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?? Orgasm Arousal Desire

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

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

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 dryness Arousal Desire Orgasm

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 modification Exercise 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