Tag Archives: Sexual Performance

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 Virginity Myth

Name: Tia
Gender: Female
Age: 19
I have a problem. I’m still a virgin, but my bf thinks I’m not. It’s really my fault he thinks this, cuz I told him I was all experienced and everything. We’ve been going together for about 8 months already and I really want my first time to be with him, but how am I going to act all experienced when I don’t know what I’m doing.

That sure enough is a pickle you got yourself into darlin’. You’ve got some ‘splanin’ to do Lucy!

Funny, because I’m more likely to hear from young women who are not virgins, who want to know how they can fool a new partner into thinking, they are. I guess we can chalk up all this deception and confusion to the powerful associations every culture imposes on virginity…female virginity, that is.

virginityLike most things sexual there is a huge double standard between the cultural and personal importance of virginity between the sexes. The cultural expectations about virginity are also tied to age as well as gender. For example, our society expects its 16-year-old girls to be virgins. To be otherwise, at that tender age, would be a scandal in most communities. But a 35year old woman who is still a virgin is considered an old maid — or worse, a dyke — in our society.

Of course, things are more fluid when it comes to boys and men. On the one hand, a 16year old boy, who is not a virgin, may raise some eyebrows in most communities. But many others in those same communities would praise him for being a stud. On the other hand, a 35year old man who is still a virgin is not only the butt of jokes — or worse, a queer — but he’s also more of a disgrace to his gender than an old maid is to hers. Funny how that works, huh?

I hasten to add that there is a lot to argue with in terms of these arbitrary cultural norms, and I encourage ya’ll to argue away. God knows I do! And you don’t have to buy into them either. God knows I don’t! But till things change these norms are the norms, like it or lump it.

I’d love to know why you felt the need to deceive your BF in the first place? Do the people you hang with, prize sexual experience over sexual innocence for a woman of 19? And what are the expectations of your group regarding a 19year old guy? I’ll bet the expectation is that he not be a virgin. Right?

Well you can see why a lot of people, not just you Tia, find this whole thing just too damned complicated. And rather than adding to the confusion or the deception, I encourage you to come clean with the BF about your cherry.Sign-Virginville-VillageOf

Here’s why I think this is the best policy. First, if the BF is sexually experienced, it will be very difficult for you to hide the fact that you’re not. Besides, like you said in your message to me. “I really want my first time to be with him.” Tell him that, sweetheart! No man is gonna turn that down…ever. Simply put, that is the most sexually charged and treasured sentence in any language.

Begin the big talk with your man like this. “Baby, I got something real special to tell you. You know how I’ve been sayin that I’ve been with other guys and shit? Well that was just my way of keeping all the other guys from pestering me for my junk. Baby, the truth is that I haven’t had sex before now. And the best part of this is I’ve decided that I really want my first time to be with you. My cherry belongs to you, baby”

Like I said, Tia, no man is gonna turn that down. The BF will be so flattered you won’t have to pretend to be something you’re not. Clearing the air like this will also allow you to relax when the magic moment finally happens. And relaxation is the key to enjoying yourself. And you should enjoy yourself.

Good luck

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

I’m just along for the ride

Dear Dr Dick,
My husband (34) and I (31) are coming up of ten years of marriage, and for the most part our sex life has been what I would consider average. He’s pretty much been the aggressor in our relationship, which has worked out fine until now. I guess after ten years my husband would like it if I occasionally expressed interest and initiated and told him what I like/don’t like etc. I really have no idea how to do that! I told him that and his comment was that maybe I wasn’t even sure what I liked/don’t like and that I’ve pretty much just been going along for the ride all these years. He’s probably right.
We used to kiss and cuddle etc. to work up to sex and now it’s, “hey, you wanna have sex?” which completely turns me off (which he knows). I’m sure this is partly due to his work schedule and having a four year old so by the time we get to bed we’re wiped out most of the time, but I’m so not into the, “hey, you wanna…” approach.
Anyway, I guess my question is how do I get started in figuring out what I like and don’t like, how do I work up to feeling comfortable enough to verbalize it and especially verbalize or show him that I’m in the mood, and then how do I tell him I don’t like something without shutting him down. There are times, I know I don’t like something but I go along with it because I don’t want to shut him down.
I should preface by saying I’m not a very confident person and tend to be a people pleaser?

You’re husband’s right. It is fuckin’ time you started lifting your share of the sexual initiation load. I mean come on! Most women would kill for a man in their life that would show an interest in what they like and don’t like. This going along for the ride stuff has got to end, darling.

female nude159How do you get started in figuring out what you like and don’t like? Masturbation! That’s the shortest and most to the point answer I can think of. Once you discover what turns your crank through masturbation you will have loads of very important information to share with you man. And hey, don’t forget toys, vibrators in particular.

How do you work up to feeling comfortable enough to verbalize what turns you on and verbalizing or showing him that you are in the mood? The answer to this question is as simple as the previous question. You masturbate for him.

Now I know that a lot of people, and that includes most women, have been socialized to think that masturbation is wrong, or at least it’s a private affair that one should keep to herself. But I’m her to tell you that’s just bull-hockey. And this is true for both women and men, gay and straight and everyone in between.

How do you tell him you don’t like something without shutting him down? Well, it’s probably much easier to tell him what you like and how you like it rather than approaching the tutorial from the negative. If he’s not completely brain dead, he WILL get the message. If, however, he starts to do something that is rubbing you the wrong way, so to speak, simply tell him as calmly as possible that he will get a much bigger and better rise out of you if he did it THIS way. And then show him…again.masturbation001

That fact that you sometimes don’t like something but that you often if not always go along with it tells me that you’ve socialized your man into thinking he’s an adequate lover when he perhaps isn’t. Its time for a confession, girlfriend! Be as gentle as you can, but for god sake, it’s time to come clean.

Take responsibility for keeping him in the dark about his lack of sexual prowess. Then tell him that there’s a very easy and fun fix for the problem and show him what you need and how you need it.

If you indeed lack the confidence you need to be honest with the one you love and who loves you back, then frankly Brandi, you deserve what little you get. But if you can muster up the gumption to throw off the tyranny of that whole people pleasing bullshit you’ve been laboring under all these years, then you have a real shot at some happiness and sexual fulfillment. It’s gonna be up to you to make this happen. If you need some support find a sex positive therapist who will help you grow some balls.

Good luck

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