Young Survivors Sexuality and Fertility Dr Christie Ganas

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

Difficult topic

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

What is normal? ? Desire Arousal Orgasm

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

Intimacy-Based Model

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

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

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

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

Issues � Vaginal � Arousal � Desire � Orgasm dryness

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? ?

Arousal � Vibrators � Dilator therapy � Pelvic floor physical therapy � Eros clitoral therapy device

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

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

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

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

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

Contraception � Condoms � Diaphragms � IUD � Permanent sterilization

Thank you