Psychological Effects of Prostate Cancer on Sexuality. Pauline Sheils. Dip. PST. Clinical Nurse Specialist in Sexuality

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1 Psychological Effects of Prostate Cancer on Sexuality Pauline Sheils. Dip. PST. Clinical Nurse Specialist in Sexuality

2 Cancer is a devastating disease that threatens a person s physical and emotional well-being. Being forced to face one s own mortality, survival is at the forefront of concerns and immediate needs are physical. As the shock subsides, other facets of one s personal existence emerge and an attempt at normalisation begins. Sexuality and sexual function is one such facet and can affect quality of life.

3 Effects of Prostate Cancer on Sexual Function Direct Effects. Physical Indirect Effects. Psychological Emotional. Social.

4 Psychological Effects Emotions that come in to play following a diagnosis of cancer cover the entire spectrum, ranging from disbelief to profound sadness. Many of these painful emotions, including anxiety and depression can have a direct impact on sexual function. Diminished self-concept and body image as well as role change are a few common issues created by diagnosis and these issues can occur at varying stages of the diagnosis, treatment or recovery periods.

5 Psychological Effects The experience of cancer can have a devastating blow to a person s sense of competence and ability. Roles in terms of husband, partner, parent or breadwinner may be temporarily affected by the cancer or the treatments. In terms of body image some patients describe themselves as damaged goods and self esteem may be negatively affected, with or without overt changes to one s body.

6 Changes to body image Many People have mixed feelings about their bodies Something minor, or major event, or psychological problem can trigger negative emotions about bodily self worth Aging brings radical but slow change Accidents and disease can cause immediate and major body changes

7 Body change or loss of a body part could be regarded as something minor, or may be experienced as catastrophic by the individual concerned

8 Impact of cancer on body image and sexuality Physical impact of cancer depends on the treatments: Surgery may be body altering Hormone treatment, loss of desire Drugs (chemotherapy) tiredness, hair loss, reduced libido

9 Psychosexual impact: Psychosexual impact of cancer and it s treatment is influenced not only by the physical changes that affect body image and sexual function, but other factors such as whether the person is in a current sexual relationship and to a certain extent a persons age

10 BODY IMAGE Price 1970 BODY IDEAL BODY REALITY BODY PRESENTATION

11 The Vital Ingredient

12 (Hints for patients) Inside and out We spend time on grooming, clothes, hair and makeup to make ourselves feel and look good, but what we look like on the outside is not always how we feel on the inside. Try to prepare yourself emotionally before going out. The person you are inside comes from what you think about most of the time, so image how you want to be.

13 Confidence is key If you have great expectations of how people will see you, and if your level of self worth is high, people will subconsciously pick up on that. You can t put yourself down then expect to feel comfortable about yourself. Think and behave positively.

14 Learn to take a compliment Whenever we are complimented our self esteem goes up, it makes us feel successful and valuable Try to live your life as if you are already the outstanding person you want to be.

15 For Good Sexual Function To Be in the right frame of mind. A good blood supply A good nerve supply. For hormone levels to be normal.

16 Psychosexual issues: Fatigue Depression and anxiety Loss of libido Loss of sense of masculinity Inability to reach orgasm/less intense orgasm Loss of sensation Loss of fertility/sub fertility Loss of personal identity, (hair loss, scars) Loss of wholeness/body integrity

17 Cont d Perceived loss of youth Loss of self worth/sense of self Psychological changes to body image Changes to relationships Fear of abandonment/rejection Fear of recurrence/death Loss of sexual self

18 Study Men confirmed the substantial effect of sexual dysfunction on the quality of their lives in 4 domains. The quality of sexual intimacy. Everyday interactions with women. Sexual imagining and fantasy life. Perceptions of their masculinity. Sexuality after treatment of early prostate cancer; exploring the meanings of ED.

19 Study Erectile Dysfunction problems were found to affect men in both their intimate and non-intimate lives including how they saw themselves as individuals. Bokhour et al 2001

20 Some Suggestions Partners can be affected by the experience also, discussion should be encouraged Be prepared to listen, then talk, discuss the negative issues Treat depression if it s an issue Have them spend time getting used to body changes, touch, self care Maintain good health practices, diet, physio, pain management, alternative therapies

21 Talking About Sex Create a safe time and place. Choose one or two goals. Focus on the positive. Remind them to avoid arguements. Discuss your fears of sexual rejection. Discuss fears about breaking up. Discuss fears about survival and recurrance. Be a good listener.

22 Listen When I ask you to listen to me and you start giving me advice, you have not done what I asked. When I ask you to listen to me and you tell me why I shouldn t feel that way, you are trampling on my feelings. When I ask you to listen to me and you feel you have to do something to solve my problems, you have failed me, strange as that may seem. LISTEN! All I asked was that you listen, not talk or do... JUST HEAR ME. Author unknown

23 Suggestions for patients Improve communication. Listen. Ask for what they need. Pleasure. Let partner off the hook! Get in help. Time together/time apart Be gentle (themselves / others).

24 More Suggestions Sensual massage. A good book. Fantasy. Share fantasies. Sex toys. Games.

25 Compliance is ultimately better if the sex therapist then works with the patient/couple to help them translate the mechanical tumescent episodes into sensitive, passionate, love making experiences. Kaplan Althof et al Turner et al 1989.

26 Sexual Activities

27 Thank you. Any questions? Contact Details: Pauline Sheils. Dip. PST. National Rehabilitation Hospital Rochestown Avenue Dun Laoghaire Co. Dublin Tel: (01) Website: