Presentation on theme: "Opening a Discussion of Sexuality in Palliative Care Peter D. MacIntyre, Ph.D. University College of Cape Breton Sydney, Nova Scotia."— Presentation transcript:
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. “Oh My God” 2. Yucky, gross, weird 3. wrinkly, slow, feeble 4. not terribly erotic, ok, healthy 5. nasty, sweet, gross 6. gross, slow, funny 7. yucky, awkward 8. Eek! (even though it shouldn’t be), good for them, healthy 9. Yuck, funny, don’t want to think about it 10. 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. A narrow view of sex Sex = Intercourse anything other than a penis in a vagina is not sex and does not “count”. Sex ends with the male orgasm
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 time arousal
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 Cancer Impairs hormonal, vascular, and neurological functions Pain is a major factor Side effects of chemotherapy and radiation may result in negative body image
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 Minimizing effects of pain Planning sexual activity at optimal times of the day Use methods of pain control such as moist heat or pain medication Find comfortable positions
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) Remember that everyone is an individual. Personal history often challenges assumptions about generations
Intercourse Positions Lateral position Allows for breast and genital play Woman-on-top Frees the woman from weight-bearing 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 Running fingers through each other’s hair Sexual fantasy Massage Tickling Stroking Scratching Sensate Focus – partners agree to ‘no intercourse’ rules, enjoy all the sensations
One last student comment Three words on sex for seniors His 3 words were… HOPE IT’S ME!