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Sexuality at the End of Life

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By Anne Katz RN, PhD

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

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

Communicating About Sexuality with the Terminally Ill

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

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

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

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

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

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

Sexual Functioning At The End Of Life

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

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

The needs of the couple

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

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

Addressing sexual needs

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

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

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

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

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

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

Complete Article HERE!

Stretching out of the sexual doldrums

Name: Gwen
Gender:
Age: 57
Location: Philly
My husband and I have been married for 33 years. Our relationship is hell when it comes to sex. My husband is overweight, and he’s stressed out about his elderly parents. Sex is non-existent. He never was the instigator in our relationship. And he is the kind of guy who thinks having sex on the couch as opposed to the bedroom is adventuresome. He has become so boring. I don’t believe the man feels sex should be that important at our ages. (I’m 57 and he’s 62) I, on the other hand, am more sexually aroused and creative than ever now that I am more mature and the kids are out of the house. Menopause and all the sex on the internet helps too. 😉 Is there anything I can do to make my man return to being a healthy sexual being once again? Thank you, Gwen

No, thank you, Gwen. Your complaint is a familiar one. In fact it’s so familiar I regularly offer therapy groups for couples in long-term relationships. Like you and your old man, these couples have, for one reason or another, hit a wall when it comes to their sex lives.senior intimacy

I take a very unique approach to these groups by inviting both straight and gay couples to the same group. At first I got a lot of resistance. Most couples, both gay and straight, think there is nothing to be learned from a couple unlike them. They can’t imagine why I would want to integrate the group in such a manner. I think most of my couples feel more comfortable being in a segregated group — straight folks with straight folks, gay folks with gay folks.

But that is of course the reason I integrate the groups. I don’t want them to feel all comfy and cozy, I wanted them to work and learn and stretch themselves out of their sexual doldrums. At first, I had to ask all my couples to suspend judgment about an integrated group until they had an opportunity to participate in one. Now I don’t encounter so much resistance. Word’s gotten out that this is a really creative solution to an otherwise tricky problem. And that old married couples, regardless if they are gay, lesbian or straight have very similar problems. And they can and do learn from one another.

To your specific issue, Gwen, I’m sad to say there’s not much you can do to beef up your sex life if there’s no interest on the part of your husband to do so. I mean, you can lead the horse to the cooch, but you can’t make him lick, if ya know what I mean.

Fat man holding a measurement tape against white background

Fat man holding a measurement tape against white background

You confide that you husband is overweight and stressed; this is not a happy combination when it comes to his sexual response cycle. In fact, your husband sounds like a heart attack waiting to happen. Perhaps if your challenged him about his general health — encourage weight loss and stress reduction, you might find that this would also reignite his sex drive. It’s worth a try.

And thank you for mentioning menopause. So many women find the changes that take place in midlife confusing and disorientating. It’s so good to hear from a woman who is eager to explore and enjoy her sexuality post-menopause.

Men also go through changes, in midlife. There’s even a name for it — andropause — the male menopause as it were. It’s clear that as we age, both women and men need more time and stimulation in which to get aroused. The slower, more sensuous foreplay that often results is a welcome change for most women and even some men.

Increased focus on sensuality, intimacy, and communication can help a sexual relationship remain rewarding even well into our senior years. I think you already know this, Gwen, but many women in my audience don’t.sensual touch

If your husband is avoiding intercourse, there still many ways of expressing your love and staying connected:

  • Hugging, cuddling, kissing
  • reading erotica aloud together
  • Touching, stroking, massage, sensual baths
  • Masturbation and oral sex

However, if your husband is more wedded to food and stress than he is to you, and if he continues to refuse to join you in finding an appropriate outlet for your sexual frustration, then it’s up to you to make this happen on your own. 57 is way too young to say goodbye to your sex life.

May I suggest joining a women’s group. Not a therapy group, but more of a support group or activities group. Getting out of the house, involving yourself with other self-actualized mature women, may uncover the secret solutions other women have put in place to find sexual satisfaction when they are without a partner or have a partner who’s no longer interested in a sex life with them. I think you will be surprised by how creative your sisters can be. Make it happen, Gwen. Don’t sink to the lowest common denominator of living a sexless life.

Good luck

More of the SEX WISDOM of Benjamin Law — Podcast #420 — 06/11/14


Hey sex fans, Benjamin Law-2

Benjamin Law, the author of the critically acclaimed book, Gaysia; Adventures in the Queer East is back with us for Part 2 of his turn on this is the SEX WISDOM show. I’m so glad he has more time to spend with us again this week because he charmed the pants off me last week.

But wait, you didn’t miss Part 1 of this conversation, did you? Well not to worry if ya did, because you can find it and all my podcasts in the Podcast Archive right here on my site. All ya gotta do is use the search function in the header; type in Podcast #419 and Voilà! But don’t forget the #sign when you do your search.

And I’m sure we’ll have another opportunity to hear Benjamin read from his book.

Benjamin and I discuss:

  • Sham marriages and marriages of convenience;
  • Growing gay consciousness in China;
  • Reparative therapy through the power of Christ, Allah, or Yoga;
  • Colonialism and sexual oppression;
  • The resilience of the sexual minority communities throughout Asia;
  • Asia, the gayest continent;
  • Cultural relativism and cultural imperialism;
  • How his travels changed his life;
  • Our queer family is global
  • His next book project.

Benjamin invites you to visit him on his site HERE! And he’s also on Twitter HERE!

Click on the cover art below for more information about Gaysia; Adventures in the Queer East.

Gaysia Adventures in the Queer East

BE THERE OR BE SQUARE!

Look for all my podcasts on iTunes. You’ll find me in the podcast section, obviously. Just search for Dr Dick Sex Advice. And don’t forget to subscribe. I wouldn’t want you to miss even one episode.

Today’s Podcast is bought to you by: Fleshlight & FleshJack.

More Sex EDGE-U-cation with Cléo Dubois — Podcast #402 — 01/15/14


Hey sex fans, welcome back.Cleo_2013a

She’s back! BDSM coach, ritualist and personal trainer in the kinky arts, that international celebrity and humanitarian, Cléo Dubois, is back with us today for another go-round on this Sex EDGE-U-cation show.

But wait, you didn’t miss Part 2 of our chat, did you? Well not to worry if ya did, because you can find it and all my podcasts in the Podcast Archive on my site, DDSA.com. All ya gotta do is use the search function in the header; type in Podcast #401 and PRESTO! But don’t forget the #sign when you do your search.

Cléo and I discuss:

  • The importance of ritual;
  • Developing the energy exchange with one’s partner;
  • Different types of climax;
  • The importance of aftercare;
  • Putting things in a contextual box;
  • The difference between fiery and dirty;
  • Everything is about power;
  • Her role as mentor and founder of The Academy SM Arts;
  • The Pain Game;
  • Kink Aware Professionals;
  • Her sexual heroes .

You’ll find lots of information about Cléo on both one of these fantastic websites HERE and HERE. Her blog is HERE! And don’t miss her Twitter feed HERE and her YouTube channel HERE!

BE THERE OR BE SQUARE!

Look for all my podcasts on iTunes. You’ll find me in the podcast section obviously; just search for Dr Dick Sex Advice. And don’t forget to subscribe. I wouldn’t want you to miss even one episode.

Today’s Podcast is bought to you by: DR DICK’S — HOW TO VIDEO LIBRARY.

drdickvod.jpg

Sex EDGE-U-cation with Cléo Dubois — Podcast #401 — 01/08/14


Hey sex fans, welcome back.

Hey everyone, HAPPY NEW YEAR! We’re all back from our winter holiday and we’re rarin’ to go. And I figure, CleoPortraitthere’s no better way to kick off the New Year than with a chat with a national treasure, especially for those of us on the sexual fringe. Yes siree, this here is the Sex EDGE-U-cation series, which brings you conversations with some of the most renowned talent in the world of fetish sex, kink, and alternative lifestyles.

Today, we travel to San Francisco to meet the incomparable Cléo Dubois.

Cléo describes herself as a BDSM coach, ritualist and personal trainer in the kinky arts. She is a woman of extraordinary wisdom and I am pleased to have this international celebrity on my show to kick off the new year. And wait till you get a load of her very sexy French accent. I guarantee, she will make you swoon.

Cléo and I discuss:

  • Our mutual friend, Eve Minax;
  • Her public and private life in the scene;
  • Dispelling the fear, coming out as kinky;
  • Depathologizing consensual BDSM;
  • Finding and embracing your erotic power-play archetype;
  • BDSM is all about intensity, energy, ritual, and communication;
  • The challenge of sexual exploration;
  • Common activity inserted into ritual changes everything;
  • Healing herself of the sexual and emotional abuse endured as a child;
  • The recreational, cathartic, and ecstatic aspects of BDSM.

You’ll find lots of information about Cléo on both one of these fantastic websites HERE and HERE. Her blog is HERE! And don’t miss her Twitter feed HERE and her YouTube channel HERE!

BE THERE OR BE SQUARE!

Look for all my podcasts on iTunes. You’ll find me in the podcast section, obviously. Just search for Dr Dick Sex Advice. And don’t forget to subscribe. I wouldn’t want you to miss even one episode.

Today’s podcast is bought to you by: Dr Dick’s Stockroom.

drdicksstockroom.jpg

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