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Sexuality and Illness – Breaking the Silence


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

By: Anne Katz PhD

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

Am I still a sexual being?

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

Just talk about it!

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

The role of health care providers

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

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

Ask for a referral

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

Complete Article HERE!

Sexuality at the End of Life

By Anne Katz RN, PhD

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

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

Communicating About Sexuality with the Terminally Ill

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

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

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

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

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

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

Sexual Functioning At The End Of Life

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

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

The needs of the couple

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

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

Addressing sexual needs

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

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

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

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

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

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

Complete Article HERE!

Beginning Sex Play — Tips and Techniques

I most frequent hear from your average Dick and Jane, (or Dick and Dick, or Jane and Jane) who want to spice up their sex life. When they write to me they inevitably describe the kind of sex they’re currently having. And almost universally that description makes this grown man cry. Jeez, the boredom. How can they stand it? It’s a wonder any of them are having sex at all.

big funWhat’s with all the humdrum, run of the mill, we’ve always done it that way mentality? Are ya’ll afraid that if you add a little something new to your sex chore from time to time that the sky will fall? Holy cow!

Today’s tutorial is yet another attempt to motivate you to get off your butts and make something interesting happen in the sex department. We’ll begin today with what was once called foreplay.

First off, I hate the word “foreplay” because it suggests that all the really great sex play activities out there are only a lead up to a single — more important activity — that is fucking. It also implies that ya’ll can dispense with the one in order to hurry up and get to the other. And that, sex fans, is always a huge mistake.

From now on I want you to banish “foreplay” from your vocabulary. Instead let’s start using “Beginning Sex Play.” It says it all. It says it’s at the beginning, but there’s no suggestion that anything in particular must follow.amazing sex secrets

I’m of the mind that we’d all be better served if we thought of sex play as a continuum of pleasure with a beginning, middle and an end. If you ask me, our sex play ought mirror our sexual response cycles — arousal, plateau, orgasm and resolution. That way we’re less likely to overburden one particular activity at the expense of all the others. Get it? Got it? Good!

Experienced sex fans agree; the best sexual encounters include an extended period of sensual play at the beginning of most all sex play. This brings increased pleasure to both partners, and will make whatever else that might follow more satisfying. Just remember, beginning sex play can be a meal in itself.

Beginning sex play brings spice to the encounter because it gets our motors started. Even all you major sex athletes out there, who are perpetually primed for sex, will benefit from more beginning sex play. It will help cool your jets and make the encounter last longer than a firecracker. And I know that you know what I mean!

erotic talkIn our hectic rush-around-world, beginning sex play is particularly important. It helps us transition from the daily cares and woes to the realm of sensual pleasures. The workaholics among us need more time to become fully aroused. Our minds are still filled with the junk of the day, and not yet ready to give or receive pleasure. And pleasuring and being pleasured, I might add, takes a big attitude shift from that of the rest of the day. In fact, if you’re gonna try and approach sex and pleasure with the same mindset as you have on the job or with the kids, give it up now and be done with it. You’ll only walk away from the encounter disappointed.

Beginning sex play primes us for maximum pleasure. Us men folk will have the time we need to come to full erection and the women folk will have the time they need to properly lubricate. (By the way, this is called the arousal stage in our sexual response cycle).

When we stop thinking of beginning sex play as “foreplay” we realize there is no such thing as spending too much time giving and getting pleasure. If beginning sex play evolves into full-on fucking — SWELL. Both partners will be fully aroused and fucking will flow naturally and effortlessly from the pleasure enjoyed at the beginning of sex play.

Beginning sex play can include everything from chocolate and whipped cream to whips and chains. But let’s not get too far ahead of our selves. Let’s start at the beginning of beginning sex play, shall we? beginner's guide

Most people miss out on the pleasure of undressing with and for their partners. Stripping out of, or being helped out of our daily wear and into something sexy or nothing at all can be very arousing. It’s also a visual signal that we’re shifting out of our work-a-day world and entering the realm of sensuality. Stripping is an art form, ya know. We could all learn a lesson or two from the folks who do this for a living, but more about this in THIS tutorial.

Creating the right sex environment is important too. Make sure the room is warm. Proper lighting and music will surely add to the mood. Scents are also important. More and more people are incorporating erotica into their sex play — reading a sexy story together or enjoying some hot porn will make the encounter memorable.

Most women complain that their partners don’t kiss long enough and rush the kissing to get at their pussy. Guys, what the fuck? You want pussy? Use your mouth to maximum advantage kiss and nibble all over everything. Literally devour your partner with your mouth. Believe me, if you do this right, by the time you get to her pussy she’s gonna want to give it up big time.

Hanky Spanky Gift SetBeginning sex play is the perfect time for setting the mood for all that might follow. It’s a time for sharing fantasies, role-playing, dirty talk or some full body massage. Always have some nice lotion available then use your hands, forearms, feet and elbows to knead your partner’s muscles and naughty bits.

Certain areas on the body are more hot-wired than others. It’s your job to find each and every one your partner has. As you massage vary your strokes and touch to stimulate your partner. Roll your fingertips across his or her nipples and behind his or her ears as you kiss him and tease her with your tongue.

If you’re doin things right, your partner will be moaning with pleasure. If she or he starts getting impatient it’s time to bring out the restraints. There’s nothing like some hot erotic bondage to punctuate the beginning sex play.

While your darling is subdued and possibly blindfolded, crank things up a notch. Add different sensations and stimuli, a warm chocolate sauce followed by ice cream. A fur mitt followed by a Loofah. Introduce some sex toys — a vibrator, tit clamps, or an anal simulator.

Don’t forget to check in with your partner from time to time. Ask for some feedback and direction. Do you like this? Or do you like this better? If you presume that you know what your partner likes simply because he or she liked it before, that, my friend, is a recipe for boredom and the dreaded bed death. If words fail you, SHOW your partner what you want. Then encourage your partner to do the same.002

Beginning sex play is not about pressing the right buttons in the right order. It is about understanding what makes your partner tick and supplying and applying those things to their greatest sensual advantage. There are many ways to give your partner extreme pleasure, and it all begins in your brain. Beginning sex play is as much of an art form as it is a necessity. Finally, the basic premise behind all of this is that the great lover is one that gives pleasure because it is its own reward, not a means to getting something else.

Good luck

When did sex become shameful?

By Hanna G Ruby

Once upon a time sex was enjoyed without shame, as a gift of God, Goddess, the Great Spirit – an act of joy, of devotion, something perfectly natural and wholly divine – all at the same time.  Once upon a time the goddesses were venerated as the embodiment of love, passion, and sex, which were considered holy when performed in reverence for and in service of the female divinity.

But the mindset of patriarchy killed off the Goddess more than five thousand years ago. She was constrained to submission at worst, or virginal purity and celibacy at best; her divinity denied. With that, the idea of sexuality as spirituality, as something inherently divine, was eradicated for all women – young and old. Indeed, for all men as well!  Sexuality was severed from spirituality and became its extreme opposite; sex was dirty, primitive, and instinctual (and feminine in nature), while spirituality was pure and clean and transcendent (and masculine in nature).

In the West, however, it was only from our Bible onward that sexuality became a sin, the means by which the devil could tempt mankind into damnation, a shameful necessity of physical gratification that was obscene and dirty. Only from our Bible onward, were women considered inherently sinful and destined for eternal punishment.

Even before Eve bit that apple, there was poor, feisty Lilith (born initially as one with Adam – “male and female created He them” says the first Biblical reference), who, according to legend, preferred to have sex on top. Lilith represents lunar consciousness (waxing and waning, death and rebirth), sexuality, body, and intuitive wisdom – all of which patriarchy degraded and denied. She got a terribly bad press.

Previously, the Goddess had ruled the mysteries of sexuality, birth, life, and death. Now the patriarchal God took control of life and death, and split procreation and motherhood from sexuality and “magic and mystery”. Lilith refused to submit and flew off in a rage. Until recent decades, she has been universally demonized as seductive, witch, outcast – the enraged, avenging goddess, wife of Satan.

Solar was split from lunar; psyche from soma or physical, corresponding to a general disassociation from the body. Mind and body, spirit and body, soul and body were split entities, and unequal. The body was inferior, an unfortunate necessity – together with its most basic of functions, sex; and it was associated with the feminine. (I once read an old text that described women as “bags of filth”. The males’ organs of excretion were not referred to.)

Male and female were unequal; spirit and nature were unequal. Man headed the chain of command – after God. As women, and as a culture, we have paid dearly for this division. The misogyny of the patriarchy affected all cultures in the last 2000 years, one way or another.

The fierce, sexual, independent-spirited wise dark goddess aspect of Lilith was replaced by submissive Eve, who was yet blamed for the whole messy business anyway. She was the sinful one, secondary to Adam, and cursed forever to give birth in pain. (Medieval midwives were sinning when they alleviated the pain of childbirth.)

As long as Eve is sinful and physical matter corrupt in any way whatsoever, our sexuality is compromised – and our liberation incomplete. This split must be healed.

I am proposing that sexuality and spirituality are aspects of the same thing; that the split between psyche and soma (the physical) is resolved in the energetic unity of a higher order. “We have lost contact with what unites them,” says Alexander Lowen in The Spirituality of the Body.  Sexuality is psychosomatic – and by that I mean, not that it’s some kind of illness, in the more common meaning of the word, but that it overtly operates on both the physical and the psychic level.

Where science and religion are finding rapprochement in the infinite wave world of quantum physics, we find fresh metaphors for the lost unifying element. Waves of sexual sensations that emanate from the body can be visualized as cosmic, psychic energy, high-frequency vibrations that bridge us to higher consciousness.

These metaphors indicate possibilities that have profound implications generally, and more so for aging women today.

Complete Article HERE!

Review: The Ultimate Guide To Sex After 50

Hey sex fans!

2015 is turning out to be a banner year for sex positive books. Here it is still only January and this is my second review of a noteworthy book about human sexuality.

A few weeks ago, January 8th to be precise, I introduced you to Cooper S. Beckett’s book, My Life on the Swingset.  In that review I mentioned that Cooper had been a guest on my Sex EDGE-U-cation Show.

Today’s review features a book written by another guest on my show, but this time it was the SEX WISDOM Show. Today’s book, The Ultimate Guide to Sex After Fifty: How to Maintain – or Regain – a Spicy, Satisfying Sex Life, was written by the brilliant, Joan Price.

Joan is on the forefront of our culture’s discussion on ageless sexuality. She is the author of Ult+Guide+Sex+50+covertwo other books, Better Than I Ever Expected: Straight Talk about Sex After Sixty and Naked at Our Age: Talking Out Loud about Senior Sex. She is a sought-after speaker and workshop leader. And, if that weren’t enough, she’s also a fitness expert. This woman is a ball of fire, sex fans, and an absolutely charming interview. Be sure to listen to the two-part interview I did with Joan, you’ll find them archived HERE and HERE!

Joan and I talked about some the many myths that surround sex during life’s second half; she covers this topic more in depth in her new book. The misinformation about sex after 50 is so pervasive that even many of us seniors and elders perpetrate it. And, of course, we’re often the butt of jokes.

1. We lose interest in sex as we age.
2. Senior sex is boring.
3. Dating as a senior/elder is depressing and hopeless.
4. Seniors with arousal issues just give up on sex.
5. Sex becomes more frequent as we age.
6. Real sex must involve intercourse and orgasm.
7. Health concerns and menopause will end one’s sex life.
8. If you’re interested in sex after you turn 50, you’re a dirty old man/woman.

The Ultimate Guide to Sex After Fifty is the perfect antidote to the dismissive and degrading way that so much of the popular culture deals with senior and elder sexuality. Joan celebrates not only the existence and appropriateness of sexual desire for seniors and elders, but how sex can and does increase the health and wellbeing of older people.

Joan states her credo in the Introduction.
“…being sexual at this time of life means:
• Enjoying arousal and orgasm, with or without a partner
• Having a zesty, sex-positive frame of mind
• Being open to new possibilities
• Giving pleasure to this body that is capable of great delights
• Making a commitment to myself to be sexually aware and healthy”

Joan invites her readers to join her in conversation. And a big part of that conversation is being aware of what’s going on with our body as we age. Being attuned to that, and being able to communicate that to a partner, is key to great senior/elder sex. (To be frank, it’s the secret of great sex at any age, but I digress.) To that end, Joan includes in her book actual comments from real people that she has encountered in her work. These anecdotes reflect an array of feelings that underscore the conflicts, successes, and complexities of real life situations. And this being the Ultimate Guide, Joan includes the input from many of our colleagues who weigh in with their expert opinion on the topics she is addressing.

I love that Joan often makes the point that having a fulfilling sex life is not dependent on having a partner. Lot of seniors and elders are without a partner, but that ought not be an impediment to sexual enjoyment. Self-pleasuring, with one’s hand, or any of the myriad toys available to us, is the foundation of a rich, healthy, rewarding, and ageless sex life.

Joan also examines a topic near and dear to my life. In my book, The Amateur’s Guide To Death And Dying; Enhancing The End of Life, I took great pains to include a chapter about the sex and intimacy needs of sick, elder, and dying people. Joan does something similar in her chapter — Cancer, Cancer Treatment, And Sex. I am so grateful that Join addressed this timely topic, suggesting, as she does, that people challenged with cancer, or any other chronic condition for that matter, take their sexual performance questions to their doctors. I think we both believe this will go a long way to underscore the notion that wellbeing is not merely about absence of disease, it’s’ about quality of life. There’s also a marvelous section about sex and grief too.

And, just so you know, this isn’t a hetero-centric book. Joan includes all sexual orientations and lifestyles.

I highly recommend Joan’s new book, The Ultimate Guide to Sex After Fifty, to everyone. If you are a fellow senior or elder, this book is chock full of important and practical information about things we care about. It also provides much needed support and encouragement as we make our way through this season of life. If you’re not a senior or elder, this book is an indispensable resource for you too. Not just so that you will be sensitive to the needs of others, but that you’ll grow in appreciation of the fact that sex is for a lifetime. And hey, you just might learn a little something new from someone who isn’t “new”.

I want to say a special thanks to Cleis Press, Joan’s publisher, for sending me this review copy of The Ultimate Guide to Sex After Fifty.

Kudos to Joan! Your book is a marvel.

Be sure to check out Joan’s websites: and

PS:  This book would make a fantastic Valentine’s Day gift.

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