Presentation on theme: "Opening a Discussion of Sexuality in Palliative Care"— Presentation transcript:
1 Opening a Discussion of Sexuality in Palliative Care Peter D. MacIntyre, Ph.D.University College of Cape BretonSydney, Nova Scotia
2 I asked my university students: Think of 3 words that come to mind when you think about two seniors having sex…“Oh My God”Yucky, gross, weirdwrinkly, slow, feeblenot terribly erotic, ok, healthynasty, sweet, grossgross, slow, funnyyucky, awkwardEek! (even though it shouldn’t be), good for them, healthyYuck, funny, don’t want to think about itGood for them, gross, healthy
3 Ideas That May Limit Our Thinking About Sex Sex is for reproduction onlypeople past their sexual prime do not have sexual needs.A narrow view of sexSex = Intercourseanything other than a penis in a vagina is not sex and does not “count”.Sex ends with the male orgasm
4 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.
5 Sexuality and Aging After adolescence, sex is normal human behaviour About half of those over 60 are sexually activeGood healthPrior interestRegular sexual activityPeople tend toward androgyny in later yearsEmphasis on quality over frequency
7 The sexual response cycle (modified) Sexual desireInterest, willingness, attractionExcitementPhysical reactions begin, desire buildsPlateauHighly aroused, intense emotion, focusOrgasmRelease, intense feelingsResolution / RefractoryCalm down, lower interest in sexAfterplayContent, relaxed, emotional attachmentMastersandJohnsonarousaltime
8 Sexual Impact of Common Medical Conditions ArthritisDoes not directly impair sexual responseBody image, depression, chronic pain and fatigue, and medications have an effectCancerImpairs hormonal, vascular, and neurological functionsPain is a major factorSide effects of chemotherapy and radiation may result in negative body image
9 Sexual Impact of Some Medical Conditions Cerebrovascular accidents (strokes)Impairments of motor, sensory, emotional, and cognitive functioningOften decline in frequency of interest, arousal, and sexual activity
10 Medication effects on the Sexual Response Cycle Reduce DesireAntidepressants (Paxil, Effexor)Antipsychotic medications (Valium, Xanax)Antihypertensive medicationsPrescription gastrointestinal and antihistamine medicationsAnticancer drugsNonprescription gastrointestinal and antihistamine medications
11 Medications and the Sexual Response Cycle Reduce arousalAntidepressantsAntipsychotic medicationsAntihypertensive medicationsPrescription gastrointestinal and antihistamine medicationsNonprescription gastrointestinal and antihistamine medications
12 Medications and the Sexual Response Cycle Reduce OrgasmAntidepressantsAntipsychotic medicationsAntihypertensive medications
13 Coping Accept limitations and enjoy options that remain Expand definition of sexualitySex is much more than Penile – Vaginal intercourse ending with the male orgasmMinimizing effects of painPlanning sexual activity at optimal times of the dayUse methods of pain control such as moist heat or pain medicationFind comfortable positions
15 Guidelines for Consideration When Discussing Sexuality Do not betray confidences.Ask permission to talk to another personTry 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 expressionConsider why they have made a decision about sexual activity now, their emotional and cognitive state.
16 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 differencesPre-1960s: tended to be strict, more privateMid 1960s: sexual revolution & the pill, but not for everyonePost 1960s: freedom but with consequences (e.g., HIV)Remember that everyone is an individual.Personal history often challenges assumptions about generations
18 Intercourse Positions Lateral positionAllows for breast and genital playWoman-on-topFrees the woman from weight-bearingFlexion, abduction & external rotation (FABER)Allows the partner easier accessRear-entry, “spooning”
19 When Intercourse Is Not Possible CuddlingHoldingHuggingKissingManual genital stimulationRunning fingers through each other’s hairSexual fantasyMassageTicklingStrokingScratchingSensate Focus – partners agree to ‘no intercourse’ rules,enjoy all the sensations
20 One last student comment Three words on sex for seniorsHis 3 words were…HOPE IT’S ME!