Elephants and Tea - September 2019 - 18

Sexuality

INTIMATE ISSUES WITH MARLOE

Combination (estrogen + progestin) hormonal options
include oral pills taken daily, a transdermal patch placed on
your skin that is changed weekly, or an intravaginal ring that
is replaced weekly.
Some hormonal methods do not contain estrogen. Short-acting progestin-only options include a daily pill (the "mini pill")
or an injection given every 3 months. Long-acting methods
include an implantable rod (Nexplanon) inserted under the
skin of your arm and a hormonal (LNg) IUD.
Hormonal methods can be very effective when used correctly,
but they are not right for everyone. For example, if you were
diagnosed with a hormone-sensitive cancer or are less than 6
months out from treatment, your provider may recommend
avoiding hormonal options. Other potential contraindications
may include a history of radiation to your chest, a risk for blood
clots, a diagnosis of osteoporosis (weak bones) or impaired liver
function or if you are a smoker over the age of 35. Talk with your
provider to determine if hormonal birth control is safe for you.
Intrauterine Device (IUD) Methods
An IUD is a small T-shaped wire or plastic device that sits inside
your uterus to prevent pregnancy. In addition to the hormonal
(progestin-only, or LNg) IUD mentioned above, there is a
non-hormonal (copper) IUD option. Both are very effective types
of long-acting, reversible birth control.
The Society of Family Planning's guidelines on cancer and
contraception indicate that women who are immunosuppressed can safely use an IUD for birth control. Evidence
for this recommendation is based on the results of studies
looking at other immunocompromised populations, which
have not shown an increased risk for infection with IUD use.
Unfortunately, studies have not focused specifically on women
being treated for cancer.
If you have an IUD in place at the time of your diagnosis,
you may be able to leave it in place throughout treatment.
However, insertion of an IUD during treatment or when your
immune system is not working properly may be contraindicated. Your provider may also have concerns about insertion
or use of an IUD if you have low platelet counts.
Natural Methods
Natural methods do not use a device or medication to prevent
pregnancy.

Withdrawal (or the "pull-out" method) is when a penis is
pulled out of a vagina before ejaculating, thus preventing sperm
from coming in contact with an egg.
Fertility awareness-based methods (FAMs) include using a
calendar to track your menstrual cycle and monitoring for signs
that are associated with ovulation, such as changes in cervical
secretions and body temperature. FAMs work by helping you
determine which days you are most likely to get pregnant, so
that you can abstain from intercourse (or use another method)
during that time-frame.
Failure rates for natural methods are fairly high because they
can be difficult to use. Pairing a natural method with another
form of birth control improves effectiveness.
Permanent Methods
Non-reversible surgical procedures are available for both men and
women that can permanently prevent pregnancy.
BUT THIS STUFF IS SO HARD TO TALK ABOUT!
If your oncology provider addressed birth control with you before
beginning treatment, yay! But if not, you're not alone. Even though
healthcare professionals agree that providing timely, accurate and
complete information on fertility and safer sex and contraception
is an essential aspect of cancer care, these topics often get left out
of the conversation.
Don't be afraid to bring up birth control at your next appointment. Your provider can help you understand your risk
of pregnancy and what options may be right for you. If you
still have questions, ask to be referred to a specialist such as
a gynecologist or urologist, or to someone with expertise in
reproductive medicine or fertility issues.
You can learn more about contraception and cancer at the
resources listed below. Other trusted online resources include Center for Disease Control and Prevention and Planned
Parenthood.
IN CONCLUSION...
Cancer can change our view on what it means to live life to the
fullest. It can also change how we plan for the future. Careful
consideration and consistent use of birth control allows you to
choose if and when a pregnancy should occur, which means that
you can seize all of the days ahead of you, in all the ways that you
want to. Carpe Diem!

Resources:
Britton, L. E. (2017).
Unintended pregnancy.
Clinical Journal of
Oncology Nursing 21(2):
189-196.
Green, Laci. (2018)
Sex Plus. New York,
NY, HarperCollins
Publishers.
Katz, Anne. (2014)
This Should Not Be
Happening: Young
Adults with Cancer.
Hygeia Media, Pittsburg
PA.
Katz, Anne. Meeting the
Need for Psychosocial
Care in Young Adults
with Cancer. Pittsburgh,
PA, Oncology Nursing
Society, 2015.
Kelvin, J.F., Steed,
R., Jarrett, J. (2014).
Discussing safe sexual
practices during cancer
treatment. Clinical
Journal of Oncology
Nursing 18(4): 449-453
Memorial Sloan
Kettering Cancer
Center, Sexual Health
and Intimacy, accessed
7/8/19.
National
Comprehensive Cancer
Network Guidelines:
Survivorship.  www.
nccn.org, accessed
7/8/19
National
Comprehensive Cancer
Network Guidelines:
AYA Oncology.  www.
nccn.org, accessed
7/8/19.
Patel, A., Schwarz,
B. (2012). Cancer
and Contraception.
Contraception 86(3):
191-198.
Schover, Leslie R.
(1997).  Sexuality and
Fertility After Cancer.
John Wiley & Sons, Inc.
UpToDate: Comparison
of Effectiveness of
Contraceptive Methods,
accessed 7/8/19.

M A R L OE E S C H, B SN, R N, O C N, A N D YOU NG A DU LT C A NC E R SU RV I VOR , GR A DUAT E D F ROM
T H E U N I V E R SI T Y OF W IS C ONSI N-M A DIS ON S C HO OL OF N U R SI NG (G O BA D GE R S!) I N 2 0 0 8 .
A N E N T H USI A S T IC SU PP ORT E R OF SE X UA L H E A LT H A N D W E L L N E S S , SH E H A S H A D T H E
OPP ORT U N I T Y TO SPE N D T I M E I N H E R C OM M U N I T Y E DUC AT I NG - B OT H SU RV I VOR S A N D
H E A LT HC A R E PROF E S SIONA L S ON T H E TOPIC OF C A NC E R A N D SE X UA L I T Y, I NC LU DI NG
PR E SE N T I NG FOR T H E YOU NG SU RV I VA L C OA L I T ION, T H E ONC OL O GY N U R SI NG S O C I E T Y
W IS C ONSI N C A PI TOL C H A P T E R , A N D PL A N N E D PA R E N T HO OD OF W I. SH E HOL DS A
C E RT I F IC AT E F ROM T H E SE X UA L H E A LT H C E RT I F IC AT E PRO GR A M T H ROUGH T H E U N I V E R SI T Y
OF M IC H IG A N, T R A I N I NG I N B OT H SE X UA L I T Y E DUC AT ION A N D SE X UA L I T Y C OU NSE L I NG , A N D
H A S M A DE I T H E R M IS SION TO BR I NG SE X I N TO T H E SU RV I VOR SH I P SP OT L IGH T.

18

ELEPHANTSANDTEA.COM
SEPTEMBER 2019


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