Sexual dysfunction

Question 1

Definition of sexuality

Answer 1

• process of giving and receiving sexual pleasure and is closely connected to a sense of being
• feeling of belonging, being accepted by another
• conviction that we are worthy to live and enjoy life

Question 2

Definition of intimacy

Answer 2

• Sharing of identity, closeness and reciprocal rapport
• emotional closeness

Question 3

List health benefits of sexual and intimate expression

Answer 3

• Pain relief
• A distraction from day to day challenges
• Heightened pain threshold
• Improved sleep
• muscle relaxation
• oxytocin release - less anxiety and depression

Question 4

Impact of life limiting illness on sexuality

Answer 4

• fatigue
• dyspnea
• incontinence
• disfigurement
• pain
• nausea
• weight changes
• fluid retention
• xerostomia
• altered body image
• feelings of complex loss and grief
• catheters
• colostomy bags etc

Question 5

Normal ageing and women

Answer 5

• reduced vaginal lubrication
• shortening of length and width of vagina
• altered sensation to clitoris
• potential loss of libido
• menopausal sx

Question 6

Normal ageing process for men

Answer 6

• increased time to erection
• less rigid erection
• seminal fluid decreases
• orgasm strength decrease
• higher erectile dysfunction (ETOH, depression, meds)

Question 7

Impact of chemotherapy on sexuality

Answer 7

• infertility
• need to discuss options to preserve fertility before chemotherapy
• symptoms of menopause
• symtoms of androgen deprivation from chemo
• sx of andrigen deprivation from hormonal meds for prostate and breast cancer

Question 8

Safe sex while undergoing chemotherapy

Answer 8

• cytotoxic waste can be excreted through bodily fluids in first 48 hours
• dental dams and condoms recommended during sex in chemotherapy

Question 9

Radiotherapy sexual side effects

Answer 9

• fatigue, diarrhea, nausea, skin reactions
• pelvic radiation tissue effects
• vascular damage to pelvic/vagina –> less blood flow, less lubrication and dilation, Erectile dysfunction
• during radiation, a woman can be encouraged to have sexual intercourse or use vibrator or dilator 3-4 times per week to reduce changes of vagina shrinking
• infertility if direct radiation to gonads
• spinal cord lesion

Question 10

Myths and misconceptions

Answer 10

• external beam radiation makes you radioactive
• temporary internal radiation implants do transmit radiation
  
  • avoid close contact while in place
• sexual activity can spread cancer to partner
• sex can make cancer worse or negate treatment
• past actions (affairs, abortions, illegitimate children) have caused the cancer

Question 11

Barriers for HCP to bring up sexuality

Answer 11

• lack of time
• belief that patient is too ill or not interested
• belief that disfigured bodies are not sexually attractive
• fear of opening Pandora’s box
• medico-legal issues
• presence of third parties at appointments

Question 12

Describe management of physical issues that impact sexual function

Answer 12

• Pain
  
  • medications
  • dyspareunia - lubricants and mositurizers
• Dyspnea
  
  • medications
  • ventilation
  • pursed lip breathing
  • avoid long kisses on mouth
• Fatigue and weakness
  
  • plan for time of day
  • different positions
  • avoid extrem temp, alcohol
• Nausea and vomiting
  
  • medical assessment
  • avoid oils, perfumes
  • gentle sensuality
• Xerostomia
  
  • oral hygiene
  • artificial saliva
  • saliva stimulants
  • pilocarpine
• Incontinence
  
  • bath and shower foreplay and post coital
  • shower chair, fluffy towel over incontinent sheet

Question 13

Sexuality in hospital/hospice

Answer 13

• provide privacy on unit
• normalize sexuality and intimacy
• do not disturb signs
• designated areas with double bed, bath, access to lotions and music

Question 14

List common symptoms associated with pelvic malignancy

Answer 14

• Pain
• skin irritation / fistula/ malignant wounds
• Infection
• Bleeding
• Ureteric obstruction
• Lower limb edema
• DVT
• MBO

Question 15

Approach to counselling/ discussion of sexuality

Answer 15

PLISSIT

Permission

• Give permission, normalize
• ask permissiont to discuss
• make no assumptions

LImited information

• provide info in sensitive way in small amounts
• regular checking in

SS Specific Suggestions

• alternatives to penetrative intercourse
• non sexual ways
• lubricants, aids, different positions

IT Intensive Therapy

• sildafenil, urethral alprostadil pellets
• external vaccum device for men
• penile implants if cured of cancer
• sexual therapy