INTIMACY AND RELATIONSHIPS AFTER CANCER DIAGNOSES PAULINE SHEILS, CNS IN SEXUAL WELLBEING, PST, RNP.

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1 INTIMACY AND RELATIONSHIPS AFTER CANCER DIAGNOSES PAULINE SHEILS, CNS IN SEXUAL WELLBEING, PST, RNP.

2 Self image Biological sex Sexual attraction Sexual Practices Sexuality flower Spirituality Relationships Emotions Adapted from Hibberd, J 2006

3 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.

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 Fears around rejection and abandonment, ability or failure to perform can lead to patterns of sexual avoidance.

6 PROFESSIONALS V S PATIENTS: Fear of opening a can of worms... It is not taught so we are inadequately equipped Sexuality may not be part of the presenting problem Embarrassment We feel it might embarrass the patient Fear of being judged ungrateful Breaking down and crying Cannot find the right words / language issue. Not feeling entitled to start the conversation Embarrassed. Fear of embarrassing healthcare professional

7 IMPACT ON RELATIONSHIPS: Positive Brings partners closer Surviving reminds them to not take life or each other for granted. Previous irritations/conflicts do not matter the same way. We got through this we can get through anything Some couples spend more time together while completing rehab S. Standish 2016 Negative Less communication as focus is healthcare needs/concerns Physical separation Increased worry about financial weel-being. Fatique Normal routine disrupted Roles unclear and/or changed Future is uncertain.

8 YOU AND YOUR PARTNER What do partners care about most? In spite of what you might imagine or fear, studies show that the answer is simply: Their loved one is alive and feeling well. The loss or alteration of a breast (body part) is almost meaningless in contrast. Most caring partners (both men and women) see their lovers as having many parts to love, and as being more than the sum of those parts. Your partner is also dealing with worry, anxiety and maybe even quilt. It may be hard to figure out your own needs and concerns let alone tell them to your partner.

9 COMMUNICATION IS THE KEY. Find some time: schedule some time in a quiet place where you won t be interrupted. Start somewhere: talk about the weather etc. then talk about your fears, concerns, how the illness has changed you, and the importance of your relationship. Keep talking: if your not talking you re listening, stop and get feedback, eye contact and touch can give your words greater meaning. Reassure your partner: make it clear you want to hear how he/she is feeling and that you're in this together. If you can t talk write it down.

10 PSYCHOLOGICAL EFFECTS The experience of cancer can have a devastating blow to a person s sense of competence and ability. Roles in terms of wife, 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. If you see yourself as damaged goods don t assume your partner feels the same way.

11 IMPACT OF CANCER ON BODY IMAGE AND SEXUALITY Physical impact of cancer depends on the treatments: Surgery may be body altering Hormone treatment, early menopause, Drugs (chemotherapy) tiredness, hair loss, reduced libido

12 BODY IMAGE: Is about the person How we experience the world How we feel about ourselves and our sexual self A sense of ourselves as a man or woman How attractive we feel How confident we feel Whether we feel sexy, sexually desirable Gives us a sense of comfort with our relationship or how we relate to others

13 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

14 BODY IMAGE Price 1970 BODY IDEAL BODY REALITY BODY PRESENTATION

15 THE VITAL INGREDIENT

16 SINGLE PEOPLE Don t allow your cancer define who you are, you don t have to bring it up until you are ready and have some stake in the relationship. Ease back in to the dating world. Find a friend: a partner who cares about you as a friend before you reveal too much Practice: what you want to say Be honest: say clearly what was done, how you re doing, what you feel. Put yourself in your partners place. Dump a person who can t cope.

17 TALKING ABOUT SEX Create a safe time and place. Choose one or two goals. Focus on the positive. Remember to avoid arguements. Discuss fears of sexual rejection. Discuss fears about breaking up. Discuss fears about survival and recurrance. Be a good listener.

18 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 Spend time getting used to body changes, touch, self care Maintain good health practices, diet, physio, pain management, alternative therapies

19 MORE SUGGESTIONS Ask for what you need. Pleasure. Let partner off the hook! Get in help. Time together/time apart Be gentle (youreslves / others).

20 COMPLIMENTARY THERAPIES: Complimentary therapies can aid healing and promote a sense of well being Meditation Relaxation. Reflexology. Massage. Acupuncture.

21 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 imagine how you want to be.

22 LOSS OF DESIRE: You ve lost your hair, your body/breast is altered or gone, you ve put on weight, you have no energy, you're tired, you re nauseated, and you hurt in new places. No wonder you re not feeling sexy!! Treatment induced menopause, depression and hormones can all affect libido. While you re recovering try concentrating on pleasure from touching, kissing and imagery rather than genitally focused sex.

23 How can you show someone you love them without having sex? How would you like to be shown love without having sex?

24 SEXUAL ACTIVITIES

25 SOME SOLUTIONS: Arousal: its important to feel comfortable and relaxed and then aroused. Foreplay is an essential factor in becoming aroused. Staying focused in your head and body. Try new positions. Practice without a partner. Oral sex. Masturbation Massage.

26 AIDS AND APPLIANCES TO ENHANCE SEXUAL FUNCTIONING Female: Lubricants. Vibrators. Dilators. Eros therapy. Male: Oral erectogenic agents. Intracavernousal Injection Therapy. Vacuum Pump. Penile Implants.

27 THE POWER OF TOUCH The human body has tremendous capacity to experience pleasure through its five senses; sight, sound, smell, taste and above all touch. It is through the skin that the tactile messages of love, tenderness, and desire are received. By touching, caressing and fondling the skin, the flame of sexual desire is kindled, while at the same time the emotions and the soul are nourished.

28 THANK YOU. ANY QUESTIONS? Contact Details: Pauline Sheils. Dip. PST. National Rehabilitation Hospital Rochestown Avenue Dun Laoghaire Co. Dublin Tel: (01) Website: