12.2 (8.8) Sexuality in pall care Flashcards
List four benefits derived from sexual and intimate expression
Reduce emotional distress, anxiety, depression * Pain relief/ heightened pain threshold* Distraction Muscle relaxation* sleep*
Until what part of a person’s illness can sexuality and intimacy remain important?
Last days
What are potential barriers to sexuality and intimacy from a patient partner’s perspective? Name 3 examples
- Inability to negotiate other forms of intimacy when penetration no longer available
- Lack of couple communication*
- Seeing the patient as asexual or childlike due to loss of bodily control (e.g. catheter)
- Increased dependency of patient*
- Anticipatory grief*
- Curative focus and unwillingness to have intimate connection (“giving up hope”)
What are HCP barriers to discussing patient sexuality in clinical setting? Name 4 examples
- MD related: Lack of knowledge, discomfort around communication
- Patient related: not seeing patients as sexual beings, feeling vulnerable to reactions of patients, making assumptions (e.g. patient too unwell, uninterested, etc.)
- Topic related: “taboo topic”, fear of crossing medico-legal boundaries, reducing sexuality to erection, menopausal status and levels of libido
- Setting related: feeling vulnerable to reactions of colleagues, discouragement of sexual expression within hospital setting
What can HCPs do to help encourage intimacy? Name 4 examples
- Self-reflecting on personal and professional influences that shape beliefs of pt sexuality (MD related)*
- Check assumptions with patients (patient related)*
- Provide opportunities for patients and partners to discuss intimacy (topic related)*
- Facilitate renegotiation re: amount and type of sexual contact between patients and partners
- Empathic listening and acknowledgement of distress
- Give permission to patient and partner to engage in intimacy (e.g. lie in hospital bed together) (setting related)*
Who on the multidisciplinary team should discuss issues of sexuality and intimacy with a patient?
All team members should be spotters of issues - if provider uncomfortable having detailed conversation, start conversation then arrange referral to an expert with patient persmission
What kind of training model for clinicians can be helpful to reduce barriers and increase confidence in discussing topic of sexuality?
Brief communication skills training model
List four changes relating to sexual function that occur in women as they age
Vaginal atrophy: tissue thinning/more fragile Vaginal dryness: Reduced natural lubricant Reduced libido Hot flushes
List four changes related to sexual function that occur in men as they age
Increased time to achieve erection
Less rigid erection
Decreased seminal fluid (semen)
decrease in size and firmness of testes
Orgasmic strength and pleasure
List five medical conditions that can cause changes in sexual function
Stroke MS PD Cancer HTN Hypotension DM Renal failure Depression
FS: VINDICATE-NP
Chemotherapy induced reduction in androgens may cause what three symptoms
Decreased mood
Decreased libido
Decreased energy
Menopause symptoms in women
What should clinicians advice patients and partners re: intimacy post chemo? (Name 2)
- Use protection for 48h post chemo as cytotoxic waste can be excreted through any blood and body fluid (condom, dental dam)
- Discuss the risk of pregnancy while on chemo
List three causes of dyspareunia (genital pain during intimacy) in pt w cancer
Premature menopause secondary to chemo
Radiotherapy local effects
Hormone treatment reducing circulating androgens
How does radiation affect sexuality?
2 general, 2 local
- General SEs of rads (nausea, fatigue, diarrhea, skin reactions)
- Infertility
- Pelvic rads -> Vaginal tissues can become thin, ulcerated, scarred, shinking/shortening
- Pelvic rads -> Vascular damage leading to reduced blood flow = dry vagina
- Erectile dysfunction
What can a clinician advice a female patient who is receiving pelvic rads?
Encouraged to have sexual intercourse/use vaginal vibrator or dilator 3-4 times/week to reduce changes of vagina shrinking
A pt has temporary radiation implants inserted. How would you counsel them on issues related to sexuality and intimacy?
What if patient has permanent radiation implants (e.g. brachytherapy)?
Once temporary implant removed - safe for contact including sex
Permanent implant - avoid close contact with people for first few days while radiation is most active, then use condom for several days post procedure
Who are considered “hidden communities” in pall care related to addressing sexuality?
- Patients who don’t reflect heterosexual norms
- Young adolescents
- Elderly people
- Single people
What are some general practical advice that can be given to increase intimacy?
Provide 3 advice.
- Having realistic expectations (relearning intimacy takes time)
- Coping with physical disfigurement by wearing night wear to conceal scars, use fantasy to imagine themselves as whole people
- Setting the scene - creating a relaxed environment, fluffy towels
- Pelvic floor muscle control and self-stimulation
A patient has dyspnea and would like to be sexually intimate with their partner. Provide 3 advice
Manage SOB Well ventilated room, fan, comfortable bed* Explore gentle intimacy Use waterbed to conserve energy* During sex, control SOB with pursed lip breathing * Avoid long kisses * Avoid positions that restrict breathing or put pressure on chest*
A patient has fatigue and weakness and would like to be intimate. Give 3 pieces of advice
Choose time of day when pt has most energy *
Explore different positions to conserve energy *
Avoid extreme temperature
Avoid heavy meals*
Avoid etoh*
A patient has urinary incontinence and would like to be intimate. Provide 2 pieces of advice
Encourage bath or shower as location for foreplay or post coital relaxation
Utilize shower chair, disabled bath or fluffy towel over incontinence sheet
List four ways of increasing privacy for patients in the clinical setting
Do not disturb sign for door Knock before entering room Provide double bed Partner bathe patient or bathe with patient Provide massage oils, music etc
What sexual aids can be offered to women and men? List 3 for each
Women:
- Vaginal moisturizer (e.g. Replens)
- Vaginal lubricant (water or silicon based)
- Topical or systemic estrogen (however controversial)
Men:
- Sexual rehab to regain erectile function
- Cialis, Viagra (phosphodiesterase 5 inhibitor drugs)*
- Penile injection therapy
- Penile implant *
- Vacuum pump erection device*
UpToDate : testosterone replacement
