Elephants and Tea - March 2022 - 12

Sexuality INTIMATE ISSUES WITH MARLOE
* Clitoral function
Because the clitoris is composed of erectile tissue similar to a penis,
this tissue becomes similarly engorged (filled with blood) in
response to sexual stimulation, enlarging in size and becoming
more sensitive to touch7
. And although orgasms can be initiated
in different ways, including stimulation of non-genital erogenous
zones like the breasts and nipples, through fantasy alone (what
can I say? The brain is a powerful sex organ!), and during sleep4
the most common route to orgasm for women is via stimulation
of the clitoris7,12
.
Even for women who report achieving orgasm during penis-partnered
sex, the clitoris is the likely star. This contradicts the claim
that there is an anatomically separate and distinguishable structure
made of erogenous tissue located inside the vagina that is responsible
for these " vaginal orgasms. " Despite the cultural ubiquity of this
so-called G-spot, its existence has yet to be proven by science7,10,12
.
Check out the section on the G-spot controversy for a rundown
on the current evidence (or lack thereof).
HOW DOES CANCER AFFECT THE ORGASM
RESPONSE?
Cancer can affect a number of components important to orgasm. For
example, altered sensations and response to touch can impact the type
and duration of stimulation needed to orgasm. Orgasms may feel less
intense or less satisfying, or you may be able to reach a plateau of tension
but never really have that pleasurable release. These changes can be disappointing
and frustrating. What's going on? The culprit of alterations in
orgasm experiences for survivors may be related to physical, mental and
emotional, or interpersonal factors. Often, it's a combination of these.
* Physiological Factors
Several treatment-related physiological changes can impact orgasms.
This includes damage to the blood vessels and nerves that
supply the genitals and pelvic floor muscles. This might occur with
pelvic surgery or radiation2,4,5,
and it can alter sensation and blood
flow. For many women, breast and nipple stimulation contributes
to sexual arousal and the orgasm response, and this can be lost
BIBLIOGRAPHY AND REFERENCES
1. American Cancer Society (2022). Managing female sexual
problems related to cancer. https://www.cancer.org/
treatment/treatments-and-side-effects/physical-sideeffects/fertility-and-sexual-side-effects/sexuality-forwomen-with-cancer/problems.html
2.
A Woman's Touch. (2020). Orgasms for people with vulvas
and vaginas. https://sexualityresources.com/wp-content/
uploads/Orgasm20-1.pdf
3. Bradford, A. (2020). Treatment of female orgasmic
disorder. UpToDate. https://www.uptodate.com/contents/
treatment-of-female-orgasmic-disorder
4. Bradford, A. (2021). Female orgasmic disorder:
Epidemiology, pathogenesis, clinical manifestations,
course, assessment, and diagnosis. UpToDate. https://
www.uptodate.com/contents/female-orgasmic-disorderepidemiology-pathogenesis-clinical-manifestations-courseassessment-and-diagnosis
5.
Bober, S. L., & Krapf, J. (2021). Overview of sexual
dysfunction in female cancer survivors. UpToDate. https://
www.uptodate.com/contents/overview-of-sexualdysfunction-in-female-cancer-survivors
6.
Hughes, M. K. (2009). Sexuality and cancer: the final
frontier for nurses. Oncology Nursing Forum 36: 241-246.
7. Mazloomdoost, D., & Pauls, R. N. (2015). A comprehensive
review of the clitoris and its role in female sexual function.
Sexual medicine reviews, 3(4), 245-263. https://doi.
org/10.1002/smrj.61
8. Slate. (2016, October 3). What the clitoris really looks like.
https://www.youtube.com/watch?v=Zo7sy3g-_Qw
9. Shifren, J. L. (2022). Overview of sexual dysfunction
in females: Epidemiology, risk factors, and evaluation.
UpToDate. https://www.uptodate.com/contents/overviewof-sexual-dysfunction-in-females-epidemiology-riskfactors-and-evaluation
10.
Vieira-Baptista, P., Lima-Silva, J., Preti, M., Xavier, J.,
Vendeira, P., & Stockdale, C. K. (2021). G-spot: Fact or
fiction? A systematic review. Sexual medicine, 9(5),
100435. https://doi.org/10.1016/j.esxm.2021.100435
11. Wincze, J. P., & Weisberg, R. B. (2015). Sexual dysfunction:
A guide for assessment and treatment (3rd ed.). The
Guilford Press.
12. Yeung, J., & Pauls, R. N. (2016). Anatomy of the vulva and
female sexual response. Obstetrics and gynecology clinics
of North America, 43(1), 27-44. https://doi.org/10.1016/j.
ogc.2015.10.011
,
after surgery for breast cancer. Chemotherapy may also damage
blood vessels and nerves, and genital neuropathies can develop6
Surgical menopause9
.
and low estrogen levels5
have been associated
with orgasm problems. Estrogen loss may affect the pelvic
floor muscles, and can impact vaginal tissues. Genital tissues
may be less likely to respond with engorgement, and there may be
less natural lubrication. Sometimes women find that while more
stimulation is needed, this can be difficult to achieve when tissue
changes make touch painful or uncomfortable.
Some medications can interfere with sexual arousal and orgasm,
too. For example, this can occur when taking SSRIs and SNRIs5
,
which are commonly prescribed for depression and (in smaller
doses) to help with hot flashes related to decreased levels of estrogen.
* Psychosocial Factors
Mental and emotional stressors unrelated to sex can be very effective
inhibitors of sexual arousal and orgasm. Our brains are
excellent at prioritizing what to pay attention to and what to ignore,
and anything perceived as threatening (like anxieties, fears, or
worries) will get moved to the top of the list, while anything less
important (like sexual arousal signals) will often get filtered out,
dampened down, or ignored.
In partnered relationships, cancer may also change how couples
relate to one another. Communication about sexual changes can be
difficult, and it might feel easier to ignore sexual problems rather
than to try and talk about them. Couples often benefit from help
initiating these discussions.
SO, WHAT CAN BE DONE?
The good news is that there are a number of techniques that can address
these issues, and that's what Part II is for! Next time, we'll look at some
strategies that survivors can explore that may help revive that loving
feeling again (or maybe for the first time). But also, we're going to put
orgasms in their place by positioning them within the overall context of
sexual satisfaction, and by unpacking the differences between pleasure
and performance. Curious? Stay tuned!
To be continued... l
MARLOE ESCH, RN, BSN, ONCOLOGY CERTIFIED NURSE (OCN), AND YOUNG ADULT CANCER SURVIVOR, GRADUATED
FROM THE UNIVERSITY OF WISCONSIN - MADISON SCHOOL OF NURSING (GO BADGERS!) IN 2008. SHE ENJOYS
EDUCATING BOTH SURVIVORS AND HEALTHCARE PROFESSIONALS ON THE TOPIC OF CANCER AND SEXUALITY,
AND HAS PRESENTED FOR THE YOUNG SURVIVAL COALITION, THE ONCOLOGY NURSING SOCIETY, AND PLANNED
PARENTHOOD OF WI, AMONG OTHERS. SHE HOLDS A CERTIFICATE FROM THE SEXUAL HEALTH CERTIFICATE
PROGRAM THROUGH THE UNIVERSITY OF MICHIGAN AND IS CURRENTLY PURSUING HER DOCTOR OF NURSING
PRACTICE (DNP) AT THE UNIVERSITY OF WISCONSIN - MILWAUKEE. AN ENTHUSIASTIC SUPPORTER OF SEXUAL
HEALTH AND WELLNESS, MARLOE IS MAKING IT HER MISSION TO BRING SEX INTO THE SURVIVORSHIP SPOTLIGHT.
12
ELEPHANTSANDTEA.COM
MARCH 2022

Elephants and Tea - March 2022

Table of Contents for the Digital Edition of Elephants and Tea - March 2022