Sexual relationships in trauma and disease

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Sexual relationships in trauma and disease
NCU Conference on Cancersexuality

• Elsa Almås and
• Esben Esther Pirelli Benestad
• Specialists i klinisk sexologi NACS
• Assistant professors Agder University College.

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WHO, 1974

• Sexual health is the integration of somatic,
  emotional, intellectual, and social aspects of
  sexual being, in ways that are positively
  enriching, and that enhance personality,
  communication and love.

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Sexual health and somatic disease

• Somatic, emotional, intellectual and social
  aspects
• Positively enriching
• Communication
• Love

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Somatic aspects

• What does cancer do to your body?
• What does treatment do to your body?
• How is your sexual function affected?
• How is your body changed?

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Emotional aspects

• Shock
• Fear
• Adaptation
• Relief
• Hope

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Intellectual aspects

• Change
• Coping
• Understanding
• New knowledge
• Flexibility
• Positive focusing

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Enrichment?

• Deeper understanding of life and perhaps the
  reality of death
• Change in value systems
• Bodily awarenes
• Self care

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Communication

• Sexuality is commmunication
• Being emotionally open and honest
• Communication of needs
• Sharing experiences
• Having time together

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Love

• Show affection
• Care
• Physical and emotional contact
• Pleasure
• Sharing
• Affirmation

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Social aspects

• Entering a new social category cancer patient
• Cancer as stigma
• Cancer as punishment for..?
• Economy
• Dealing with the health care system
• Disability
• Sustain belonging as a sexual person

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The responsibility of the health care person
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Talk about it!
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What is it all about?

• ????????????????????????

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Natural bodily functions
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Talk about it with clients?

• When the question Does people with cancer have a
  right to a sexual life, is forwarded.
• The need to talk on many levels is imminent
• Including the client level

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Some needs

• Networks, multidiscliplinary approaches
• Understand motives for sexuality
• Description of sexual dysfunctions
• How can sexuality be preserved?
• Prevention of sexual complications

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How does this become a problem to you? What do
you think about your sexuality and your
relationship?
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The PLISSIT model
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Increasing responsibility on the client
The therapeutical hierarchy of responsibility
Conversation function
Therapeutical conversation
Councellor function
Consultation

Pedagogical function
Therapeutical tecniques
Parents function
Institution treatment
Uterus function
Heart /lung machine
Life
Therapy
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Empathy

• The ability to take another persons perspective
• without losing ones own

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The experience of the cancer patient TRAUMA!

• Trauma of function
• Trauma of self perception
• Trauma of presentation

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But

• What happens when our total surface to the world
  around us changes
• for instance by constant pain?
• . or by the persistant need to take drugs?
• When we no longer fit our selfperception
• which is healthy and well.
• Only superficial people concider the surface to
  be without significance.

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The individuals perspective
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A person
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A person
Self perception
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Perception of self perceived by others
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Others response Yes or No
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Others response Yes or No
If no Submission or new reality?
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What is a no?

• You are destroyed
• You are not one of us
• You are ill
• You are wrong
• Yo re contageous
• You are non-existant because we cannot understand
  what it means to be you.

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Can disease be positive?

• Disease and pain alter the perception of self.
• How is one affirmed as gender when in hospital
  bed, when in wheelchair, when bodily molested?

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Belonging

• Is to be perceived by others the same way as we
  perceive ourselves.
• The belonging is positive when that which is
  being perceived is given a positive value both by
  oneself and by the others.

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Belonging

• As healthy
• As ill
• As ruined or destoyed
• As beautiful
• As ugly and repulsive
• As forbidding, contageous --
• As incapasitated or handicapped ---
• As ----------------

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How does this become a problem to you? What do
you think about your sexuality and your
relationship?
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Sexual dysfunction

• Sexual dysfunction is a deficiency of organic,
  psychic or mixed character that in a negative,
  unpleasant or/and painful way interferes with the
  sexual motives and need of the individual.

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The horse of Troy
EXITEMENT AND RELAXATION
LOVE
ROLE PERFORMANCE
TRANCE
PROCREATION
INTIMACY
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Motives for sexuality

• It makes me feel attractive
• The added percentage of those that answered very
  important or rather important
• Total 48 (1987) 65 (1997)
• Men 35 51
• Women 60 76

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Sexual dysfunction

• Dysfunctionin in relation to the experience of
  attractiveness is a deficiency of organic,
  psychic or mixed character that in a negative,
  unpleasant or/and painful way interferes with
  individuals experience of being attractive.

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Motives for sexuality

• It gives me physial satisfaction
• The added percentage of those that answered very
  important or rather important
• Total 75 (1987) 79 (1997)
• Men 77 82
• Women 73 78

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Sexual dysfunction

• Sexual dysfunction is a deficiency of organic,
  psychic or mixed character that in a negative,
  unpleasant or/and painful way interferes with
  physical satisfaction.

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Motives for sexuality

• It is an expression of love
• The added percentage of those that answered very
  important or rather important
• Total 89 (1987) 91 (1997)
• Men 85 86
• Women 92 94

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Sexual dysfunction

• Sexual dysfunction related to the need for love
  and for loving is a deficiency of organic,
  psychic or mixed character that in a negative,
  unpleasant or/and painful way interferes with the
  experience of loving and to be loved.

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Motives for sexuality

• It creates sexual excitement
• The added percentage of those that answered very
  important or rather important
• Total 55 (1987) 72 (1997)
• Men 59 75
• Women 51 70

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Sexual dysfunction

• Dysfunction in relation to the need for
  excitement and relaxation, is a deficiency of
  organic, psychic or mixed character that in a
  negative, unpleasant or/and painful way
  interferes with sexual tension and relaxation.

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Motives for sexuality

• It gives contact and intimacy
• The added percentage of those that answered very
  important or rather important
• Total 92 (1987) 92 (1997)
• Men 92 91
• Women 91 92

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Sexual dysfunction

• Dysfunction in relation to the need for contact
  and intimacy is a deficiency of organic, psychic
  or mixed character that in a negative, unpleasant
  or/and painful way interferes with this sexual
  need.

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Motives for sexuality

• It is to have children
• The added percentage of those that answered very
  important or rather important
• Total 22 (1987) 27 (1997)
• Men 18 26
• Women 27 28

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Sexual dysfunction

• Sexual dysfunction in relation to reproductivity
  is a deficiency of organic, psychic or mixed
  character that in a negative, unpleasant or/and
  painful way interferes with the need of pregnancy
  including habitual abortions.

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How to get on and going?

• You can start with
• Almås and Benestad Sexologi i praksis Tano
  Aschehoug, 1997.
• P.O. Lundberg Sexologi - 2002. Liber
  utbildning.
• Allgeier and Allgeier Sexual interactions 1995,
  D.C. Heath and Company.

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Reminders

• Be open to yourself and to your partner
• You may always, if possible
• bring with you to bed whatever you need to have
  good sex.
• take a painkiller before sex, most of them do
  not interfere much in clinical doses.
• Large meals, alchohol, and heavy bodily strain
  may take energy you could have used for sex.

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Reminders

• Enjoy your body and the sexual pleasures it can
  offer you also when you are alone.
• See your self as attractive to your partner.
  She/he is there because of you.
• In sexual relationships Let the one with the
  best health and/or the one with the greatest
  physical capasity take the heaviest loads.
• Dont fear technical aids or erotic toys
• Dont hurry!

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Characteristics of long lasting happy
relationships

• Respect for each other
• Respect for the relationship
• Shared values
• Ability to play
• Good sex!

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Thank you for the attention!
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