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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

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