Posts Tagged ‘medical challenges’
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
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!
Changes after Prostate Surgery: Tina Tessina
Many of you have been reading and asking about prostate cancer, how it affects sexuality, how spouses/lovers can communicate and keep their love strong while living with it. Some of the most widely read posts on this blog have been those dealing with prostate cancer, such as “A man asks about sex after prostate cancer” and “Grace Period: a novel about living with prostate cancer.”
In response to your interest, I’ve asked Tina Tessina, Ph.D. to comment on this subject. Besides being a psychotherapist and author, Tina writes from experience: her husband is living with prostate cancer. Here are her comments:
The changes that come after prostate surgery are, like all changes, not easy. We don’t like to have to deal with changes, especially those that confront us with our mortality. But, I can happily report, with some encouragement and enthusiasm from me, my wonderful husband is quite functional sexually. His surgery was in 2002, he just got another ‘undetectable’ PSA test, so we are blessed.
For us, the blessing is in how heightened our love and appreciation (which was pretty good before) has been by the threat of terminal illness. Richard is lucky — they got it early, it has not spread, the surgery went well. His second surgery to have an artificial sphincter put on his urethra, also went well.
Others, I know, have a more difficult time. But, as Gerald Haslam wrote in Grace Period, “Live for the moment, since that may be all you have.” Richard and I decided to do that in 2002, and we’ve been making the most of our moments ever since. Every day is a gift, another cup of sweetness, and we drain it to the last drop. One of our joke lines is “I’d like another one of them there drinks,” from Scrooge, referring to the Cup of Human Kindness given to him by the Ghost of Christmas Present.
For some couples, the tension of serious illness creates crabbiness and bickering. Richard and I have never wanted to waste time arguing, and we haven’t for a long time. I don’t believe it helps anything that’s going on. In my newest book, Money, Sex and Kids: Stop Squabbling About the Three Things That Can Destroy Your Marriage out from Adams Media spring 2007, I help couples who are fighting learn new methods of getting along so they can enjoy their time together.
For more, see Tina Tessina’s Dr. Romance Blog. Dr. Tessina is a psychotherapist, author of several books including It Ends With You: Grow Up and Out of Dysfunction, How To Be a Couple and Still Be Free, and The Unofficial Guide to Dating Again. She writes the “Dating Dr.” column on www.CouplesCompany.com and “Dr. Romance” on Yahoo! Personals.
Aging and Sexuality: Recommended Books for Geriatric Intimacy
In Better Than I Ever Expected: Straight Talk about Sex after Sixty, I recommended an assortment of helpful books for women and men interested in having great sex and geriatric intimacy. I thought it would be useful to reprint this resource here. I’ll divide the books by category, and I’ll add new books that have crossed my path since Better Than I Ever Expected was published. Let me know about a special book you’ve enjoyed that belongs here. (Keep checking back — this list is just the beginning!)
I’ve included links to these books on Amazon.com for your convenience and to read more customer reviews, although I encourage you to purchase from your local independent bookstore when possible.
And of course, if you don’t already have it, I hope you’ll read Better Than I Ever Expected: Straight Talk about Sex After Sixty! Order a personally autographed copy directly from the author here, or order from Amazon here.
Better Than Ever: Love and Sex at Midlife by Bernie Zilbergeld, Ph.D., (Crown, 2005). A guide to sexual enjoyment in the second half of life, including overcoming health challenges and staying sexy in long-term relationships, based on 145 interviews with men and women ages 45 to 87. This is an excellent book from the male point of view. Unfortunately, Zilbergeld died before this book could be published. We are fortunate to have his last work.
Dr. Ruth’s Sex After 50: Revving Up Your Romance, Passion & Excitement! by Dr. Ruth Westheimer (Quill Driver, 2005). Smart advice from Dr. Ruth about health issues, physical changes, and keeping your sex life with your partner interesting and fun, with stories of real couples.
The New Love and Sex After 60 by Robert N. Butler and Myrna I. Lewis (Ballantine, 2002). A geriatric physician and a psychotherapist discuss how sexuality is affected by physical aging changes, medical conditions, medications, emotional issues, and relationship changes. Rather dry writing style, but it covers the ground.
Sex Over 50 by Joel D. Block, Ph.D, with Susan Crain Bakos (Parker, 1999). Frank self-help book aimed mostly at couples, with tips (“sizzlers”) galore for recapturing romance and passion and dealing with the sexual challenges of midlife and older, plus anecdotes of geriatric intimacy.
Still Doing It: Men & Women over 60 write about their sexuality, ed. Joani Blank (Down There Press, 2000) Real people 60-plus to 80-plus tell bluntly and in graphic detail (and graphic language) what they do and what they like, including an array of sexual styles.
Rescue Me, He’s Wearing a Moose Hat: And 40 Other Dates After 50 by Sherry Halperin (Seal Press, 2005). Fifty-plus widow’s adventures with online dating mismatches. Fabulously funny and often poignant. With dating catastrophes like these, single life doesn’t look so bad.
Revolution in the Garden: The Memoirs of the Garden Keeper by Dell Williams and Lynn Vannucci, autobiography of founder of Eve’s Garden, New York women’s sex shop, written at age eighty-two. Her reminiscences include losing her virginity in date rape in 1940 and attending Betty Dodson’s masturbation workshop in 1970.
A Round-Heeled Woman: My Late-Life Adventures in Sex and Romance by Jane Juska (Villard, 2003). Sixty-six-year-old woman overcomes a restrictive sexual upbringing and places personal ad: “I would like to have a lot of sex with a man I like.” She gets plenty of responses and trysts, but the results mostly aren’t very satisfying.
Still Sexy After All These Years? The 9 Unspoken Truth about Women’s Desire Beyond 50 by Leah Kliger and Deborah Nedelman (Perigee/Penguin, 2006). Empowering self-help guide to understanding your changing sexual desire after fifty, with excerpts from interviews.
Unaccompanied Women: Late-Life Adventures in Love, Sex, and Real Estate
by Jane Juska (Villard, 2006)). Juska chronicles how her life, dating and otherwise, has changed since publication of Round-Heeled Woman. If you enjoyed RHW, you’ll enjoy this one, too.
All Night Long: How to Make Love to a Man Over 50 by Barbara Keesling, Ph.D. (Harper Collins, 2000). A sex therapist and former sex surrogate explains what a woman should understand about an aging man’s sexuality, his “temperamental penis,” and how to keep the focus on “lovemaking, not erections–partnership, not performance.” Practical, frank, and helpful.
Great Sex: A Man’s Guide to the Secrets of Total-Body Sex by Michael Castleman (Rodale, 2004). Castleman writes with warmth and honesty about issues that concern men at any age: their own and their partner’s sexuality and pleasure. An excellent book for the man in your life.
Intimacy with Impotence: the Couple’s Guide to Better Sex after Prostate Disease by Ralph & Barbara Alterowitz (Da Capo/ Lifelong Books, 2004). A frank, practical guidebook to satisfying, sensual intimacy whether or not the male partner can have erections. An array of self-help strategies, from communication and creativity to medical therapies.
I hope this helps you to age vibrantly and your senior sex life! Geriatric intimacy is something to be celebrated.