1. Young Survivors Sexuality and Fertility
Dr. Christie Ganas M.D.
Penn State Health St. Joseph

2. Difficult topic

3. Difficult topic to discuss
Uncomfortable to talk about
patient and partner
Health care provider
Taboo subject
Myths about sex
Significant impact on quality of life
Barriers

5. What is normal??
Orgasm
Arousal
Desire

6. Normal Sexual Response
Emotional intimacy
Sexual stimuli
Sexual arousal
Arousal and sexual desire
Emotional and physical satisfaction

7. Intimacy-Based Model

8. Factors Affecting Sexual Function
Medical history, illness, medications, hormones
Family, cultural, society
Partner relationship, sexual image, sexual experience
External stressors,
Psychological well-being

20. Body Changes and Cancer Treatment
Surgery
Chemotherapy
Radiation
Anti-hormonal Medications

25. Psychological Effects
Body Image
Depression
Anxiety
Fear
Guilt
Partner’s fears/concerns

27. Predictors of Sexual Health after Cancer Diagnosis
Poor vs good emotional well-being
Presence or absence of vaginal dryness
Quality of the partnered relationship

28. Issues
Vaginal dryness
Arousal
Desire
Orgasm

29. Vaginal Dryness Lubricants and moisturizers
Lubricants are a temporary measure to relieve vaginal dryness during intercourse
Water oil silicone based
Moisturizers provide long-term relief of vaginal dryness
?? Role of local estrogen- discussion with oncologist and gynecologist
Personalized and individualized plan
Risk of recurrence????

31. Arousal Vibrators Dilator therapy Pelvic floor physical therapy
Eros clitoral therapy device

33. Behavior modification
Lifestyle modification
Exercise
Nutrition
Social support
Stress, Time, Life management

34. Prepare Get comfortable with scars, changes Look, touch New normal
Communicate with partner
Setting the scene

35. Reduce anxiety Make it a priority Start gradually
Ways to feel less self-conscious
Setting the scene
Goal is pleasure -not performance

37. Alternative forms of physical love
Hugging
Fondling
Caressing
Cuddling
Kissing
Hand holding
Manual/oral stimulation
Intra thigh or intra mammary intercourse

39. Medication
Flibanserin- nonhormonal therapy that works on key sexual pathways in the brain
FDA approval
Efficacy on desire and satisfying sexual evidence
Bupropion -effects norepinephrine and dopamine uptake
Increase sexual responsiveness and orgasmic activity
Sildenafil – used to treat antidepressant associated sexual dysfunction, not FDA approved

40. Contraception
Condoms
Diaphragms
IUD
Permanent sterilization

42. Thank you