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1

mansexuality after prosatate cancer treatment

often results in loss of erectile function Despite the high prevalence, patients often report being poorly prepared to cope with ED after PCa treatment and commonly report a lack of knowledge about sexual health and ED treatments.
current sexual rehabilitation programs
overlook psychosocial factors and focus on biologicals aspects

2

The discrepancy between the effectiveness of ED treatments and the low rate of long-term use suggests that

The discrepancy between the effectiveness of ED treatments and the low rate of long-term use suggests that physiological erectile response is an insufficient indicator of successful ED treatment

3

barriers to successful use of Ed treatments

• The length of tume a couple waits before seeking treatment,
• The patient’s and partner’s attitudes, expectations, and readiness to begin a treatment protocol,
• The meaning of using a medical intervention to restore sexual acidity, the quality of the couple’s relationship outside of the seuxla context
• The presence of sexual dysfunction in the partner
• Lack of desire for sexual intercourse in the patient or partner,
• Lack fo opportunity.
Additionally, only half of patients are willing to try an ED treatment after PCa treatment

Patients should be offered treatment alternatives to those aimed exclusively at restoring erections.

4

With increasing demands, physicians relay heavily on nurses to spend more time on patient education and counseling for ED

There are many barriers of nurses addressing patients’ sexual needs:
• Inadequate training, resulting in insufficient knowledge base or experience,
• Low confidence, embarrassment, or discomfort of the health care provider,
• Perceived patient embarrassment or discomfort,
• The assumption that inquiring about sexuality is an invasion of patient privacy,
• Concerns over uncertainty regarding patients’ cultural or religious beliefs about sexuality,
• Assuming that it is the responsibility of other health care providers on the team to address sexuality
 Continuing education is an important tool for increasing nurses’ competence and confidence in addressing the sexual health concerns of oncology patients.

5

Sex &Autism

Difficulties with social contact, communication and imagination

Interpret everything literally and do not understand the meaning of non-
verbal or implicit messages

Insufficient social skills to maintain a relationship

Have sexual feelings, but these are ignored

Inappropriate sexual behavior in public and fascination for sensations that have a sexual connotation (fetisjism)
=> good sex education (concrete)

6

psyvchopharma &sexuality

Dopamine: attention and concentration, innitiate and stop (sexual) behavior, reward and punishment, emotion and orgasm

Serotonine: regulation of mood, anxiety, sleep, appetite and sexuality (ejaculation)

Noradrenaline: influences arousal (erectionn and lubricationn) and ejaculation

have direct as well as indirect effects

7

strategies to deal with sexual side effects

Acknowledge and discuss dysfunction.

Indicate that it is a side-effect.

Sexual dysfunctioon disappears when medication stops

Wait for spontaneous remission

Lower the dose

Medication-interval (weekend drug holiday). A1er a medication stop of 76h, sexual function is recovered for 50%

Use another type of medication with less side-effects

Add stimulating medication (eg viagra)

Sexuological counseling: seeking new sexual scenario’s

8

sexuality in psichiatria patients

considered as asexual or hypersexual -> ignore or inhibit sexuality

Right to sexuality, right to privacy, right to experiment with sex and relationships

Vurnerable to sexual abuse: difficulties to judge how reliable the other is, to deal with the agression and intense sexual impulses of others (and themselves) => importance of good sexual education

Vulnerable to transgressing behavior of the therapist. Therapists can become confused and aroused by the sexual and seductive behavior of their patients

9

sexualizy in psychiatric patient

Positive effects of sex: Agression regulation, anxiety reduction, comfort, self- esteem, less loneliness, less sexual incriminating public behavior, practice with making contact

Negative effects of sex: disappointment and lovesickness are experienced more intensively, higher risk of STD’s and unplanned pregnancy

10

sex and disease

Cancer: radiation => loss of sexual function, less energy, feeling less attractive

Breast cancer §Prostate cancer

Loss of urine: shame

Mastectomy, hysterectomy: feeling less feminine

Heart and blood vessels (diabetes)

Physical examinations in intimate areas: anxiety, insecurity, shame

Disturbance of psychological and relational balance in the relationship
Finding a new balance in the relationship

Change the meaning and function of sex (comfort, intimacy)

11

depression

Intereferes with level of serotonine and dopamine => reduces level of pleasure (and sexual pleasure)

Lower sexual desire and more arousal problems

Direct link: anhedonia
Indirect link: low self-esteem, feelings of guilt, feeling tired, neurophysiological changes

Role of testosterone: 2 x more depression in women

Sexual problem can be the cause of a depression: low self-esteem < not feeling
good enough as a sexual partner

12

anxiety & sex

Hypervigilant, difficul9es to relax, difficul9es to enjoy without worrying

Less sexual interest vs. sex as a mood regulator (masturba9on as coping)

Panic disorder: Avoid sex because they fear an aLack

Social phobia: difficul9es with social contact

OCD: mysophobia (fear of stains) => sex is dirty

PTSD: sexual abuse => higher risk of sexual dysfunc9ons

13

impact of disease on sex in daily life

Diseases have high comorbidity with sexual dysfunctions (50-70&)=> sexual dysfunctions, sexual adjustment problems

Influence of and on psychosocial factors
– Disturbance of psychological balance
– Disturbance of partner relationship
– Existential issues (mortality, interferes with sexual iden9ty)
– Changes in daily life

you might need to learn sex once again => explore body again, what do I like ? there from of sex then penetration

14

effects of progressing disease

Fear of relapse

Confrontation with mortality

Imbalance

Needs time

No sexuality during first year after diagnosis

Low energy

What do I need to cope with the disease?

Anger, sadness, worries, frustration, ask for help

in most cases disire comes back after 2 years

15

sexuality with mental disability

“Normal” sexual behavior requires autonomy and self-determina9on -> people with MD do not meet these standardsNo financial independece
– Dependent on others and cannot make their own decisions
=> do not ques9on the decisions of the health care providers
– They are seldom alone, have little privacy

16

attitude supervisors and social worker

Ambivalence: let sleeping dogs lie + function mentally as children + fear of unplanned pregnancy and STD

Intrusion of the privacy of the client

Feeling shy and insecure to talk about sexuality

Ethical and legal issues
– No clear rules about offering sexual services -> social workers are discouraged to
talk about and facilitate sexual interactions
Acknowledge the right to sexuality and intimacy, but do not talk about it and thus don’t know the knowledge and needs of their clients

Too little attention for positive aspects of sexuality (pleasure, desire), too much prevention

Absolute repression (protection discours) versus idealized permisiveness (normalisation discourse)
=> Do not ignore sexuality in MD, but also not the same

17

People with (mild) mental disability

Have desires for and expectations about sexuality

Do not all want the same => Tune to their needs

Differences in understanding (eg What is sex? Holding hands or intercourse?) => avoid transgressions

Anticonception

Parenthood

Socio-sexual consciousness increases with age (≠ between <18 en >18)
Þ Are aware that their peers and siblings have more autonomy regarding sex and
relationships and they feel not satisfied about this inequality
Þ Are aware of secrecy and deception

Can understand mutual consent and trust in relationship, want to marry and have children, know about masturbation and need more privacy

Internalize negative sexual attitudes of healtcare providers and family -> develop negative attitudes regarding own sexuality

18

sexual abuse and mental disabilities

60 % of people with disability are confronted with sexual abuse once or more in their life
=> Less autonomy and more dependent on others

=> Show difficult to interpret behavior (environment does not believe them)

=> Low resilience

=> Boundless life

=> No or incorrect sexual education

=> Lack of judgement

=> Many intimate contacts (less control over their own body)

=>Disturbance of physical boundaries

19

how to deal with sexual abuse

Acknowledging possible signals

Talk about suspicions

Open attitude

Become aware of own attitudes and experiences with sexuality and sexual abuse

Good observation skills (body language!) and being alert

Alerts: physical damaging, difficulty to talk about sex, sleeping & eating problems , over sexualised bahevour , physiological/ emotional complaints

20

difficulties when discovering abuse

Changes in behavior are aLributed to the disability

Environment denies the abuse

No witnesses

Police has difficul9es to find out the truth
– Justition ≠ Healthcare
(Obligation to report: Signals vs. proof)
– Complementary

21

effects of abuse on md

Traumatic experiences are more difficult to process

Takes longer

Abuse can exacerbate the disability

Behavioral problems

Learn wrong ideas about sexuality -> Cross the sexual borders themselves and become abusers

22

preventing abuse

Adequate sex education (Sex can be learned!)

Learn about norms, values, boundaries (what is ok!)

Optimize communication skills

Train resilience

Pay attention to environment!
– Dependency, (socially) isolated, and live in context with power inequality

Importance of policy about sexual abuse!

23

sex education

Adequate sex educa9on, adjusted to
– Developmental stage (physical, mental, social-emo9onal)

Body-image

body experiences

sexual experineces

norms and values
-what is good & wrong ?

relationship devolpment

resilience
How can I set my boundaries?
– Acknowledging emotions and differentiate between pleasant and unpleasant emotions


Tailored sex education
– Has a direct and measurable effect on their capacity to make decisions about
rela9onships
– Increases their understanding of consensual versus abusive rela9onships
– Increase their autonomy and self-determina9on

Only half of people with MD get sex educa9on

Higher risk of STD, unplanned pregnancy and abuse

24

Frequently reported disturbances to sexual functioning after diagnosis and treatment of breast cancer in Western women (and non-Western women) include:

• Dyspareunia
• Fatigue
• Vaginal dryness
• Decreased sexual interest or desire
• Decreased sexual arousal
• Numbness in previously sensitive breasts
• Difficulty reaching orgasm
• Lack of sexual pleasure
• Coital pain
• Sexual dissatisfaction
• Deterioration of the sexual relationship
• Loss of interest in their partner

woman who undergo Chema are at higher risk

25

breast cancer & relationship

The quality of a woman’s relationship is a stronger predict of sexual satisfaction, sexual functioning and sexual desire after breast cancer than the physical and chemical damage to the body.

26

Begin preparing couples for sexual recovery in advance of PCa treatment

The role of the health care provider is essential in encouraging patients and partners to develop positive, but also realistic expectations about sexual recovery
they should be informed that it might take some months

27

consequences of a prostate treatemnt

While men may still experience sexual arousal, most men attain errections insufficiently firm for intercourse, and some don’t attain errection at all.

loss of sponatnety

28

raesons for nonadherance

Men do not readily seek treatment for erectile dysfunction, even though there are many treatments available.
• When they do seek treatment, they are often not satisfied with the results and don’t continue with it.
• Even fairly successful treatments of ED don’t always result in a return to sexuality men knew before treatment.

Interventions to increase adherence to erectile dysfunction treatment include offering treatment choices for erectile dysfunction and mounting a nationwide written information campaign.

Frequently reported reason for former nonadherence were inhibition to talk about the problem and being afraid of a medical examination.
• Psychosexual counseling along with the offer of ED treatment resulted in greater use of intracavernosal injections.

29

the psychological work

• At each state, men must do a small intentional piece of the psychological work of grieving in order to maintain focus and complete the sexual act.
• When men relax into the refractory phase of the sexual act, sharing grief with a partner can reinforce bonding, which then may reinforce desire for more sexual activity.

30

bassom as a partial solution to mens loss of spanatnity

• Sexual receptivity – a deliberate decision based on context and self-awareness – is a new skill that men may need to develop after the losses associated with prostate cancer treatment.
• As they cannot rely on the spontaneity of erections, they must make a series of adaptations that will enable them to have a satisfying sexual experience  for this they have to work through feelings that are posed to derail them at several stages until those feelings are no longer powerful because of their unfamiliarity of influential because grief had not been addressed