coping with sexuality issues

Men's Intimacy, Sexuality
and Relationship Issues
after Cancer
Sylvie Aubin, Ph.D.
Segal Cancer Centre
Jewish General Hospital
McGill University
Objectives
 Acknowledge sexual changes
experienced by men after cancer
 Present ways to improve intimate
and sexual relationships
Treatments Impacting Intimacy and
Sexuality
 Surgical treatments (OS, laparoscopic,
robotic)
- Radical prostatectomy,
cystoprostatectomy, orchiectomy
Treatments impacting Intimacy and
Sexuality
 Chemotherapy

Radiation therapy (external, internal)
 Hormonal treatments (injections, oral)
- lower or suppress testosterone
 Transplant (bone marrow, stem cell)
What To Expect Sexually…
 Sexual response
- Low/absent sexual desire
- Sexual arousal (decreased ability to obtain or sustain erection,
decreased sensitivity penis, scrotum or feeling aroused)
- Orgasm (intensity, frequency, consistency, dry orgasm)
- Structural changes of genital area (penis/testicular size/length)
- Gynecomastia (growth of breasts)
- Sexual pain during/after orgasm or ejaculation
What Else to Expect…
 Compromised fertility

Decreased urinary control
Hot flashes
Weight gain
Fatigue, low energy level/stamina
Loss of muscle mass
Hair loss
What Else to Expect…
 Decreased body/self-image, sense of masculinity

Character changes:
- Emotional sensitivity (short fused, irritability)
- Lack of motivation, initiative
 Escalation of depressive/anxious mood

Cognitive function problems, the "chemo brain"
(distractibility, focus, concentration)
Your Couple Relationship. What to
Expect…
 Shift from reciprocal spouse/lover to patient/caregiver

Decreased frequency and quality of sexual activities
- Change in sexual role (active to passive)
- Avoidance of sexual activities
 Decreased intimacy due to:
- Less frequent physical contacts/touching
- Breakdown of sexual communication
- Decreased closeness or connectedness to the
Common Barriers to Addressing
Sexual Changes
 Helplessness
- "It's over. My erections are gone"
- "There is nothing that can be done about it"
 Embarassment
- "Why start something you can't finish"
- "I can no longer satisfy my partner"
 Misinformation
- " Having sex will cause my cancer to come back or to
worsen"
Intimacy and Sexuality. What to Do…
 Penile "Rehab" or treatments for ED
- Viagra, Levitra, **Cialis (PDE-5 Inhibitors)
- Injections (ICI, MUSE)
- Vacuum and constriction devices
- Combination Rx (injection and constriction
- Penile implants
Intimacy and Sexuality. What to Do…
 Hormonal treatments
- Testosterone gel
- Estradiol
Intimacy and Sexuality. What to do…
 Re-define sexual life
- Establish slow, gradual sensual versus performance
based sexual encounters
- Use resources available to healthy sexuality
• Erotic literature (ex: written/visual)
• Sexual toys
 Share initiation of sexual encounters
Couple Intimacy. What To Do…
 Build couple closeness
 Block weekly couple block of time, the "date
exercise"
Couple Intimacy. What To Do…
 Re-initiate sexual communication
- Discuss concerns, barriers and fears
- Identify sexual preferences and needs
- Use non-verbal, hand guiding during sexual
encounters
How to Approach Your Partner About
Intimacy and Sexuality
 Have you noticed changes in our intimacy or sexuality
since the cancer?
 How have these affected you?

What are your concerns or fears about our sex life?
What would you like to improve in our sex life?
Intimacy and Sexuality. What Else To Do…
 Weight gain and loss of muscle mass
- Exercise
 Urinary incontinence
- Pelvic muscle exercises with/out feedback
(physiotherapy)
 Treat depression, anxiety
- Psychotherapy with psychotropic medication
 Initiate individual or couple sexual therapy
Concluding Thoughts
 Become educated about available medical and
psychological interventions
 Start by re-connecting on a non-sexual, intimate level

Expand your definition and repertoire of sexual
encounters
 Set realistic goals

Seek support

Source: http://www.fhcrc.org/content/dam/public/Treatment-Suport/survivorship/Relationships_Men.pdf