June has been declared Adult Sex Ed Month (#AdultSexEdMonth) by Ms. Quote
(@GoodDirtyWoman on Twitter) who blogs at A Good Woman’s Dirty Mind. This idea caught on, and this month, hundreds of posts designated #AdultSexEdMonth from sex educators and bloggers appeared all over the Internet. View the list with links here.
In my world — advocating for senior sex and educating about older-age sexuality — every month is Adult Sex Ed Month. This month has been particularly fruitful.
This month, I participated in a Huffington Post Live event titled “How Old Is Too Old To Have Sex?” with fellow panelists Ashton Applewhite, Walker Thornton, Sidney Schwab, and Ken Solin, hosted by Abby Huntsman. Of course the answer to the question in the title is obvious to us (though not obvious to Abby, until we raised her consciousness), but you’ll find the discussion interesting even though you know the answer! Watch it here:
The annual conference of the American Association of Sexuality Educators, Counselors
and Therapists conference always makes my brain swell with new information and ideas from sex educators who are trailblazers in the field. Counselors, therapists, sex educators in community or medical settings, and other people who care about your sexual knowledge and enrichment gather to learn from the leaders. Then people like me come home and spread it around – to people like you.
As always, it was impossible to attend all the sessions of interest, and there’s no way I can share all of the 25 pages of single-spaced notes that I took on my laptop, no matter how many blog posts I write. But here are some highlights and tips that are especially relevant to our age group:
- Some sexual issues are psychological; some are medical or physiological. But even when it’s a medical issue, a sex therapist can be important to help you work with whatever is going on. Medical sexual issues affect your sense of self and your relationship. “Any pharmacotherapy for sexual dysfunction should occur within the context of sex and relationship therapy.” (Ricky Siegel)
- One more good reason to quit smoking: Nicotine has been shown to decrease blood flow to the penis and increase venous outflow from the penis — in other words, less ability to get and maintain an erection. (Ricky and Larry Siegel)
- Women with vulvar or vaginal pain have a difficult time getting the pain diagnosed and treated effectively. Possible causes of pelvic pain are varied, and with the wrong diagnosis (or no diagnosis!), the wrong treatment follows. Look for a three-pronged approach: a sexual medicine physician, a pelvic floor physical therapist, and a certified sex therapist, such as used by the Summa Center for Sexual Health in Akron, Ohio. (Kimberly Resnick Anderson)
- Pelvic floor physical therapists are trained to do internal evaluation of the pelvic floor muscles — evaluating muscle function, strength, tone, and any points of tenderness. Regular physical therapists are not trained to do this. (Amy Senn)
- Men with low libido: Anxiety, mood, relationship, and religious factors affects libido. “First know what’s going on in the relationship before throwing medication at it.” (Larry Siegel)
- “Nerve sparing” prostate surgery is “a bit of a misnomer.” Erectile nerves on the outside of the prostate are very difficult to see and avoid during surgery. “The prostate is deep in the pelvis, and they go pushing around with stainless steel instruments. If cauterizing instruments are anywhere near nerves, it damages them for life. Nerves recover from the pushing and pulling – it takes a long, long time. Nerves go into shock and stop sending message to blood vessels to relax and let blood in.” (Anne Katz)
- “Sexual arousal requires healthy blood flow for everything else to work. Otherwise, nothing happens. Take a 15 minute walk with your partner before sex. It will prime the pump.” (Ellen Barnard)
- After treatment for female genital cancer, using a vibrating wand internally will reduce scar tissue. “Vibration directly to the scar tissue starts breaking up that scar tissue, allowing it to expand, become more comfortable, and allow penetrative sex if we want it.” (Ellen Barnard)
- After cancer treatment, start getting to know “what is”: “What feels good? What doesn’t feel good? What’s numb? What’s painful? How does arousal happen? What does it take? How does orgasm happen and feel? When during the day do I have energy?” (Ellen Barnard) You need to learn this for yourself before you can teach your partner. (JP: This applies to aging in general, also.) A Woman’s Touch has excellent educational brochures for both men and women online at no cost, for example, Healthy Sexuality After Cancer. Visit www.sexualityresources.com, see the Educational Brochures link in the upper left hand corner of the menu bar for a complete selection.
The huge news this month for me as a senior sex educator was an invitation from Cleis Press to write a book for them: The Ultimate Guide to Sex after Fifty! I’m thrilled to have a new book to write on my favorite topic, and I’m proud to be part of the fabulous Ultimate Guide collection of sexuality guidebooks. You can be sure you’ll hear more about my new endeavor as it unfolds.
Meanwhile, if there’s a topic you want to be sure that I cover in this new book, please either post it as a comment here or email me. I love to hear from you. I’m too busy to promise to answer all your questions in detail, but I try to acknowledge your email and point you in the right direction. I admit sheepishly that I have about 400 unanswered emails waiting. If one of these is yours, I thank you for your patience! (I do give private, educational consultations answering your questions by phone or Skype for a modest fee — email me for more info about this.)
I’m writing the chapter about cancer and sexuality for my new book, Naked at Our Age: Talking Out Loud about Senior Sex. The stories people sent me about reclaiming their sexuality after cancer treatment fill me with admiration. I looked back at some older posts on this blog that deal with sex & cancer, and decided to bring back this one from 2006. With the prevalence of Viagra use, I think BillyBob’s experience and his thoughts about it are important. – Joan
BillyBob, age 62, has told some of his story previously as a comment here. He recently sent me an email detailing an experience that he wants to share — and he makes an important point:
I started dating a lady I have known for a year, mostly through phone conversations. I knew that she likes sex. Last weekend we went for dinner. After dinner she wanted to go back to my place for a while.
Well, as it turned out, it was the most embarrassing time I have ever had, all because of a misconception some woman have about impotency.
I took a Viagra after we got back to the motel hoping it worked fast! It did its normal thing and got me sexually aroused but not 100%. She knew I had to take it because of the prostate cancer killing my prostate.
Here is where the misconception comes in. It seems that women who do not know about Viagra seem to think if you take it you just get ramrodding hard, and they do not need to do any stimulation. Well that’s just plain wrong. Men still need stimulation along with the Viagra. The drug is not a sack of cement installer.
And I was not about to masturbate myself in order to get it hard. Not in the presence of a woman.
So as it turned out she turned me off instead of on. What a bummer. It was so disappointing. I had looked forward to our meeting for some time. And the possibility of finally enjoying good sex with some one that likes sex.
All a woman needs to know about the drug is that you do things as normally, using stimulation together. So please tell your readers what my experience was.
BillyBob, thank you for sharing this experience. Viagra helps when there’s a physical cause for lack of erection, as you know, but it doesn’t increase libido, or substitute for all those other crucial components of good sex that you (and I, and probably everyone reading this) crave — touching, kissing, bonding, stimulating each other physically and emotionally, enjoying each other’s pleasure as well as our own.
It sounds like most of this experience was missing for you. What a bummer, I agree. I’m sorry you didn’t feel you could communicate your needs and desires to your partner — I don’t know, maybe she would have been happy to help you get aroused if she had understood. It’s hard to understand why she didn’t seem interested in stimulating you just as part of the sex play (with or without Viagra), since that’s a good part of the fun of sex.
I know you were too embarrassed to masturbate in front of her when she didn’t help arouse you, but as a woman, I find it very pleasurable and exciting to watch a man stimulate himself. I don’t know if your partner would have reacted this way, but I’ll bet she would have.
If you see a future or at least a repeat date with this woman, I hope you’ll communicate candidly with her before you get to “the act.” And please continue to write.
Thank you again, BillyBob.
Cancer — not a sexy topic, and not what you’d expect me to write about on Christmas Eve. But cancer knows no seasons and respects no holidays. Maggie, age 62, wrote to me:
Recently, I met a nice guy who after dating for a while, told me that he had surgery for prostate cancer 7 months ago. He went on to tell me all the bad news that the Dr. had told him about side effects. My question is, do you know any where that I can get some straight answers on what we are looking at, possibility wise? The information I have found online so far has been very negative, almost always putting the pressure on the woman if things were going to work or not. He advised me that he would never be able to have an ejaculation & that sex for him would never be the same. I got the idea that he would never feel the pleasure of having a climax again. My fear is that if this is true, what would be the point of him having sex? I am a very sexual woman & would just like to know if there is any chance that there can be a sexual relationship? Any guidance that you could offer would be greatly appreciated.
I sent Maggie’s question to cancer and sexuality specialist, Anne Katz, RN, PhD. Here is her response:
There are a number of possibilities in this situation, some of them good and some of them not so good. Here are the facts:
1. Having surgery for prostate cancer (a radical prostatectomy or complete removal of the prostate gland) will result in significant changes in a man’s ability to have an erection. Depending on what his erections were like before the surgery and the amount of damage done to the nerves responsible for erections during the surgery, the man may be able to have erections after the surgery but he is most likely always going to need some help (from medication like Viagra, Cialis or Levitra). These medications only help about 50% of the time but there are other erectile aids (the vacuum pump or penile injections) that can help too. Some men are able to have an erection but it may not last very long. Some men can only achieve a thickening of the penis and this may not be sufficient for penetration. Progress in regaining erections may continue for up to two years after surgery but what he has at that point is usually as good as it is going to get.
2. Orgasms are still possible, even with a flaccid penis. The orgasm will not be accompanied by ejaculation however (the prostate gland makes the fluid portion of the ejaculate and so when it is gone, so is the emission). Some men report more intense orgasms after this surgery; some say they are much less intense.
3. Libido (or sexual desire) is not affected by removal of the prostate but the mind is a very important part of a man’s sexuality. Repeated failure to have an erection sufficient for penetration may cause him to lose some interest. Although some men just keep on trying and trying and trying – the human spirit is a powerful force and many men retain hope for many years despite little success.
4. Many couples find a way around these difficulties. There are more ways than just penetration for both the man and the woman to achieve orgasm and satisfaction and some creativity goes a long way. This may be challenging for a new relationship. But the lust and attraction in a new relationship may also provide more impetus than a 30 year relationship! There is no right way or wrong way in this; a lot depends on how you want to look at the situation.
5. If you read anything that you feel puts the onus on the woman (or male partner) to fix things, then stop reading! This is a couple’s issue and both partners have to work on finding a solution. Communication is a very important part of sexuality. You should be able to talk openly about what works for him and what doesn’t. You should be able to talk about what you want and what creativity you can both bring to sexual activity. In your letter you state that you “got the idea” – you will have to ask questions and not rely on innuendo to help you understand what is possible and what is not.
New relationships are challenging and exciting and inspiring and joyful. When illness or injury have occurred it puts a lot of pressure on this new partnership. Good luck!
Anne Katz, RN, PhD, is the author of the award-winning text book Breaking the Silence on Cancer and Sexuality: A Handbook for Health Care Providers . Dr Katz has also written three books for consumers: Sex When You’re Sick: Reclaiming Sexual Health after Illness or Injury; Woman Cancer Sex, and Man Cancer Sex. She is the sexuality counselor at CancerCare Manitoba in Winnipeg, Manitoba, where she provides counseling to men and women experiencing sexual difficulties as a consequence of cancer and its treatments. Visit her website at http://www.drannekatz.com/.
Neil, age 74, who wrote his Personal View of Prostate Surgery and Sex here, wants to add this:
I hope I did not leave the impression that I am anti-physician. I do not want to imply that my caregivers were incompetent or uncaring. I certainly don’t think anyone lied to me. I am blessed with a caring and extremely competent urologist who has given me nine years free of prostate cancer.
The urologist was aggressive in treatment. Tests were conducted well before my PSA even reached critical numbers. Normal range is 1 to 4 — mine was a little over 2. The disease was caught early because of a very dedicated doctor.
My urologist routinely spends 12 to 14 hour days in the battle against cancer and has very little personal time. I am grateful for what was done for me. My physician, by the way, was not the person who gave the word that sex didn’t matter after 55. That was a second opinion guy at another medical center.
I suppose the myths and lack of information come from two areas:
(1) The work load of dedicated health care professionals is unbelievable. When faced with a choice of saving life or providing sexuality education, I would want my doctor to first go after the cancer. I was very grateful my urologist did just that. I am here today because of this priority.
(2) While some counseling was given, my physician candidly stated that not much training was given in matters of sexuality. There simply was not enough time for everything. I believe that. As I have talked to other urologists, the story is the same. There is just not enough time to get everything into the program of study.
I am sure that we, as sex educators, have some responsibility to assist in making things better. Perhaps more of us will somehow find our way into relationships with medical school faculties. Hopefully, we can also raise awareness that would provide support to local medical groups as well. I would hope that we could be of assistance to the medical profession without getting in the way of their very important clinical work. I am sure that your book will also provide more information that can be placed in the hands of the health care community.
Above all, I want to leave the message for men to find a competent urologist and stay with their professional judgment. This stuff is nothing to mess with or take lightly. I prefer that we work hand in hand with health care professionals in the battle against cancer as well as the enhancement of sexuality.