Sex and intimacy after Prostate Cancer treatment

PRESENTATION NAME
Sex and Intimacy
after Prostate Cancer Treatment
Tan Tock Seng Hospital
Mon 11 June 2018

Dr. Martha Tara Lee
Clinical Sexologist
• Doctorate in Human
Sexuality
• Masters in Public Policy and
Management
• Bachelor of Counselling
• Bachelor of Arts (Comm)
• Certificate in Sex Therapy
• Certitificate in Practical
Counselling
• Cert in Life Coaching

Agenda
1. What Might Be
Happening
2. What Might Be Useful
3. Non Ejaculatory Orgasm
4. What Else to Take Note
5. Resources

Misconceptions about Sex and
Intimacy After Surgery (Mental)
1. Be grateful to be alive.
2. Things will get better.
3. Sex is about penetration.
4. Sex is about the orgasm.
5. Sex is all about him.
6. No need to think about sex
if single.
7. Too old anyway
Copyright 2018

Stages of Grief (Emotional)
1. Denial (This isn't
happening to me!)
2. Anger (Why is this
happening to me?)
3. Bargaining (I promise I'll
be a better person if...)
4. Depression (I don't care
anymore)
5. Acceptance (I'm ready
for whatever comes)

• Difficulty with self-esteem
because of feeling ill and being
unable to fill all your usual roles
in the family and at work
• Body image changes from
surgical scars or openings that
affect how you feel about your
body
• Affected by what your partner
may experience.
• Stress in the relationship with
your partner
Emotional Effects of Treatment on
Sexual Functioning
Copyright 2018

1. Sickness or feeling sick
2. Tiredness (fatigue)
3. Irritability
4. Sadness or depression
5. Frustration, anxiety or tension
6. Pain
7. Bowel problems such as diarrhea
8. Breathing, Mouth and Bladder
problems
9. Skin changes or scarring
10. Changes in your sex hormones
11. Concerns about changes in the way
you look
Having Cancer or its Treatment can
Cause (Physical)
Copyright 2018

Preserving Fertility in Men with
Cancer
1. Radiation shielding
2. Sperm banking
Limitations
• Fast-growing
cancers
• Infectious diseases
• Costs
3. Other ways to collect sperm
• From the urine (for
males with retrograde
ejaculation)
• Electroejaculation
• Sperm extraction and
aspiration procedures
Source: https://www.cancer.org/treatment/treatments-and-side-effects/physical-side-effects/fertility-
and-sexual-side-effects/fertility-and-men-with-cancer/how-cancer-treatments-affect-fertility.html

Cancer Can Affect a Man’s Ability to
Ejaculate
1. Surgery
• Radical prostatectomy
• Radical cystectomy
• Abdominoperineal (AP) resection
• Total mesorectal excision (TME)
• Total pelvic exenteration
2. Dry orgasm
3. Nerve damage
• The most common way surgery affects erections is by
removing or injuring the nerves that help cause an
erection.
4. Urine leakage during ejaculation

Other Things that Affect Erections
After Surgery
1. Age
2. Strength of erections before surgery
3. Other conditions, such as
Peyronie’s disease

Sexual Functioning Concerns
1. Loss of desire for sex
after cancer
2. Negative thoughts and
feelings during sex
3. Difficulty feeling
pleasure during sex
4. Difficulty reaching
orgasm
Copyright 2018

Issues of Intimate Sexual
Relations at Advancing Age
As men get older,
erectile difficulties
becomes more
common.

Dealing with Sexual Desire and
Arousal Problems
Problem Side Effects Treatment
Arthritis Joint pain due to arthritis can make
sexual contact uncomfortable
• Exercise, rest, warm baths, and
changing the position or timing of
sexual activity
• Joint replacement surgery and
drugs may relieve this pain.
Chronic
pain
Can lead to sleep problems,
depression, isolation, and difficulty
moving around.
Chronic pain can often be treated.
Diabetes Many men with diabetes do not have
sexual problems, but this is one of the
few illnesses that can cause
impotence.
In most cases medical treatment can
help.

Problem Side Effects Treatment
Heart
disease
Narrowing and hardening of the
arteries.
Can lead to trouble with erections in
men, and high blood pressure
(hypertension).
Always follow your doctor's advice.
Incontinence Loss of bladder control or leaking of
urine.
The good news is that this can
usually be treated.
Stroke Problems with erections are possible Try using different positions or
medical devices to help them
continue having sex.
Dealing with Sexual Desire and
Arousal Problems

Goals of Penile Rehabilitation
Penile Rehabilitation (PR) is the
process of regaining erectile
function, erectile length and girth,
and hardness. The main goals of
PR are to:
1. Increase daily oxygen
exchange to the penis, and
2. Maintain length and girth of the
penis such that full erection size
and hardness are possible once
the nerves have recovered.
Source: Penile Rehabilitation Booklet www.sexualityresources.com/PR _booklet_2013

Techniques of Penile Rehabilitation
1. A low nightly dose of PDE-5
Inhibitor medication
2. Gentle stretching and massage of
the penis
3. Use of a Vacuum Erection Device
(VED) twice daily
4. Pelvic Floor Muscle Exercises

1. A low nightly dose of PDE-5 Inhibitor
medication, in combination with
Vacuum Erection Devices to preserve
girth and length.
2. Gentle stretching and massage of the
penis - 10 minutes per day:
• Select a personal lubricant
• Holding the tip of the penis with one
hand, use your other hand to gently
squeeze and massage the shaft
toward the body (removing blood
from the penis)
• Then, gently stroke and stretch the
penis away from the body (allowing
blood to flow back in).

3. Vacuum Erection Device (VED)
Vacuum erection device (VED) therapy has a very high
rate of consumer satisfaction (92%), and most
importantly, is the only therapy that preserves both the
length and the girth of the clitoral body inside of the
penis.
Restorative pumping methods include:
Double Pumping is easier to do—just be sure not to
pump too quickly.
The Pump-3-Release Method takes some counting,
but this variation more effectively moves blood
in and out of the penis.

4. Pelvic floor muscle
exercise
The pelvic floor is a sling
of muscles that surround
and anchor the base of
the penis, helping to
hold blood in the penis
during erections

Products for Sexual Wellness and
Pleasure
1. Basic Erection Pump - features a
simple squeeze pump, a see-
through chamber, and a hole in the
side of the chamber to release
vacuum pressure.
2. Finger Pull Pump - This erection
pump has an ergonomic pump
handle, a see-through chamber,
and a vacuum-release button on
the tubing.

Pleasure
3. Power Pump - Vacuum strength,
and quick pressure release as
expensive medical pumps, but at an
affordable price.
4. Lasso Erection Ring -
Adjustable erection rings are a
good choice for any man
(regardless of ejaculatory
capacity) who uses aVED, or
who wants to quickly loosen or
remove the ring before
ejaculation

Pleasure
5. Lasso Ring with Vibrator - An adjustable
lasso ring combined with vibration adding
sensation for the wearer and/or against a
partner’s genitals during penetration.
6. Relaxed Fit Elastomer Erection Ring
- Because of its stretchy comfort, this
has become a store favorite because it
is discreet while providing a strong
grip.

Pleasure
7. Elastomer Erection Ring - Sturdy but
secure, and a good choice for non-
ejaculatory men who want to prevent
urinary incontinence during intercourse.
8. Elastomer Pump Sleeve - This simple,
flexible sleeve is made to fit onto the
end of a vacuum pump shaft to create
a snug, comfortable fit.

P + V = PV
Breaking Sex Down
Copyright 2018

Three Cycles of Arousal
Copyright 2018

Link Between Play vs Practice Sessions
Copyright 2018

Ejaculation
IS NOT Needed for
Orgasm
Erection
is NOT Needed for
Orgasm
Copyright 2018

1.Kegels
Super Duper Orgasms
• Frequency
•Duration
•Intensity

Super Duper Orgasms
2. Intention

5. Movement
Super Duper Orgasms

7. Fantasy
Super Duper Orgasms

1.Kegels
2.Intention
3.Breath
4.Sound
5.Movement
6.Touch
7.Fantasy
Super Duper Orgasms

Sensate Focus
Stage 1
•Without genital touch
Stage 2
•With genital touch
Stage 3
•Go with the flow
Copyright 2018

Competent Communicator
1. Code Words
Red, Yellow, Green
2. Open Ended
Questions
3. Closed Ended
Questions
4. Scale 1 to 10
Copyright 2018

1. Enjoying being close to
each other
2. Touching and stroking
3. Kissing
4. Massaging
5. Talking
6. Holding hands
Focus on Showing your Feelings for
One Another in Other Ways by
Copyright 2018

Single Men with Prostate Cancer - if
Dating or want a Serious Relationship
1. Find a friend
2. Practice
3. Be honest
4. Put yourself in a
potential partner's
place
5. Move on
Copyright 2018

Why Do Medical and Mental Health
Care Professionals Need to
Understand Sexual Problems?
Sexual problems have
an adverse effect on
interpersonal relationships
and the quality of life.
Copyright 2012 Eros Coaching

Resources
Man Cancer Sex
http://amzn.to/2CNBR94
Intimacy With Impotence
http://amzn.to/2E1iqsP

Resources
Love, Sex and Intimacy after Prostate
Cancer
http://www.sexafterprostatecancer.com.au/e-
book.html
Sex and the Man With Cancer
http://bit.ly/2oBLwXC

1. Sex Is Bigger Than Any
Body Part
2. Even If You’re Afraid To
Ask — Ask
3. Don’t Wait, Act Now
4. You Are Not Alone
5. Don’t Give Up
Takeaways
Copyright 2018

Thank You!
Dr. Martha Tara Lee
Clinical Sexologist
Eros Coaching Pte Ltd
Website: www.eroscoaching.com
Email: drmarthalee@eroscoaching.com

Sex and intimacy after Prostate Cancer treatment

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