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Sexual restrictions or possibilities?Literature:
- Emilee, G., Ussher, J.M., & Perz, J. (2010). Sexuality after breast cancer: A review.
Maturitas, 66, 397-407.
- Walker, L.M., Beck, A.M., Hamptom, A.J., & Robinson, J.W. (2014). A biopsychosocial
approach to sexual recovery after prostate cancer treatment: Suggestions for
oncology nursing practice. Canadian Oncology Nursing Journal, 24, 256-263.
- Clayton, A.H., Croft, H.A., & Handiwaia, L. (2014). Antidepressants and Sexual
Dysfunction: Mechanisms and Clinical Implications. Postgraduate Medicine, 126, 91-
99.
- Morales, E., Gauthier, V., Edwards, G., & Courtois, F. (2016). Women with Disabilities’
Perceptions of Sexuality, Sexual Abuse and Masturbation. Sex and Disability, 34, 303-
314.
- Schaafsma, D., Kok, G., Stoffelen, J.M.T., & Curfs, L.M.G. (2017). People with
Intellectual Disabilities Talk About Sexuality: Implications for the Development of Sex
Education. Sex and Disability, 35, 21-38.
- Kamavarapu, Y.S., Ferriter, M., Morton, S., & Vollm, B. (2017). Institutional abuse –
Characteristics of victims, perpetrators and organisations: A systematic review.
European Psychiatry, 40, 45-54.
Emilee – Sexuality after breast cancer: A review.
Women’s sexuality can be particularly complex after breast cancer, with sexual changes often
becoming the most problematic aspect of a woman’s life. The impact of such changes can last for
many years after successful treatment and can be associated with serious physical and emotional
side-effects.
Breast cancer is the most common cancer in women worldwide, and the second leading cause of
cancer deaths in women.
Positivist-realist paradigm: privileging the physical and material aspects of women’s experience.
engage in satisfying sexual activity, their satisfaction with the frequency of that activity and their
level of their sexual ‘dysfunction’ post-breast cancer.
Recent research has shown, however, that engaging in sexual intercourse may not be positioned as
women’s primary focus of sexual adjustment and satisfaction after a breast cancer diagnosis and that
engagement in sexual intercourse does not necessary equate to sexual satisfaction. Moreover, the
primary focus on the material effects of breast cancer on sexual behavior assumes that a woman’s
experience of sexuality is limited to its physical dimensions, negating the influence of the social
construction of sexuality and illness.
Social constructionist paradigm: has provided insight into women’s lived experiences of changes to
sexuality after breast cancer, and the ways in which socio-cultural discourses shape the experience
and interpretation of sexuality. However, intrapsychic and intersubjective aspects of women’s
experiences are often ignored, and the physical body is either position as the passive object of socio-
cultural constructions, or it is absent from explorations of lived experiences of sexuality after breast
cancer.
,In order to address the limitations of both realism and constructionism, this review will adopt a
material-discursive-intrapsychic perspective, which acknowledges the materiality of sexual changes
following breast cancer, women’s intrapsychic experience of such changes within a relational
context, and the influence of the discursive construction of femininity and sexuality.
Results:
- Disturbances to sexual functioning frequently reported following the diagnosis and
treatment of breast cancer include: dyspareunia, fatigue, vaginal dryness, decreased sexual
interest or desire, decreased sexual arousal, numbness in previously sensitive breasts,
difficulty achieving organs, and lack of sexual pleasure.
- Women with breast cancer who undergo chemotherapy are at higher risk for sexual
dysfunction after treatment than those who have not received chemo. chemically induces
menopause (CIM).
- Chemotherapy is most significantly associated with problems of arousal, lubrication, orgasm,
and sexual pain. Radiation is less associated.
- Results of research examining the impact of breast cancer surgery on the sexual functioning
of women are mixed.
Mascectomy = removing of the breast.
Is more associated with sexual interest, difficulty in relaxing, enjoying sex difficulty reaching orgasm
etc.
Whilst some women experience the changes to their sexuality after breast cancer positively, the
majority of evidence shows that women with breast cancer experience a range of serious negative
emotional changes as a result of disturbances to their sexuality including fear of loss of fertility,
negative body image, feelings of sexual unattractiveness, loss of femininity, depression and anxiety
as well as alterations to their sexual self.
Although the physical pain of breast cancer and treatment diminishes with time, the experience of
emotional pain may persist as women grieve the loss of their breast or feel as though a part of them
has died. When breasts are taken away, women feel as if their only half women.
It is suggested that body image and sexuality are most significantly affected by breast cancer during
the first year of survivorship, and that body image is more likely to be affected by mastectomy
compared to breast conserving treatment or breast reconstruction.
The strongest predictor of sexual problems after breast cancer is lower perceived sexual
attractiveness, and that woman who have a poor body image after breast cancer have lower rates of
sexual satisfaction and are more dissatisfied with their sexual relationship than those with a positive
body image.
Overall, it is suggested that body image and sexuality are most significantly affected by breast cancer
during the first year of survivorship, and that body image is more likely to be affected by mastectomy
compared to breast conserving treatment or breast reconstruction.
Women who receive breast conserving surgery report fewer problems with dressing, body image,
and being naked, than women who have had mastectomy.
One of the most important and consistent predictors of sexual health in women with breast cancer is
the quality of their partnered relationship. In fact, the quality of a woman’s relationship is a stronger
predictor of sexual satisfaction, sexual functioning, and sexual desire after breast cancer than the
physical or chemical damage to the body after treatment.
There are 4 different ‘breast talks’:
, - Medicalized breast: constructed as a symbol of women’s emotional abilities to nurture
others.
- Gendered breast: constructed as a symbol of femininity, beauty, and sexual desirability.
- Functional breast: constructed as a symbol of women’s emotional abilities to nurture others
- Sexualized breast: which incorporates the look and feel of the breast.
a particular type of breast is both privileged and normalized: the breast that is round, not sagging,
and firm.
Only 30% of couples who were coping with breast cancer had discussed sexuality with a health
professional, suggesting that this is an aspect of quality of life that is often neglected.
Question:
Problems on bio-psycho-social level in woman with breast cancer
Biological: vaginal dryness
Psychological: lower self esteem
Social: problems in relationships with problem
Advice to give:
Physical problems depending on what it is. Vaginal dryness: use lubrication or medicine. It really
depends on physical problems.
Psychological renegotiation for sexual involvement (can be for all levels), try other things + be
more open for other experiences.
Social communicate with partner
Walker – A biopsychosocial approach to sexual recovery after prostate cancer treatment:
Suggestions for oncology nursing practice.
Introduction
- Treatment of prostate cancer (PCa) often results in significant loss of erectile function.
- Loss of Erectile function is often one of the most difficult survivorship issues, negatively
impacting intimate relationships, and contributing to declines in quality of life for both
patients and partners.
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