Posts by Joan Price
Intimacy after prostate surgery
Several readers have posted and emailed me about sex and intimacy after prostate surgery. I asked Anne Katz , RN PhD, author of Breaking the Silence on Cancer and Sexuality: A Handbook for Health Care Providers and sexuality counselor at CancerCare Manitoba in Winnipeg, Manitoba, to respond to a common question:
Ever since my husband had his prostate removed because of prostate cancer, he has been reluctant to touch me. This is so upsetting. I love him very much and don’t know what to do.
It is common for men to be unable to have an erection after this surgery. Depending on the type of surgery (nerve sparing or not), his ability to have erections may or may not return. Many men are deeply distressed by this and may avoid all physical contact with their partner so as not to “lead them on” or disappoint them. This leads to a very unhappy partner who wants to express his/her love and support but feels cut off and cut out.
What is important is for the couple to TALK. It is often really difficult to talk about a sensitive topic when emotions are running high. But talking goes a long way to healing and connecting. Start with an “I” statement: “I miss touching you and being touched by you. How can we reconnect again?” Or perhaps: “I love you so much and want our relationship to be the way it was before the surgery. What can WE do to help this happen?”
While there are medications and treatments that may help, further treatment should be a couple’s decision and the man should always include his partner in medical appointments so that both people can express themselves and have their questions answered. Because communication is so important, the couple may need professional help to start the communication flowing. But seeking help is the first step.
For more posts about cancer and sexuality, please click “cancer” in the “labels” list in the right-hand column.
Is this helpful? Let me know what questions you’d like me to explore as we age and encounter physical and emotional challenges to our sexuality.
–Joan
Tips for reclaiming sexuality after a health event
Many readers have reported concerns about how to reclaim their sexuality after a heart attack, cancer, or other health event. I asked licensed psychologist and sex therapist Stephanie Buehler, Psy.D., to provide some tips for the new book I’m writing. Her information was so valuable that I didn’t want you to have to wait for the book:
- Speak to your physician about when you can resume sex and what kinds of limitations you might expect or need to work around. If you are uncomfortable talking about it with the physician, perhaps you can bring it up to the nurse. Nurses are often interested in helping patients achieve an optimal quality of life, and are trained to educate patients as well.
- If neither your physician nor the nurse is sexually savvy, then contact whatever organization is associated with your disease. For example, both the American Heart Association and the American Cancer Society publish booklets on sexuality and illness.
- Broaden your ideas about what constitutes “sex” after an illness event. Sex is more than intercourse. Count holding hands and cuddling as sex, and you and your partner might feel less disappointed or glum.
- If you are the person affected with a health problem, don’t conclude that if your partner isn’t bringing up sex, it is no longer important. Your partner may not want to intrude or make demands and is waiting for a sign of readiness from you.
- If you are the partner of the person with a health problem, accompany your partner to a physician’s visit to discuss sexual effects of any surgery or treatment. Educate yourself so that you can be a support to your partner, and so that you and your partner can discuss how to go forward.
- If you had sexual problems before the illness event, now might be a good opportunity to address them. It may be that your health problem contributed to your sexual problem. Again, discuss this with your physician or nurse.
- If you are having trouble resuming satisfying sexual activity, consider seeing a sex therapist. A sex therapist can help you identify obstacles and give you information and suggestions. Sometimes there can be deeper problems, like facing the fact that you are not invincible, that can also be addressed with a therapist.
Stephanie Buehler, Psy.D. is a licensed psychologist and sex therapist, and Director of The Buehler Institute in Irvine, California. Visit her blog about sex and intimacy.
Note: You can locate a sex therapist in your area through AASECT, American Association of Sexuality Educators Counselors & Therapists.)
Want more ideas? Read my 7 Tips to Spice Up Your Sex Life post.
Seniors: Please Just Say Yes to Condoms
The media blast continues over the Big News that seniors are still having sex. (At what age were we supposed to stop,and why?) I’m happy to see this media coverage help raise awareness, even though I marvel that it’s also raising eyebrows.
A very interesting story appears in the August 13, 2007 print edition of U.S. News & World Report about a subject I’ve harped on all year — the fact that seniors in the dating world are often in denial about their risk for contracting STDs. “Sex Ed for Seniors: You Still Need Those Condoms: Sexually transmitted diseases stalk older singles, too” by Deborah Kotz makes this point:
With Viagra and Internet dating sites at their fingertips, a growing number of seniors are enjoying a renaissance between the sheets, but some are paying the piper, contracting sexually transmitted diseases. As HIV carriers live longer, the majority will be over age 50 by 2015, and even now about 15 percent of new infections occur in this age group, according to the Centers for Disease Control and Prevention. Other STDs, including herpes, chlamydia, and human papillomavirus, which is linked to cervical cancer, are also making the rounds. “While it’s a good thing that older people are more sexually active, they need to connect the dots, see that they’re at increased risk, and make sure they use condoms,” says Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases.
Kotz discusses a University of Chicago study revealing that nearly 60 percent of unmarried women ages 58 to 93 said they didn’t use a condom the last time they had sex. An Ohio University study found that about 27 percent of HIV-infected men and 35 percent of HIV-infected women over 50 sometimes have sex without using condoms.
Kotz makes the excellent point that postmenopausal women may be particularly prone to getting infected with blood-borne diseases like HIV or chlamydia.
That’s because their thinner and more fragile vaginal lining can easily tear during penetration, allowing pathogens to enter the bloodstream. And new research indicates that older women are at risk of getting infected with HPV, which can give rise to genital warts or cervical cancer.
The message is this: If you’re dating and sexually active, please use condoms, whatever your age. Men complain to me that it makes sex less pleasurable, especially when erections are less reliable. Women insist that they’re not at risk and they would be embarrassed to insist on condoms. Haven’t we heard variations on these objections from youth? Isn’t this one area where we can learn from experience and our own good sense?
New England Journal of Medicine: Seniors having sex despite “bothersome problems”
When the news splashed all over the media today that older adults are, indeed, having sex, my first reaction was to laugh and say, “Duhhh!” The idea that senior sex is alive seemed to me as much a news story as the revelation that most people find feet at the end of their legs!
But there was much more to the story. “A Study of Sexuality and Health among Older Adults in the United States,” published today in the New England Journal of Medicine, was a major study of 3005 U.S. adults (1550 women and 1455 men) 57 to 85 years of age which revealed some fascinating facts and a few surprises:
The majority of older adults are sexually active and regard sexuality as an important part of life. The prevalence of sexual activity declines with age, yet a substantial number of men and women engage in vaginal intercourse, oral sex, and masturbation even in the eighth and ninth decades of life.The frequency of sexual activity reported by sexually active older adults (age 57+) is similar to the frequency reported among adults 18 to 59 years of age.The study reported that 78% of men 75 to 85 years of age, as compared with 40% of women in this age group, had a spousal or intimate relationship. Since women live longer, and on average, older men marry younger women, this disparity can be accounted for by the lack of available men for the older single women. The sexually active people in the oldest age group interviewed — 75 to 85 years of age — reported having sex at least two to three times per month, and 23% reported having sex once a week or more.About half of the sexually active men and women reported at least one “bothersome sexual problem,” and almost one third reported having multiple problems. The women’s most prevalent sexual problems were low desire, difficulty with vaginal lubrication, inability to climax, finding sex not pleasurable , and pain, usually during entry. The most prevalent sexual problems for men were erectile difficulty (14% of all men interviewed reported using medication or supplements to improve sexual function), lack of interest in sex, climaxing too quickly, anxiety about performance, and inability to climax. About one quarter of sexually active older adults with a sexual problem reported avoiding sex as a consequence.
Most surprising, given the extent of these problems that prevented sex from being satisfying or pleasurable, was this fact:
Only 38% of men and 22% of women reported having discussed sex with a physician since the age of 50.
The study suggests that the reasons for poor communication include the unwillingness of both patients and physicians to talk about sex and the gender and age differences between patients and their physicians.
Negative societal attitudes about women’s sexuality and sexuality at older ages may also inhibit such discussions.
When I give workshops and talks, both women and men frequently bring up physical problems that affect their sexuality and want me to provide a solution. I always say, “Please get a diagnosis from your doctor.” I emphasize that the problem may be caused by retreating hormones, or by an underlying health condition that you don’t know you have, or a medication, or interactions of medications. You can’t treat a problem until you know what’s causing it.
As the NEJM article states,
Sexual problems may be a warning sign or consequence of a serious underlying illness such as diabetes, an infection, urogenital tract conditions, or cancer. Undiagnosed or untreated sexual problems, or both, can lead to or occur with depression or social withdrawal. Patients may discontinue needed medications because of side effects that affect their sex lives, and medications to treat sexual problems can also have negative health effects, yet physician–patient communication about sexuality is poor.
I invite your comments!