Disease and disability Flashcards
Patients perspective on why sexuality might not be discussed at the doctors
- information about the disease is paramount
- Concerned how physician would perceive them if they discussed sexuality
- do not want to be rude to their physician
- disregard feels of sexuality since cancer is important topic
- accept changes in sexuality as part of the cancer experience, and do not know they can be adressed
- assume that all important info will be discussed by yhe physician
Physician’s perspective on why sexuality might not be discussed at the dpctprs
- view sexuality as ‘taboo’ in the face of cancer
- lack of time
- a sense of embarassement
- own personal beliefs that sexuality is not important
- lack of training and confidence to discuss sexuality with the patient
- assime that the patient will bring up the topic if they feel it is important
Sexuality and disease/disability
In the last decade the view on sexuality and chronic diseases and disabilities changed considerably
- nowadays we talk about persons with a physical disability
- in the earlier days we called them ongelukkige kinderen en gehandicapten
–> this shift shows that the person has become more important than the body with deficiencies
- in the past it was unthinkable that a person with a physical disability could have sexual needs
Healthy person
Sexuality is considered to be relaxing, comfortable and pun
- a healthy body is private
Persons who are ill or have a handicap
Sexuality is considered to be uncomfortable and problematic
- the body is seen, toucjed, dispossessed by others, for instance health professionals
–> however, sexuality can offer comfort, assurance, the feeling to be normal, loveable, can help patients who are in pain
Sexuality and limiting conditions
Many people are subject to sexuality limiting conditions owing to:
- congenital conditions, appearing at birth, such as Down syndrome
- spine injuries
- vision and hearing impairment
- chronic illness (diabetes, cardiovascular disease, arthritis)
Healthy puberty
- physical changes associated with puberty
- dating competence, increased subjective awareness of sexual orientation, exploratory sexual experiences
Puberty when ill
- timing of physical changes may be delayed or altered
- parents can be overprotective
- increased dependency on family members and institutions for care
- increased shame about illness and/or body
- less sexual experiments
- concerns about decreased life span, fertility, potential for genetic transmission of disease
Pre-existing sexual difficulties and resources, body image, gender
Pre-existing problems:
- lack of knowledge
- traumatic experiences
- sexual dysfunctions
- body image problems
- couples conflicts
Resources, resilience:
- sexual education and knowledge
- positive sexual experience
- history of resolving or coping with sexual problems
- partner and social support
Threat of disease
a. destruction
b. disfigurement
c. disability and pain
d. dysfunction
e. dysregulation
f. disease load and drugs
Destruction
Destruction of genital organs and loss of fertility. Local pain, hormone withdrawal
- breast
- cervix
- uterus
- ovaries
Disfigurement
Visible changes of the body’s outer appearance through disease and therapy
- breast cancer
- skin changes
- scars
- hair losss
Disability and pain
Loss of mobility and generalized pain
- diseases of musculoskeletal system
- neurological diseases
Dysfunction
Loss of function of sesory, vegetative, motoric neuromuscular, and vascular effectors
- cardiovascular
- neurologic and metabolic diseases
Dysregulation
Dysregualtion of the hormonal balance and/or neurotransmission in the brain
- neurologiical and psychiatric diseases
Disease load and drugs
Deterioration of function due to accompanying symptoms
- incontinence drugs
- irritable bladder
The partner of the ill
- may be forced to become the primary wage-earner
- may become the primary caregiver for children/parents
- may need to take on miltiple other roles
- perception that sexual intercourse with ill partner is inappropriate
- partners are anxious to cause harm to their partner with cancer
- partner may view their significant other in a child role: in need of being cared for, and it feels inappropriate to act sexually
Changes in the couple’s dynamic interaction
To be able to help:
- dominant leading
- partner becomes caregiver. Abuse and violence
Preserve identity:
- DISTANCE
- abondon. new relationship
To be able to accept help:
- dependent following
- complete dependence
Create intimacy:
- CLOSENESS
- amalgamation
Biological of biopsychosocial
Aging (hormonal and bodily changes), hormones (testosterone), vascualr problems due to disease or injury; mediaction, alcohol, drug use, fatigue, pain etc.
Social of biopsychosocial
Situational pressure (divorce, death, job stress, infertility and/or relationship difficulties), lack of intimacy, social isolation, ineffective communication, performance pressure, culture/religion etc.
Psychological in biopsychosocial
Feeling of not being normal, priorities are changed, preoccupation with disease, loss of control, anxiety for sex, depression, anger, guilt, being ashamed, avoidance behavior (pain, being hurt), disfigurement etc.
Quality of sexual life
Physical, psychological and social –> real situation
Culture, attitudes towards relationships and own wishes and desires –> desirable situation
–> sexual satisfaction is the overlap of the real situation and the desirable situation
HPV - Human paillomavirus
More than 170 varieties of HPV exist:
- viruses that cause skin warts
- LrHPV: viruses that cause genital warts
- HrHPV: viruses that can cause cancer (cervix, anus, penis, vagina, vulva and throat)
- most HPV infections do not lead to cancer
Risk factors and prevention of HPV
Risk factors:
- number of sex partners
- weakened immune system
Prevention:
- HPV vaccination
HPPV infection
Almost all (wo)men are infected with HrHPV during their life
- usually, they become infected almost immediately after they become sexually active
- the virus is not only present on the penis, rectum, and vagina, but also in the pelvic area, fingers and mouth
–> immune system defeats infection within 2 years. no other treatment
Cervical cancer
No symptoms in the early stage, later:
- vaginal bleeding (also after sex)
- unusual vaginal discharge
- pelvic pain
- pain during sexual intercourse
Cervical cancer treatments
Cryotherapy: use extreme cold to destroy abnormal cells
Cone biopsy: surgical removal of a segment of cervix
Hysterectomy: removal of uterus
Endometriale kanker
Kanker op het slijmvlies van de baarmoeder, waarbij een symptoom is dat je bloedingen hebt op andere momenten dan de menstruatie, of na de menopauze
- hysterectomie, bestraling of chemotherapie
Eierstokkanker
Heeft symptomen zoals een opgeblazen gevoel in de buik, krampen, overgeven en diarree
- oophorectomy, hysterectomie, bestraling of chemotherapie
Breast cancer in the Netherlands
Approximately 13000 in 2020 were diagnosed
- 1 in 7 will develop at some point in their life
- most prevalent cancer in NL women
- average age is 61 years
- each year about 3000 deaths
- 87% of diagnosed survuve at least 5 years, 77% 10 years
Signs and symptoms of breast cancer
- a breast lump or thickening that feels different from teh surrounding tissue
- change in the size, shape or appearance of a breast
- changes to the skin over the breast, such as dimpling
- a newly inverted nipple
- peeling, scaling, crusting or flaking of the pgmented area of skin surrounding the nipple or breast skin
- redness or pitting of the skin over your breast, like the skin of an orange
Risk factors of breast cancer
- being female
- increasing age
- drinking alcohol
- obesity
- a personal history of breast conditions or breast cancer or a family history of breast cancer
- inherited genes that increase cancer risk
- if you received radiation treatments to the chest as a child/younf adult
- beginning your period at a younger age <12
- beginning meopause at an older age
- having your first child at an older age >30
- never been pregnant
- postmenopausal hormone therapy. The risk decreases when women stop taking these medication
Diagnosis of breast cancer
- breast physical exam
- mammogram
- breast ultrasound
- biopsy
Surgical treatment of breast cancer
- mastectomy: removal of breast
- lumpectomy: removal of part of breast
Adjuvant therapy for breast cancer
- radiotherapy
- chemotherapy
- hormone therapy
Psychological response to cancer diagnosis
- major depression
- frustration, anxiety, irritability
- fear of recurrence/death
- fear of rejection
- loneliness
- body image concerns
- pregnancy concerns (infertility)
Outcomes of breast cancer
- women can have worrisome concerns about her sexual identity and attractiveness: she may feel scarred and be fearful of rejection
- women have reported vaginal dryness, pain with intercourse, lack of interest in sex, difficulty to orgasm or inability to have penetrative sex after diagnosis/treatment
- however, some studies show positive effects: couples physically touched more often and appreciated each other more
COPD
Chronic Obstructive Pulmonary Disease
- progressive disease that makes it hard to breathe
- up to 75% of people who have COPD smoke or used to
- no cure, only symptom relief
Physical consequences of COPD
- cardiovascular comorbidity is common
- 75% of men have erectile problems
- shortness of breath, feeling tired, chronic cough, mucus production
- weight gain, yeast infections (due to drugs)
Psychological consequences of COPD
- becoming anxious for shortness of breath
- being ashamed, negative self-image
- being agitated depressed (due to drugs)
Social consequences of COPD
- being dependent on partner
- partner is fearful that ill partner will suffocate
- being dependent on oxygen (during the night or always)
Yeast infections
Antibiotics and corticosteroids can cause yeast infections as a side effect
- in mouth or vagina
- these infections may hinder kissing or sexual activity
Diabetes Mellitus
Erectyle dysfunction is a common problem amongs men who have diabetes affecting 35-75% of male diabetics
- up to 75% of men sufferung from diabetes will experience some degree of erectile dysfunction over the course of their lifetime
- men who have diabetes are thought to develop erectile dysfunction between 10 and 15 years earlier than men who do not suffer from teh disease
- over the age of 70, there is a 95% likelihood of facing difficulties with erectile function
Quantum model of seks
Suggereert dat algemene responses, waaronder een orgasme, een reflex is. Een persoon heeft voldoende stimultie odig om een seksuele reactie op te wekken
- drempelwaarde: opwinding en orgasme
Drie factoren die drempelwaarde beïnvloeden
- het lichaam geeft seksuele prikkels door en reageert erop
- seksuele prikkels: het moet plezierig genoeg zijn
- mentale factoren en instelling
