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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!

The Yin and Yang of Desire

Today I’d like to talk about: The Yin and Yang of Desire — Dopamine, Prolactin and Testosterone.

Let’s talk about love, lust and desire. But instead of looking at these things as social phenomena, let’s look at the chemical reactions going on inside our bodies that make us feel and behave the way we do.

sex-on-the-brainThere are clear links between certain chemicals and our most basic drives, which explains, for example, why we feel horny one moment and utterly disinterested the next. Or why our sex drive peaks after exercise. At the core of our sexual and affectional interests and behaviors lie the two chemicals — dopamine and prolactin. In many ways they are complimentary to one another; dopamine turns on desire and prolactin turns it off.

Dopamine is a neurotransmitter. This is basically your body’s pleasure and reward system. Our brains releases dopamine, to one degree or another, when we see, read or think about something sexy, taste something sweet, puff a cigarette, or come into skin-to-skin contact with another person. When dopamine levels are high, our libido goes into overdrive. Sometimes levels can be so dramatic that a person will neglect other essential bodily functions like eating and sleeping. Some “street” drugs —meth and coke among them — can mimic the body into thinking it’s dealing with dopamine.

Dopamine is critical to the way the brain controls our movements. If there’s not enough dopamine, we can’t move, or control our movements. If there’s too much dopamine, we are plagued with repetitive moments like jerking, tapping and twitching.

Get this; novel situations can increase dopamine releases. For example, hooking up with someone for the first time triggers especially high levels of dopamine. Curiously enough, these same high levels will not occur again during subsequent hookups with that same person. This is called the one-night-stand phenomenon; it’s why you can be attracted to someone at first encounter but not afterward.hormones and the brain

However, falling in love with someone can sustain high dopamine levels for a longer period of time. This explains why physical infatuation is at its peak in the beginning months of a relationship. Also dopamine floods the brain when we get drunk or take certain drugs, which is why drinking alcohol can make a potential partner look more attractive.

Prolactin is dopamine’s foil. It causes dopamine levels to plummet. Prolactin is a hormone, as opposed to a neurotransmitter, like dopamine. It floods the body during orgasm, virtually shutting down the sex drive, which is nature’s way of allowing us to attend to other essential bodily functions like eating and sleeping. Prolactin release in men will temporarily disable our ability to have an erection. This is called the refractory or recovery phase of our sexual response cycle. And prolactin is at least partially responsible for that happy, relaxed state after we cum. This is precisely the release women get while breastfeeding; in fact, the word “pro-lactin” directly indicates its role in milk production.

growing larger and largerProlactin primes the mind for long-term attachment — a role that helps the mother bond with her suckling child as well as lovers to each other. This means that if you stick around cuddling with your partner right after sex, you may actually start to like him/her more and more. This is called the pair-bonding effect. But prolactin’s dopamine-reducing action has a darker side. It cancels the tolerance you may have for your partner’s flaws.

While dopamine and prolactin are good indicators of the immediate workings of sexual pursuit, it is testosterone that best explains long-term changes in courtship. Testosterone is responsible for the masculinization of the adolescent male body during puberty. And it increases the dopamine levels that regulate our sex drive. But testosterone leaves its fingerprint on the body as much as the brain. It’s the catalyst for changes in skin tone, fat distribution, musculature and demeanor, which are signals to others that this individual male is sexually mature and in good health.

However, if you get a fever or become depressed, your testosterone levels can drop significantly. Malnutrition or high levels of anxiety or stress will also interfere with testosterone levels. The most immediate effect of this is a decrease in libido, and a noticeable drop-off in energy levels as well as confidence. There’s no doubt about it; testosterone levels will signal to potential mates that you are in the throws of depression, stress, anxiety or malnutrition. You will appear a little less attractive to people subconsciously. That’s why a confident, dominant male with high-testosterone levels generally enjoy more mating success.tits

Testosterone levels are highest in the morning, then wanes throughout the day. It’s also much higher in men in autumn and lowest in the spring.

However, sexual desire is still more complicated than is known to science, and there may be multiple archetypes of partners we’re drawn to — there is evidence that aggressive high-testosterone men appear sexier to women and gay men for a one-night stand. But softer, more sensitive balanced men are more likely to tug at our heartstrings in a relationship. Scientists reason that the bulkier mate is more likely to be physically powerful and carry good genes to create strong children. While the slimmer guy is a more loving, reliable partner likely to help raise the kids so they survive to adulthood. The effect of this strange contradiction seems to be a biological predisposition against monogamy and sexual exclusivity.

But none of this is carved in stone. A man’s hormone’s levels increase when he is in a competitive environment or carries out acts of aggression, which can explain how guys seem to bulk up quickly when they go to prison or join sports teams. These levels decrease when he feels intimidated or humiliated, which might explain why those who get picked on at school stay skinny and mild-mannered compared to their peers. This in turn made them easier targets and only increased the likelihood of them being bullied.

butt shakeThis is not uncommon behavior among primate colonies that have huge alpha males looming over a population of smaller, submissive males and females. While this is not a perfect parallel to human social groups, it does go a long way in explaining how a social environment can be a precursor to physical body changes. And just so you know, our testosterone levels also drop during long-term relationships, giving the male brain a sense of stability and mellowness, easing off the drive to forage for new sexual partners.

Science alone lacks a moral element, and fails to explain, in a modern context, why we should desire to be masculine, aggressive, potent or dominant in the first place. In nature, the alpha-male is the most likely to enjoy reproductive success, but that isn’t what gives our lives value today. We might have more success being an average male that falls in love and becomes a good provider. And in the modern world it’s probably the more stable and sensitive man who is most likely to sire children.

Still, science gives important clues to what’s going on in our minds and bodies and that of our potential partners. A lot of our basic inclinations are out of our control, but when we know what causes them or what to expect, we can work with them for the best outcome.

Sexual Tension or Domestic Tranquility

Name: Barbara
Gender: Female
Age: 48
Location: Santa Cruz, CA
I’ve been with my current lover for 5 years and I dearly love him. A couple of years ago he had hemorrhoid surgery and was in the hospital for a month. When he got home he refused to have sex with me but once a month of so. After two years his sexual interest is less and less. We have a wonderful time together, except for the sex. He’s a great guy and I know he loves me. We talk about it, but he tells me that he doesn’t need sex and he wants a platonic relationship. He’s not open to therapy. If he doesn’t want to be physical, I don’t want to force it but I’m masturbating all alone and I’m very frustrated. I don’t what to leave him, but I can’t stand the status quo.

This is a classic lament, Barbara. So many couples struggle with much the same thing. Love, intimacy, and sex—three very different things—yet we are socialized into thinking that they should always come to us as a package deal. And anything that doesn’t is less than optimum and often downright bad or sinful. What a tiny little box we’re all supposed to fit in.

sexual-FrustrationI believe there is a fundamental difference between love, sex, and intimacy, but so many people confuse or conflate these very different needs to their detriment. Some go so far as to destroy an otherwise good and vibrant relationship just because it doesn’t conform to what we perceive as the norm…ya know the big package deal I just mentioned.

I don’t know how we got it into are head that the only legitimate or wholesome sex is the sex that happens in a loving relationship, or that if there is no sex in a loving relationship, then that relationship is somehow flawed or defective. That’s simply not the case.

The way I see it, passionate sex is dependent on a good deal of sexual tension. Ya know, like the grips of hot monkey love that happens at the beginning of a relationship. In time this sexual tension dissipates. I might add that it takes a great deal of work to keep that kind of tension alive. Most couples don’t invest that kind of energy, even though they may pay lip service to the desire for is too short

Intimacy, on the other hand, is dependent on domestic tranquility, in other words, the elimination of tension in the relationship, which often also includes sexual tension. And since most couples desire intimacy over sex they choose (either consciously or not) the domestic tranquility option. But the result is the kind of sexual frustration you report, at least for some.

Those who wish to have both sexual passion and intimacy need to be creative in developing both. It simply isn’t enough to believe that loving someone is enough to make it happen. It takes a lot of very hard work.

That being said, Barbara, if your partner refuses to join you in any effort to find a solution to the problems that plague your relationship, he is telling you that your sexual concerns are unimportant to him. My counsel is always the same under these circumstances. If your sexual needs are as pressing as you say they are, then confront him in no uncertain terms. No beating around the bush, darlin’, it’s ultimatum time. Tell your partner that dragging his feet, or obstructing all together your efforts to solve your relationship problems signals to you that the relationship, at least as it is currently configured, is in desperate trouble.

As I’ve suggested earlier, you can tell him that there are several ways of keeping the relationship going without expecting he fulfill all or any of your sex needs if he’s gonna be fulfilling your intimacy needs. But living without sex in your life is a deal breaker. He needs to know that you are serious about the crisis that exists. Of course, if you do this you will have to follow through on the ultimatum. To do otherwise would tell him that you don’t believe your concerns are all that important either.

If you ask me, life is too short to be living with all that sexual frustration. Don’t tolerate the frustration make it work for you. Your sexual frustration could be the very thing that motivates you to create better your situation for yourself and possibly your old man too.

Good Luck

Teenage Sexual Assault

Name: TC
Gender: Female
Age: 13
Location: indiana
I really dont know that much about sex, so i let my boyfriend do it all. He keeps calling me a scardy cat cuz i wont touch his dick or give him any pleasure, and he is getting really bored with me

I am so sorry to hear of the trouble you are having with your boyfriend. Actually, he’s no friend at all. Real friends honor their friend’s limits and boundaries, and he’s not doing that.

You can’t be expected, at your tender age, to know much about sex. Hell, you don’t even sound like you are particularly interested in the topic. You don’t mention your boyfriend’s age, but it sure sounds like he is way more advanced than you, at least when it comes to his interest in sex. Unfortunately, he’s not so advanced that he’s man enough to leave you alone when you ask him to. And that really makes me angry. Bullying, belittling or harassing someone for sex, particularly when it’s clear that person is not ready or not interested is abuse. And that is never a good thing.

I hasten to add that in the eyes of the law he is a criminal. He is taking advantage of an underage person for his own sexual gratification and that’s against the law. If you guys get busted, there will be hell to pay.

I know the kind of pressures you are experiencing. You want a BF and you want your BF to like you. But if you let him take advantage of you, it’s not the same thing as him liking you. It’s more an indication that he’s focused on his needs and desires, not yours. I don’t think his behavior indicates he cares for you, but he is showing you that he has power over you and is able to manipulate you into doing what he wants. And what kind of relationship is that?

Listen, TC, you don’t have to submit to him. You can stand tall and tell him NO. He will, in the end, respect you more for your courage to defy and deny him than if you just cave in to his will.

I’m not sure I know what you mean when you say that you “let your boyfriend do it all.” But it sure doesn’t sound like a good thing to me. If he’s having his way with you, even though you are being very passive about it, doesn’t make it right. I hope this isn’t how you intend to interact with other males who will come into your life in the future. And there will be plenty of them. If they sense that you are weak and vulnerable, you will be a goner for sure. You could easily wind up being a victim for the rest of your life. Please, TC, don’t let that happen to you.

I know you’d probably rather be thinking about a lot of other stuff at this time in your life, but the situation with your BF demands that you grow up fast and get savvy about the fundamentals sex right away. I’ll have a number of resources for you in a second, but I can’t emphasize enough how important it is for you to wise up about pregnancy protection. I wish I didn’t have to say that to you, but I must. If you are being sexually active, even if you are just letting your BF do everything, you absolutely must protect yourself from an unwanted and unplanned pregnancy. If you don’t you will find that you will be the one having to deal with the consequences. If your BF is not considerate enough to respect your wishes when it comes to sex in general, you know for sure that he’ll not be around to look after you and your unborn child.

Ok, here are those resources I mentioned. Planned Parenthood, SCARLETEEN, Sex Ed 101 and Midwest Teen Sex Show.

Promise me that you will take this seriously. That you’ll not just roll over (literally or figuratively). Promise me that you will respect yourself and take a stand and not allow your BF to manipulate you into anything you don’t want to do. More hangs in the balance than you can comprehend. You’ll have to trust me on this.

One last thing, if you were wise enough to find my sex advice website and you were mature enough to write to me, then I believe you are strong and resourceful enough, despite your tender age, to stand up to your BF. Do it now. Demand that he respect you, your body and your wishes.

Good luck

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