Slæður frá vinnusmiðju Woet Gianotten

1. Oncosexology for Iceland 28-01-2011 Woet L. Gianotten MD-psychotherapist consultant in oncosexologythe Netherlands 2002

2. Financial disclosure I have been connected to Bayer Schering Pharma for presentation / teaching in the areas of: Multiple Sclerosis & sexuality Hemophilia & sexuality

3. 1. IntroductionSexuality / gender / disease / general approach 2. The sexual aftermath of cancer & treatment 3. Various oncosexology treatment (approaches)

4. Prevalence numbers in cancer (Dutch estimates) %% of total adult population (> 20 yrs) ± 4.0% Cancer diagnosis survivors ± 0.2% recovery treatment palliative † ± 0.1% terminal

5. Total ±4.3%

6. Oncology professionals (& other medical prof’s) Talking sex? Very Scared:What to ask? How to deal with that? Patients Talkingsex? Veryscared to start! > 85% willnever start thatdiscussion In 62% of womenwithgynaecologiccancerthe topic had not been addressed! Sadovsky R et al. Cancer & sexualproblems. J SexMed2010;7:349–73.

7. A change in approach and a change in consequences ! Differentiation Disease Disease bio- psycho- social causes Sexualdisfunction a pro-active responsibility! sexual sexual function identity sexual relationship

8. Differentiation Sexualfunction Sexuallidentity Sexualrelationship sexual activity

9. before her bowel cancer after the intervention

10. Gender differences

11. Default Need for contact.Always relating & trying to be nice. testosterone At birth these differences are already measurable Need for autonomyand disconnecting T acts on the genitals and on the brain L Brizendine: ‘The female brain’, 2006 L Brizendine: ‘The male brain’, 2010

12. That is not better, That is not worse ! Typical female-male differences MaleMore orientedon ‘SEX’ genital orgasm penetration Female More orientedon relating contact sensuality More assertive Bad antennae More submissive Rather sensitive More feelings of sexu of ´sexual guilt´

13. girls / women are more ‘people-oriented’ boys / men are more ‘thing-oriented’

14. In case of cancer? Women: more busy‘restoring the relation’ with partner Men: more busy ´restoring function´ Problemswitherection / orgasm Problemswithdesire Problemswith‘disfigurement’

15. Male and worries? Male and (diagnosis of) prostate cancer ± 25% of the men went to see their doctor because his wife told him to do so. ± 10% of the men didn’t tell his wife about the visit to the doctor! Shame!

16. Female and worries? Femalefeelguiltyaboutnothavingdesire. There is a big differencebetween‘nodesire’ and ‘nodesire’ My desire has completely disappeared since my disease / treatment I don’t like sex at all. I hate him! Guilt!

18. Sexual function (for oncosexology)

19. The basics of sexual function excitement arousal orgasm desire

20. Usual female pattern:First contact & committment.Then evt. arousal. Then desire can develop and evt. continue to orgasm Man and woman are different Usual male pattern:First desire. Then continuation(more or less linear)Then ‘black hole’(refractory period) Sexualdesire

21. Needed for desire: Enough testosteron Good enoughneurotransmitter balance: Dopamin, prolactin, etc Sexual desire

22. T / androgen levelsover the male life 40 30 20 10 0 nmol/L Testicular testosterone Adrenal testosterone Puberty

23. T / androgen levelsover the female life 4 3 2 1 0 nmol/L Ovarian testosterone Adrenal testosterone Puberty Menopause

24. Androgens for the womanNeeded for: ● sexual desire,● ability to get aroused ● ability & strength of orgasm● assertiveness● physical strength (not being tired)● general wellbeing● good mood (T acts as an antidepressant) bone mass muscle mass SHBG 4 3 2 1 0 nmol/L Ovarian testosterone Adrenal testosterone Puberty Menopause

25. Why? Why do people have sex? Why is discussingsexuality important?

27. Recreation (fun, adventure, lust, etc)

29. Physical: musclerelaxationvaginal / cervicalstimulationincreases the pain threshold (byendorphines) safest ‘sleep medication’ decreasesvaginalatrophy  massage and orgasmincreaseoxytocin-level (and as suchincreasemutual trust)

30. More reasons why we have to discuss sexuality Becauseformanypatients (and partners) sexuality and intimacyare important aspects of QoL. Because our treatment interventions cause so much harm!

31. Discuss sexuality with all patients?

33. Being single

34. Gay / lesbian

35. Culture

36. Etc Should not be arguments to not give attention

38. Gay men and cancer? Cancer causes Different sexMore risk for STD HIV HPV HBV HCV more Kaposi sarcomamore oral cancermore anal cancer (??)more penis cancer more liver cancer Different lifestyleLess overweight More alcohol consumption More recreational drugs + / - other cancer?

39. Lesbian women and cancer : causes Different sexLess risk for HPV Be aware: even in ‘pure lesbians’ HPV was found 1 Less cervix cancer More ovarian cancer Different reproductive historyLess oral contraception Less pregnancies Less lactation More endometrium ca. More breast cancer Different lifestyleMore smoking More overweight More alcohol consumption Less healthy diet More bowel cancer 1 Bailey JV, Kavanagh J, Owen C, et al. Lesbians and cervical screening. Br J Gen Pract. 2000; 50 (455): 481-2.

40. Discuss sexuality in the palliative phase- terminal phase? “Those last months we had sexveryfrequently. In spite of the cancerhe was myhero.We bothenjoyedthatsoverymuch!”Widow (74 yrs) of man whodied of livercancer

41. “Intimacy is a casualty in the battle against cancer!” Focus on cancer & sexuality? or Focus on treatment & sexuality?

43. Prostate cancer

44. Ovariancancer

46. Breast cancer: (sexual) treatment consequences

49. ‘Presumedorganconfined’ Spread outside the prostate Prostate cancer Diagnosis Staging (T/N/M) Where? Life expectancy? ADT AndrogendeprivationTr. ‘Short’ ‘Long’ WW In case of failure(PSA increase) Whencastrationresistencydevelops: Surgery Brachytherapy Chemotherapy, (docetaxel, etc.) ExtBeam RT

50. ADT WW Surgery Brachytherapy Chemotherapy ExtBeam RT

52. Androgen (testosteron) supply 4 3 2 1 0 nmol/L Ovarian testosterone Adrenal testosterone Menopause Puberty

54. Ovarian cancer No estrogen!Acute menopausal troubles 4 3 2 1 0 nmol / L Possible androgen deprivation symptoms Ovarian testosterone Adrenal testosterone

56. 4 3 2 1 0 nmol / L the full range of androgen deficiency Ovarian testosterone Adrenal testosterone

58. Unmet needs Here liesour faithfulSexlife 10 Jan 197821 March 2006

60. Medication

61. Dealingwithsexualsideeffects

62. Tools and toys

63. Relationshipcounselling

64. Restructuringsexual scripts

65. Dealingwith lost sexualidentity (mourning)

66. Restoring / dealingwith male/femaleinteraction

68. 2010 Cancer & Sexuality editors John P. Mulhall Irwin Goldstein Luca Incrocci Ray Rosen Contains > 50 chapter > 60 authors Springer : March ? 2007 2011 2010 2007

69. Thankyou ! @ .com woet gianotten