps.

The biggest point to emphasize to a younger sibling is the difference between sex and gender, and that gender is a social construct that is governed by expectations and norms that align with the gender binary system. To expand on that, include notes about how gender is made up of multiple components that fall along a spectrum; there are new models, like the gender unicorn, being developed to illustrate this idea; the colorful and simple designs are engaging for young learners and a great visual representation of the spectrums in general.

Most of all, encourage youngsters to explore and contemplate their own gender identity by questioning the norms they’re conditioned to live in accordance with, and support them unconditionally in their discoveries. Your unwavering love may serve as an example for when they find themselves being a support for a friend or peer one day.

3. Contraceptives

For siblings that are approaching the age of dating and having sex, a little brush up on contraceptive options is a helpful addition to sibling sex-education sessions. This goes for all gender identities, not just the ladies! Everyone should be aware of how to protect themselves and their partner of choice, so that everyone can feel safe and focus on other matters at hand. A quick browse through the “Birth Control” tab on teenshealth.org gives an extensive explanation of the various methods of birth control and contraceptives, the intended uses of each, the effectiveness rates and some FAQs.

While talking with a healthcare provider is the best idea for beginning a birth control plan, providing kiddos with information about their options allows them to reflect on what they’re comfortable with and choose an option that suits them if and when they need it.

4. Virginity

When younger siblings are thinking about becoming sexually active, a chat about the virginity construct can help them reflect on what sex means to them. There is heavy emphasis placed on the “losing of” one’s “virginity” and how the experience is meant to be transformative, pivotal and special. For some, the giving of virginity to another person signifies an act of deep trust, intimacy and comfort. For others, the concept of virginity is merely an ancient phrase sometimes used to label the beginning of their sexual adventures.

There is no right or wrong way to think about a first sexual experience, nor is there a universal definition of what composes the official loss of virginity, which some sex beginners don’t get the chance to contemplate before diving in. The concept of virginity loss is associated with impurity and places the person taking someone’s virginity in a position of power, while the person who “lost” it is seen as sacrificing something valuable.

Contemplating the idea that virginity is not a physical state or thing, but instead a construct that can be accepted or disregarded, allows young people to decide for themselves how they want to think of sex and define it in their own terms. First times are a lot of things, ranging from spontaneous, meaningful, messy, calculated or a combination of everything. Restructuring the way young adults think about their first sexual experiences gives them the power to conceptualize their sexual debuts as they choose to.

Beyond everything, the most important thing about having a conversation with siblings about sex is just to have it (the conversation). In the era of change kids are growing up in, the taboo topic of sex is not yet a conversation of full disclosure, even as it gains traction. Being an advocate for positive sexuality development by starting dialogue can help change this, one awkward chat at a time.

The following websites are excellent resources with information on the topics above and many more! They’ve got tips for curious teens and lots of advice for how to start a conversation.

Complete Article HERE!

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Why Your Sex Drive is Crashing and How to Fix It

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Expert tips on how to get your mojo back

By Linda Bradley, MD and Margaret McKenzie, MD

A low sex drive, also known as low libido, is one of the most common issues among our female patients. Most are very relieved to find out they are not alone in this struggle. This generally happens to new moms and menopausal women, or just simply when work and family life takes its stressful toll on a woman.

Sometimes we just aren’t in the mood for sex and that is OK. Being present in your relationship and having a responsive partner are important for continued sexual interest in your relationship. Knowing that fatigue and stress as well as problems in our relationship can cause us to have a low drive, you need to let your doctor know what’s going on in your life because social stressors affect sexuality.

There are a lot of external factors that could hinder your sex drive as well. Are you taking hormones or anti-depressants? How much do you drink? Any new illnesses? Sign of abuse in your relationship? Financial problems? Children or family problems? Lack of privacy in your bedroom? Your health care provider needs to probe deeply to determine if any of these factors may influence your libido. We want to help you get your mojo back and exploring these sensitive topics is warranted. In other words, we’re not being nosy or intrusive.

Women suffering from low sex drive report their sexual desire and receptiveness to sexual activity to be approximately none at all to once a month or even once every couple of months. While there’s no fast and sure cure, the first step to overcoming this would be to recognize it without blame or shame, then brainstorm ways to make sex a priority once again. There are various strategies women can adopt alone or together with their partner.

For instance:

  • Make if a point to enjoy some “you” time in order to de-stress.
  • Relax in a long (hot or cool) bubble bath.
  • Refuel emotionally through meditation or journaling.
  • Exercise regularly to increase your stamina.
  • Schedule a date night with your partner — and stick to it!

If sex is painful, or if hormonal problems are the issue, then medical attention is necessary. Generally, though, women have to come to grips with the fact that a strong, healthy sex drive doesn’t just automatically happen after spending years in a relationship. You must put effort toward it and make it a priority. In addition, as relationships age, and was we and our partner age, other factors like body image, chronic disease, blood pressure medications, anti-depressants, and certain hormonal therapies may impact sexual desire.

Having a lack of desire is one of the most commonly reported sexual issues that our patients bring into the arena of sex. Don’t be afraid to bring this up as many times as you need to. Doctors have many helpful solutions. So be bold and write it on your list of things to discuss at your visit with your doctor so you don’t forget.

Complete Article HERE!

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How to introduce BDSM to the bedroom without terrifying your partner

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Everything you need to know about adding a bit of kink to your bedroom

First things first, let’s clear up exactly what BDSM means: bondage and discipline (B&D); dominance and submission (D&S); sadism and masochism (S&M).

It’s split up this way because BDSM means a lot of different things to the people who identify with it. And don’t believe the 50 Shades Of Grey hype – when performed consensually, those people aren’t mentally unstable or have a history of abusive behaviour, they just have a kinkier nighttime ritual.

Another 50 Shades misconception is that BDSM involves pain or sex at all. It doesn’t (unless you both want that). The only requirement involved with BDSM is trust and consent. There is always a dominant person (gives orders, is in complete control) and a submissive participant (receives orders and does as they’re told by the dominant). EL James obviously wasn’t a fan of fact-checking.

Yet the book, which is generally looked down on by BDSM fans, has helped it become more mainstream, High Street even – some Ann Summers stores now have their own BDSM sections selling all the impedimenta you need, which, plainly, is great if you always wanted to partake but were too afraid to ask. But there’s still a slight stigma attached to it, so you’ll need to plan this carefully.

First of all, research is key. Settle in for a long session on a BDSM tube, hit a BDSM chat room (yep, they still exist), read BDSM erotic fiction – expose yourself to as much of it as you can and work out exactly what it is you like. Once you’ve got your head around it, share it with your other half. This is not the time for shock and awe – start gently, maybe showing them a video you’ve seen. Say, “Looks kind of sexy, don’t you think?” and gauge their reaction. If they’re into it, great. If not, park it. It may plant a seed in their mind that does eventually flower, it may not. You can’t force them. That’s not what BDSM’s about.

Assuming they’re happy, it’s time to introduce it to the bedroom. BDSM isn’t an impulsive act; it takes planning, research and preparation, but a good transitional device is a mask. Buy one and ask if they want to wear it/mind you wearing it during sex. It might seem trivial, but whoever’s wearing the mask (the submissive) has to put all of their trust into the person who isn’t (the dominant) and that’s where things should get sexy. If it felt good, suggest a massage with a vibrator while their eye mask is on.

If that’s the extent of your fantasy, great. Mission accomplished. But if you want to edge towards the kinkier side of things, you need to keep establishing that trust by never exploiting it, obviously, but also by having plenty of post-coital discussions about what you both liked and what else you could try. Then you need to prepare yourself. When I said BDSM wasn’t impulsive, I meant it – you need an awful lot of gear if you want to explore BDSM more broadly.

Want to tie someone up? You’ll need a specialist product that reduces the risk of rope burn. Then you’ve got to think about adjustments. Things like spreader bars (Ann Summers sells out of these every Valentine’s Day) and nipple clamps aren’t necessarily designed for pain because you can change how tightly they fasten, and some days you or they may wish to be in more or less pain than the time before. Then there’s putting on the BDSM uniform. Whether that’s just lingerie or, well, a uniform – it all takes time and a very free schedule. But if procuring the products, setting them up and getting dressed up is worked into the ritual of kinkier sex, the prep can become its own pleasure.

By now, you should be in full swing, enjoying all the safe, sexy delights BDSM can offer, whatever that might mean to you. I bet they put Christian Grey‘s efforts to shame.

Complete Article HERE!

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How to Talk Openly With Your Kids About Sex

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By Michele Hutchison,Rina Mae Acosta

This spring, Rina’s four-year-old kindergartner Bram Julius will learn about colors, shapes, how to play nicely with other children, and take his first steps towards learning about sexuality at school. In these early sex ed lessons the class will discuss butterflies in your stomach, friendship, and whether or not you’re happy to hold hands with another child. Meanwhile, my nine-year-old daughter Ina will be having class conversations about the physical changes during puberty and romantic relationships.

Each spring, Dutch children between the ages of four and twelve receive a week-long national sex-education program at school. The aim of these lessons is to allow for open, honest discourse about love, relationships, feelings, personal boundaries, and sex. The Dutch approach is even more surprising when I think about the climate I grew up in. Sex-ed was something you were taught at school in an embarrassing biology lesson. You couldn’t talk about it openly. The Dutch national sex-ed school program might seem odd or controversial, especially since a recent CDC study shows that nearly 80% of American children and teenagers do not receive any formal sex and sexuality education before having sex. But given the bigger picture, we think the Dutch are onto something.

The United States has the highest teen pregnancy rate in the developed world while the Dutch have among the lowest—eight times lower than their American counterparts. Research also indicates that, on average, teens in the Netherlands do not have sex at an earlier age than those in the US. This is the case even though Dutch society and parents are more relaxed, even allowing romantic sleepovers in their own homes. If you treat teenagers as if they are mature and responsible enough to make decisions, they might actually live up to those expectations.

It seems that with American children being constantly exposed to sexual content in the media through music videos, prime-time TV, and the internet, American parents anxiously avoid talking to their children about sex in the hope of not exposing them any further. This, in a climate where sexting, sending sexually explicit texts, is becoming increasingly common, even as early as in middle school.

While Dutch schools are providing age-appropriate lessons on intimacy and sexuality, instilling in children a safe code of conduct and respect for others, Dutch parents keep nothing from children. Nothing is taboo. Questions are answered simply and honestly, at the child’s level of understanding and maturity, as they arise. It was one of the first pieces of parenting advice we received from other parents here. Recent questions from my son, Ben, who is just a couple of years shy of becoming a fully-fledged teen, include: “Is sex fun? How?” and “How does a sperm donor get the sperm out?” I have been answering my kids’ questions on anatomy and reproduction from almost as early as they could talk.

Of course, sex can be a tricky, embarrassing topic no matter what culture you’re a part of. But by talking more openly about sex, parents can ease into discussing topics that become more complicated as their children grow older. Topics like gay marriage, sexuality, gender issues, and consent. There’s an added bonus to all this communication: children who have a good relationship with their parents tend to wait longer before having sex.

Like most expats, we were shocked to hear that Dutch parents allow their teenage children to have friends of the opposite sex to stay the night. But here, most teenagers have their first sexual experience in the safety of the parental home—how many Americans can say the same? According to a UNICEF report, 75% of Dutch teenagers use a condom the first time they have sex, and data from the World Health Organization shows that Dutch teens are among the top users of the birth-control pill. So teenage sex is allowed, but preferably in a controlled environment, that is, under the teen’s parents’ own roof. A safe place to have sex encourages safe sex.

Dutch children are well equipped with knowledge about sex before they enter puberty. If they are, the Dutch have learned, they will take fewer risks later on and know how to protect themselves.

It’s no wonder that Dutch kids are considered to be the happiest kids in the world! The Dutch have a very different view of what a child actually is—including accepting the reality that their children will have sex at one point or another . If American parents are anxious to keep their children safe, perhaps it would be better if they, and teachers, were more open about sex after all.

Complete Article HERE!

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