Opening a Discussion of Sexualit

Opening a Discussion of Sexuality in Palliative Care Peter D. MacIntyre, Ph.D. University College of Cape Breton Sydney, Nova Scotia I asked my university students: Think of 3 words that come to mind when you think about two seniors having sex… 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. “Oh My God” Yucky, gross, weird wrinkly, slow, feeble not terribly erotic, ok, healthy nasty, sweet, gross gross, slow, funny yucky, awkward Eek! (even though it shouldn‟t be), good for them, healthy Yuck, funny, don‟t want to think about it Good for them, gross, healthy Ideas That May Limit Our Thinking About Sex  Sex is for reproduction only  people past their sexual prime do not have sexual needs. Sex = Intercourse anything other than a penis in a vagina is not sex and does not “count”. Sex ends with the male orgasm  A narrow view of sex    These ideas limit our thinking by:  Neglecting the sexual needs of the elderly who are seen as being past their sexual prime. Devaluing other forms of sexual behavior. Placing performance pressures on both men and women. Creating unrealistic expectations for sexual expression. Ostracizing sexual activity between members of the same sex.     Sexuality and Aging  After adolescence, sex is normal human behaviour  About half of those over 60 are sexually active    Good health Prior interest Regular sexual activity  People tend toward androgyny in later years Emphasis on quality over frequency  Notes on physiology and its consequences The sexual response cycle (modified)  Sexual desire  Interest, willingness, attraction Excitement  Physical reactions begin, desire builds Plateau  Highly aroused, intense emotion, focus Orgasm  Release, intense feelings Resolution / Refractory  Calm down, lower interest in sex Afterplay  Content, relaxed, emotional attachment Masters and Johnson arousal      time Sexual Impact of Common Medical Conditions  Arthritis   Does not directly impair sexual response Body image, depression, chronic pain and fatigue, and medications have an effect Impairs hormonal, vascular, and neurological functions Pain is a major factor Side effects of chemotherapy and radiation may result in negative body image  Cancer    Sexual Impact of Some Medical Conditions  Cerebrovascular accidents (strokes)   Impairments of motor, sensory, emotional, and cognitive functioning Often decline in frequency of interest, arousal, and sexual activity Medication effects on the Sexual Response Cycle  Reduce Desire  Antidepressants (Paxil, Effexor)  Antipsychotic medications (Valium, Xanax)  Antihypertensive medications  Prescription gastrointestinal and antihistamine medications  Anticancer drugs  Nonprescription gastrointestinal and antihistamine medications Medications and the Sexual Response Cycle  Reduce arousal      Antidepressants Antipsychotic medications Antihypertensive medications Prescription gastrointestinal and antihistamine medications Nonprescription gastrointestinal and antihistamine medications Medications and the Sexual Response Cycle  Reduce Orgasm    Antidepressants Antipsychotic medications Antihypertensive medications Coping   Accept limitations and enjoy options that remain Expand definition of sexuality  Sex is much more than Penile – Vaginal intercourse ending with the male orgasm Planning sexual activity at optimal times of the day Use methods of pain control such as moist heat or pain medication Find comfortable positions  Minimizing effects of pain    Discussing Sex Guidelines for Consideration When Discussing Sexuality       Do not betray confidences.  Ask permission to talk to another person Try to be natural in conversation.  Sex is normal human behavior. Do not interrupt and do not be impatient.  It can be difficult to start a conversation, for everyone. Be encouraging.  Examine your own attitudes, e.g., is sex dirty? Do not criticize.  There are a wide variety of ways for sexual expression Consider why they have made a decision about sexual activity now, their emotional and cognitive state. Guidelines Continued  Consider the nature of the family.  Are they married, divorced, widowed, or single?    Consider the level communicative skill that the individual possesses. Are they in a safe and/or protected environment? Consider the generational differences    Pre-1960s: tended to be strict, more private Mid 1960s: sexual revolution & the pill, but not for everyone Post 1960s: freedom but with consequences (e.g., HIV) Personal history often challenges assumptions about generations  Remember that everyone is an individual.  Doing it Intercourse Positions  Lateral position  Allows for breast and genital play Frees the woman from weight-bearing  Woman-on-top   Flexion, abduction & external rotation (FABER)  Allows the partner easier access  Rear-entry, “spooning” When Intercourse Is Not Possible      Cuddling Holding Hugging Kissing Manual genital stimulation      Sensate Focus – partners agree to „no intercourse‟ rules, enjoy all the sensations  Running fingers through each other‟s hair Sexual fantasy Massage Tickling Stroking Scratching One last student comment   Three words on sex for seniors His 3 words were… HOPE IT‟S ME! Questions? http://faculty.uccb.ns.ca/pmacintyre/palcaresex.htm