dr. christie ganas m.d. penn state health st. joseph

Young SurvivorsSexuality and Fertility

Dr. Christie Ganas M.D.Penn State Health St. Joseph

Difficult topic

Uncomfortable to talk about◦patient and partner◦Health care provider

Taboo subject Myths about sex Significant impact on quality of life Barriers

Difficult topic to discuss

OrgasmArousalDesire

What is normal??

Normal Sexual Response

Emotional intimacy

Sexual stimuli

Sexual arousal

Arousal and sexual

desire

Emotional and

physical satisfactio

n

Intimacy-Based Model

Factors Affecting Sexual Function

Medical history, illness, medications,

hormones

Family, cultural, society

Partner relationship, sexual image,

sexual experience

External stressors,

Psychological well-being

Surgery Chemotherapy Radiation Anti-hormonal Medications

Body Changes and Cancer Treatment

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

Psychological Effects

Poor vs good emotional well-being Presence or absence of vaginal dryness Quality of the partnered relationship

Predictors of Sexual Health after Cancer Diagnosis

Vaginal dryness Arousal Desire Orgasm

Issues

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????

Vaginal Dryness

Vibrators Dilator therapy Pelvic floor physical therapy Eros clitoral therapy device

Arousal

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

Behavior modification

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

Prepare

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

Reduce anxiety

Hugging Fondling Caressing Cuddling Kissing Hand holding Manual/oral stimulation Intra thigh or intra mammary intercourse

Alternative forms of physical love

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

Medication

Condoms Diaphragms IUD Permanent sterilization

Contraception

Thank you