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11a bolte san antoniofinal2010bolte
- 1. Sage Bolte, PhD, LCSW, OSW-C Oncology Counselor Life with Cancer ® Fairfax, VA [email_address]
- 3. 1. Information or Event: External events that affect sexual function or affect aspects of sexuality (e.g., disfigurement, positive sexual experiences, etc.) 2. Sexual Esteem : Cognitive, Attitudes, Sexual Schemata 3. Sexual Affect/Feelings: Feelings about sexuality and function: Includes distress or negative/positive . CANCER The Experience of Cancer can bring multiple events New information has to be absorbed into the sexual self. The sexual self could stay stable, or could experience a large effect. 4 . Sexual Behavior and Function
- 10. Female YA childhood survivors reported higher means of problems with all aspects of sexual functioning than male survivors, however, all were significant with aspects of quality of life (Zebrack et al., 2009) Zebrack, B., Foley, S., Wittmann, D., & Leonard, M. (2009). Sexual functioning in young adult survivors of childhood cancer, Psycho-Oncology.
- 11. From: Zebrack, B., Foley, S., Wittmann, D., & Leonard, M. (2009). Sexual functioning in young adult survivors of childhood cancer, Psycho-Oncology.
- 15. The impact of cancer treatments on the physiological , psychological and social aspects of sexuality and sexual function.
- 20. Assessment tools for assessing sexuality and intimacy
Notas do Editor
- You have in your handouts the lists of Biological, Psychological and Social Effects – all of which many of our patients experience and many who have no idea that a medication they are taking could possibly complicate the problem they are already experiencing OR that a simple change in medication or positions could help eleviate the problem!!! Impacting the four phases of sexual response. It is important to know where are clients are being affected so we can better help them find solutions. If their problem is desire, because of fatigue or not being attracted to themselves or their partner than we can help prescribe solutions that focus on that, RATHER than just handing them viagra! Psychological; misbeliefs about the origin of the cancer, guilt related to these misbelifs, coexisting depression, changes in body image, stresses to personal relationships. Can be desire disorder, arousal disorder, orgasmic disorder (pain or unable) and sex pain disorders
- An evaluation tool that can be flexible with clinician’s knowledge and experience (Robinson and Annon, 1976) PLISSIT model uses a series of discussions about the specific effects of treatment on sexual function and options for adaptation or resumption of sexual activity Shipes and Lehr, 1982 estimated that 70% of sexual problems related to cancer therapy can be managed by using the first three levels of model
- Before Getting Permission: Social Worker must be comfortable with the topic Establish rapport before openly discussing sexuality and use patient’s language and terms Do not wait for the patient to bring up sexuality Normalize questions “Many of our patients taking chemotherapy lose interest in sex. Is this a problem for you?”
- Of Course it depends on the relationship you have with the patient and or their significant others that determines the questions you use
- Be informed about the sexual implications for your patient Do not assume patients or loved ones know normal sexual physiology Include sex education in all interactions with patients (this could be as simple as providing the ACS booklet Sexuality and Cancer)
- Positioning and finding other ways to build intimacy – especially for the single person Suggetion: Sensate focus exercise Worry that sex my cause recurrence Time, encourage not to rush Pouch covers for ostomy patients Changing time of day and positioning for intimacy when there is pain or fatigue “ Sexuality and Cancer”, ACS booklet provides detailed sexual advice and guidance Provide tips on maintaining intimacy without sex, exploring alternative pleasurable activities Direct to self help books, or information on dilators, lubricants, etc Sensate focus exercises Take a bath before sex to relax, use lubricants and change position if concerned about pain
- Plastic or rubber tube used to stretch vagina
- 70% of patients will only need the first three interventions Referral for psychological or sexual therapy may be required for past trauma or troubled relationship Know your limitations and skills, continue to assess needs Support and Compassion = Normalizing and Validating concerns and providing appropriate referrals
- Research is extremely important in this area…you have a great population that can easily be assessed so we can learn more and learn how to better provide our patients with information.