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Assisted-living facilities limit older adults’ rights to sexual freedom, study finds

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Georgia State University

senior intimacy

ATLANTA — Older adults in assisted-living facilities experience limits to their rights to sexual freedom because of a lack of policies regarding the issue and the actions of staff and administrators at these facilities, according to research conducted by the Gerontology Institute at Georgia State University.

Though assisted-living facilities emphasize independence and autonomy, this study found staff and administrators behave in ways that create an environment of surveillance. The findings, published in the Journals of Gerontology: Social Sciences, indicate conflict between autonomy and the protection of residents in regard to sexual freedom in assisted-living facilities.

Nearly one million Americans live in assisted-living facilities, a number expected to increase as adults continue to live longer. Regulations at these facilities may vary, but they share a mission of providing a homelike environment that emphasizes consumer choice, autonomy, privacy and control. Despite this philosophy, the autonomy of residents may be significantly restricted, including their sexuality and intimacy choices.

Sexual activity does not necessarily decrease as people age. The frequency of sexual activity in older adults is lower than in younger adults, but the majority maintain interest in sexual and intimate behavior. Engaging in sexual relationships, which is associated with psychological and physical wellbeing, requires autonomous decision-making.

While assisted-living facilities have many rules, they typically lack systematic policies about how to manage sexual behavior among residents, which falls under residents’ rights, said Elisabeth Burgess, an author of the study and director of the Gerontology Institute.

“Residents of assisted-living facilities have the right to certain things when they’re in institutional care, but there’s not an explicit right to sexuality,” Burgess said. “There’s oversight and responsibility for the health and wellbeing of people who live there, but that does not mean denying people the right to make choices. If you have a policy, you can say to the family when someone moves in, here are our policies and this is how issues are dealt with. In the absence of a policy, it becomes a case-by-case situation, and you don’t have consistency in terms of what you do.”

The researchers collected data at six assisted-living facilities in the metropolitan Atlanta area that varied in size, location, price, ownership type and resident demographics. The data collection involved participant observation and semi-structured interviews with administrative and care staff, residents and family members, as well as focus groups with staff.

The study found that staff and administrators affirmed that residents had rights to sexual and intimate behavior, but they provided justifications for exceptions and engaged in strategies that created an environment of surveillance, which discouraged and prevented sexual and intimate behavior.

The administrators and staff gave several overlapping reasons for steering residents away from each other and denying rights to sexual and intimate behavior. Administrators emphasized their responsibility for the residents’ health and safety, which often took precedence over other concerns.

Family members’ wishes played a role. Family members usually choose the home and manage the residents’ financial affairs. In some instances, they transport family members to doctor’s appointments, volunteer at the facility and help pay for the facility, which is not covered by Medicaid. They are often very protective of their parents and grandparents and are uncomfortable with new romantic or intimate partnerships, according to staff. Administrators often deferred to family wishes in order to reduce potential conflict.

Staff and administrators expressed concern about consent and cognitive impairment. More than two-thirds of residents in assisted-living facilities have some level of cognitive impairment, which can range from mild cognitive impairment to Alzheimer’s Disease or other forms of dementia. They felt responsible for protecting residents and guarding against sexual abuse, even if a person wasn’t officially diagnosed.

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Co-authors of the study, Georgia State alumni, include Christina Barmon of Central Connecticut State University, Alexis Bender of Ripple Effect Communications in Rockville, Md., and James Moorhead Jr. of the Georgia Department of Human Services’ Division of Aging Services.

The study was supported by a grant from the National Institute on Aging at the National Institutes of Health.

Read the study HERE!

Complete Article HERE!

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‘I’m 62 and my sex life is more important now than ever’

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‘I don’t believe I shouldn’t have a sex life just because I haven’t met ‘the one’’

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Sex is just as important for women after 50: that’s what the European Court of Human Rights made clear when it ruled that the judges who reduced a 50-year-old woman’s compensation for a botched gynaecological operation had discriminated against her.

Maria Morais, who is Portuguese and has two children, sought compensation on the grounds that she was unable to continue a normal sex life, but the judges in the original case had argued that the importance of sex declines for women as they get older.

The European Court of Human Rights found that this constituted sexual discrimination, and that the judges had “ignored the physical and psychological importance of sexuality for women’s self-fulfilment and other dimensions of women’s sexuality”.

Sex doesn’t stop at a certain age

In popular culture, portrayals of relationships among older people are becoming more common, implying a greater acknowledgement of older women’s sexuality

In popular culture, portrayals of relationships among older people are becoming more common, implying a greater acknowledgement of older women’s sexuality. The film It’s Complicated (2009) starred Meryl Streep (inset), whose character has an affair with her ex, played by Alec Baldwin, decades after their divorce. This year, Hampstead saw Diane Keaton as a widow falling in love with a man living wild on Hampstead Heath, played by Brendan Gleeson.

Data backs up her case, too. In 2014, a Saga survey of 9,685 people aged over 50 found three-fifths are sexually active and 23 per cent are having sex once a week.

Research released by the Longevity Centre in 2016 showed that 60 per cent of men and 37 per cent of women aged over 65 had sexual activity in the past year.

Caitlin (not her real name), 62, needs no court ruling or Hollywood film to tell her that her sex life is important. She has been in a number of monogamous relationships, but is now having intimate relationships with more than one man.

Having an active sex life makes me feel alive. There’s a deliciousness about it.

I’m single and I have sex regularly, but I’ve been celibate in an earlier relationship when my partner lost interest. I have also been a mistress, where I discovered the thrill of coming to terms with my non-vanilla side. I feel more in touch with my sexuality now than I ever have done.

Sex is not the be all and end all. While I’m passionate about sex for those who want it, I’m also very aware that other people can get satisfaction from other things. But I think if one has the desire, sex is such a fabulous, life-enforcing thing at any age. It’s just a marvellous sensation.

Being 62 doesn’t mean I have to settle

I talk openly about my sex life with my close friends; it’s a running joke with them about what my neighbours would make of me.

I’m not hankering for my ‘one and only’. If I met them, that would be delightful. But I don’t believe I shouldn’t have a sex life just because I haven’t met ‘the one’. You can have good enough relationships that are absolutely fine without being the big thing. I don’t like compromising – just because I’m 62, it doesn’t mean I have to settle.

It would be fabulous to meet somebody who ticks all of the boxes, but I don’t feel I’m missing out because I haven’t got that. Having a sense of adventure and not knowing who I may meet is great fun.

I wanted to be open minded about sex

‘I was stood in the college library and thought, ‘I’m going to go and masturbate’

I grew up in a village South Wales and lost my virginity aged 18 to the man I thought I was going to marry. It was a huge thing because I was still a practising Catholic and it was not the done thing to have sex at school.

At that age, I wanted to be open minded about sex. I enjoyed it. I loved the power of being able to turn a man on, But with everything around you [at that age] you have a patriarchal version of sexuality. The whole thing of ‘what is sexy’ comes from the images you see.

I never masturbated as a teenager – I think I was quite proud that I didn’t. Then I got into this relationship and started to think there must be more to sex than this. When I was 19, I was stood in the college library and thought, ‘I’m going to go and masturbate.’ And I went back to my room and I did!

I began exploring my sexuality in my forties

‘I set myself a goal of being able to use a computer.’

I’ve always had sexual fantasies about spanking, which meant I had a life time of growing up with these suppressed fantasies that I thought were sort of dangerous.

I began exploring my sexuality in my forties when I posted adverts in a magazine. I met someone I thought I was going to be with for the rest of my life when he responded to my advert.

He already knew that I had these fantasies from reading my advert. Our sex life was completely vanilla but fantastic and very active until about six years in, when he developed an illness and went off sex. He seemed almost relieved of the burden.

I cared about him and so I put up with it and set myself a couple of personal goals. One was to learn to use a computer properly. Another was to start creative writing – I had always wanted to write erotica.

Things changed with this exploration of female sexuality and fantasies. I realised I wasn’t going to bring the world crashing down because I have sexual fantasies.

Age 56, I started advertising for lovers

‘I discovered this community out there with the same interest.’

Writing erotica was fun and I was curious to find out if what worked for me sexually worked for other people. I discovered this community out there with the same interest and it brought me back to life.

I started communicating with a man online. We discovered we were both in sexless relationships. I had never been unfaithful and took monogamy very seriously but I was getting to the point where I couldn’t continue like this. I told my partner I was going to struggle to stay faithful if our relationship remained non-sexual.

Suddenly, we had a fantastic sex life again. But it only lasted a fortnight.I told my partner again that I would not be able to be faithful in a sexless marriage and he left me. The man I was talking to online became my lover.

I began putting adverts out online to meet other people and started having other sexual partners. I was 56 at this time.

Sex has to be intimate

We have the rituals you have as a couple; going out together, watching TV, going on holidays

For me, there has to be a level of intimacy in sexual encounters. I met a couple of guys where there was a coldness and that is just not right for me. But there can be a level of intimacy without love.

There’s a chap I’ve been seeing for a few years and we’re very comfortable with each other. We have the rituals you have as a couple; going out together, watching TV, going on holidays.

I see other people because the time we have together is limited and I want more. The ages of the people I see varies; I recently stopped seeing someone who was five years older. The oldest chap I was seeing was about 69. But I’ve also had relationships with people in their thirties and forties.

I’ve now moved back to the village where I grew up. I’m part of the Women’s Institutes and I’ve done relatively serious things work wise. It’s just nice that there is this other part of you that is private, such fun and so life-enhancing.

Complete Article HERE!

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What straight couples can learn from gay couples

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When I embarked on the seven-year journey that would result in a trilogy of comedy shows and my first book, I had no idea what a huge part sexual orientation would play.

Yes, I’m a lesbian and that has influenced much of how I’ve socialised and dated for the 20 years or so since I came out. Yet, as I talked to more and more LGBT people – particularly those a little older than me who had experienced way more discrimination – I realised that being forced to think ‘outside the box’ around the concepts of love and family had resulted in some very self-aware, savvy and compassionate strategies for coping with the complexities of human relationships.

While I welcome the progressive legal changes that have seen a huge rise in acceptance for LGBT people, I worry that a blanket assumption that we all aspire to marry, have children and be ‘normal’ means that we might lose sight of some of the very best of these pioneering ideas.

Gwyneth Paltrow and Chris Martin used the term ‘consciously uncoupling’

Open relationships can be incredibly successful. Gay men fairly typically negotiate sexually open partnerships and have done for many decades. However, what is less widely-reported is just how good they are at remaining emotionally faithful to a primary partner. Their separation rates are the lowest of any section of society. Figures from 2013, from the Office of National Statistics, showed that civil partnership dissolution rates were twice as high for female couples as they were for male. While early divorce statistics in the UK evidence that ratio increasing further still.

So what are the relationships lessons straight couples can learn from the gay community?

1. An ex can be a best friend

Long before American author and family therapist Katherine Woodward Thomas devised the phrase ‘conscious uncoupling’ and Gwyneth Paltrow made it famous, lesbians were the godmothers of the concept of compassionate endings.

Recently, Dr Jane Traies conducted the first comprehensive study of older lesbians in the UK. She told me, “It’s not uncommon for a lesbian’s ex-partner to be her best friend.” She described one couple, now in their seventies, one of who had previously been in a straight marriage. The other had always been openly gay and had many more significant exes, who they would regularly spend time with. The central relationship seemed to be richly rewarded by having this framework of other ongoing connections supporting it.

2. ‘Living Apart Together’ can be great

Although the idea of ‘LAT’ couples is now more widely discussed, it was the LGBT community who originally piloted this idea. As my friend, the gay poet Dominic Berry, points out, “Perhaps if people are doing something widely viewed as deviant, making another deviance from the norm isn’t too big a jump.”

A lot of the automatic assumptions that are made about relationships – that you must get married, be monogamous, have children, move in together – have been cheerfully dispensed with. In many cases, an alternative romantic framework suited the individuals in the relationship much better.

Some straight couples can be reluctant to talk openly about sexuality

3. Talking about love, desire and sex is good

When I conducted a survey for my comedy show, I asked respondents if they actually  discussed sex and fidelity with a partner. One straight woman wrote, ‘Good lord no! It’s one thing to do the deed but we’re too uptight to actually talk about it. Thank goodness.’

My gay friends, by contrast, tend to have spent so many years agonising about their sexual identity that discussion of it with friends and families has been essential as part of the ‘coming out’ process. In many cases, this had lead to a readiness to air other really important questions around desires, boundaries and consent once they were in an adult relationship.

4. ‘Family’ doesn’t have to mean blood

When I arrived in London as a young student in the Nineties, the LGBT community provided me with the strongest sense of belonging I have ever experienced.

In the face of prejudice and discrimination, gay people historically partied hard together and took more care of one another within the bubble of separatism. They cultivated a concept of ‘friends as family’, something the writer Armistead Maupin refers to as ‘logical family’.

5. Love isn’t like it is in the movies

Because films depicting same-sex relationships have generally been far-removed from the sugary rom-com ideal, gay people are more pragmatic and realistic about the extreme challenges of falling in and out of love and staying together.

In 2017, we may not be facing quite as much adversity as the characters depicted in Carol or Brokeback Mountain, but we know that the ‘fairy tale’ romance is a load of old hokum.

6. Rules are made to be broken

When the activism group Gay Liberation Front formed in the early Seventies, they gleefully celebrated their difference from the oppressive, beige ‘norms’ that most of society were having to follow. This resulted in an inclusive, embracing atmosphere and a sense of fun and freedom for anyone who wanted to reinvent and rethink traditional relationships and try out different models of being together.

Complete Article HERE!

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What it’s like to be a male sexual surrogate

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The Sessions looked at the work of sexual surrogates

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For most adults, sex is an activity that can bring joy, frustration, contentment or disappointment – the full range of human responses. But for a few people, the very thought of sexual contact with another human being causes such anxiety that they can never get close to the act.

For them, psychosexual therapy is usually a good choice. And in a few cases, this can involve a particular form of therapy: use of a sexual surrogate.

Sexual surrogates are trained and professional stand-in partners for men and women who have severe problems getting to an intimate/sexual relationship. Normally, the client will be undergoing counselling with a psychosexual therapist, and then, in parallel with that, will have ‘bodywork’ sessions with a surrogate partner.

Andy, 50, is a psychosexual therapist who also worked as a surrogate for a number of years. Clients tend to be aged from their mid-thirties to around fifty and most came to him through word of mouth. “Some people have never experienced sexual intimacy,” he explains. “I had one client who had never gone beyond kissing.” Others have experienced abuse and have negative connotations around sex or have physiological problems.

“I would usually do between six and ten monthly sessions of three hours each. The first sessions would be about getting comfortable being in a room with a man. So I will say, ‘So you’re in a room with a man, how does that feel for you?’ And perhaps it reminds them of being a teenager so we’ll talk about what that teenage part of them needs – to be more confident, say.”

Although the sessions would build towards penetrative sex, it would be a long way down the line. But some clients want to take things too quickly, he says. “If they want to rush into sexual intimacy or penetration then I’ll slow them down and ask them where that comes from. Most of them do need to slow down because they’re rushing into what they think is the goal of sex.”

After a few sessions, Andy would bring touch into the sessions. “I would ask them what sort of touch they would want to receive. And they might like to receive some sort of massage, fully clothed or partly unclothed. Sometimes we would sit opposite each other on the sofa and find out what happens in her system if one of us leans closer. Does she get excited? Does she want to run away? Does she want to reach out and have more contact?”

Once the client was comfortable with touching, nudity would be introduced. “I might do an undressing process where I would invite them to take off one piece of clothing and each time to name a limiting belief that stops them really enjoying and celebrating their body and allowing pleasure in it. ‘One thing that stops me is my belief that I’m unattractive and my bum’s too big.’ They would take off that piece of clothing and that belief. Then I would offer feedback about what I see, so, ‘Your breasts feel very sensual and feminine to me’.”

Sexual surrogacy has been operating in Britain for a few decades, introduced from America, where it was also the subject of the Oscar-nominated film The Sessions, based on the true story of partially paralysed polio survivor Mark O’Brien and Cheryl Cohen-Greene, the surrogate he worked with to overcome his problems.

While most surrogates are female working with male clients, there are a handful of male surrogates in Britain who work with female clients. Male surrogates tend to be mid-thirties and older.

For many men, being hired to act as an intimate partner for a woman they barely know would be a strange situation. So how did Andy feel during these sessions? “Sometimes it was quite challenging, sometimes engaging, sometimes arousing,” he recalls. “And client reactions were very varied too. Some would feel ashamed, sometimes emotional or physical discomfort. Or they would feel excitement and confidence. It was moment to moment – it’s like how you feel in a relationship, you feel many things.

“It’s an interesting line to walk. There are many clients that I have worked with who I really liked and I enjoyed the work with them both sexually and emotionally but I’m also aware that I’m not there to be in a relationship with them.”

He is glad he did the job but it did cause him difficulties, not least in relationships with his own partners, whom he always made aware of his work. “I supported many women through a very challenging and sometimes life-changing process,” he says. “But I found that ultimately it took too great a toll – energetically, physically and emotionally. I was putting myself in situations of intimacy with a client that I wouldn’t necessarily have chosen. And I found that draining. I would sometimes ask, ‘Why did I do that to myself?'”

Overall he believes they key to sexual surrogacy involves being realistic about what will come of it.

“I think surrogacy is to be entered into with as much self-awareness as the client can muster,” he says. “While it can point them in the right direction, it’s not the answer. Ultimately, they have to find confidence within themselves. It can be a step on that journey.”

Complete Article HERE!

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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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