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Sharon Bober, PhD
SharonBoberPhD (Physician - Psychiatry (Verified) )| Communities: All Cancers | Answers: 8 |
| Member Since: Jul. 2012 |
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Professional Statement
Sharon Bober, Ph.D. is the Founding Director of the Sexual Health Program at the Dana-Farber Cancer Institute and Assistant Professor in the Dept. of Psychiatry, Harvard Medical School. Dr. Bober’s clinical and research efforts focus on sexual health, cancer survivorship and developing effective models of sexual rehab intervention for cancer patients and survivors. Dr. Bober frequently lectures to clinicians about how to address sexuality with medical patients in a frank and straightforward manner.
Professional Info
Primary specialty: Psychiatry
Fellowship: Harvard Vanguard Medical Associates/HPHC, Advanced Mental Health
Areas of expertise: Adult psychosocial oncology, Psychology, Sexual health, Cancer survivorship
Hospital affiliation: Dana-Farber Cancer Institute
Practice address:
450 Brookline Avenue
Boston, MA
02215
Practice phone number: 617-632-6547
SharonBoberPhD Activities
Low libido is a very common problem for women and this is the case for many women regardless of having had cancer treatment. One thing we know is that libido is like a recipe consisting of many ingredients that work in tandem; it is not primarily driven by biology or psychology or emotion alone. Although libido can be significantly disrupted by changes in any of those arenas, it can similarly be jump-started by positive changes in any of those aspects of our experience. For example, many women talk about “waiting to feel like I am in the mood” and then they realize that the more time that goes by, the less “in the mood” they feel. Although it may seem counter-intuitive, if you allow yourself to engage in behavior that awakens your senses, that feels sensual, calming, relaxing etc., you might be surprised to see how the mind can “follow” the body. That is, physical sensation that is pleasurable can positively awaken dormant feelings or thoughts that are more sexual in nature and in this way, instead of waiting to be in the mood, the mood actually follows the experience of pleasure. From this perspective, I advise women in this situation to focus on the idea of pleasure rather then sex per se. I think it is critical to engage in a variety of activities that appeal to a range of sensation such as taking warm baths, massage, exercise, etc. Also libido can be jump-started by really using the power of imagination. It can be so helpful to think about harnessing the power of the mind, the power of fantasy, as way to tune in and get turned on. There is a lot of sex-positive erotica that is very pro-woman and we are not talking about “plain old porn”. Many women find that reading this kind of material helps them tune into sexy images or scenarios that help spark desire. Finally it is important to recall what used to be exciting or engaging and think about how to call upon that experience as way to reconnect with sexy thoughts and feelings.
New answer by SharonBoberPhD (Physician - Psychiatry (Verified))
1
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9 months ago
It is not as difficult as it might seem. For doctors, I suggest using simple straightforward questions such as, “Many cancer survivors notice changes in sexual health after treatment, what has this been life for you?” or “Since your treatment, are you having any sexual problems or changes that you would like to discuss?” For patients, I think it is appropriate to say something like, “I have noticed some changes in sexual function that I am concerned about. This is an issue that I need help with. Can I talk to you about this?” If for any reason, a doctor does not say yes or the interaction does not seem helpful, it is perfectly acceptable to ask the provider to help you find resources, either hospital-based or community-based.
New answer by SharonBoberPhD (Physician - Psychiatry (Verified))
1
Answer |
9 months ago
There are a number of common sexual problems that we see with our female cancer survivors. For women, changes in arousal, desire, and orgasm are common. Also, pain or discomfort associated with sexual activity, is common and needs attention. We also see changes in body image, decreased self-esteem, increased anxiety and worry related to intimacy. Again, we see treatment-induced menopausal symptoms that are very severe and unpredictable. Most importantly, I would say that many of these problems do not get better by themselves. For example, severe vaginal dryness for women can lead to vaginal atrophy. A problem like this calls for intervention and by not attending to the issue of atrophy, symptoms may worsen over time. I think it is important to take a pro-active approach to dealing with such common sexual side effects.
New answer by SharonBoberPhD (Physician - Psychiatry (Verified))
1
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9 months ago
There are many important issues that are relevant for both men and women after cancer. First, it is critical to acknowledge that everyone deserves to optimize quality of life after cancer and sexual health is a part of that quality of life. Second, I think it is important to remember that sexuality is much broader than intercourse or a specific physical act. Sexuality encompasses how we think and feel about ourselves, about our bodies, about how we feel in relation to other people. Not everyone experiences sexuality in the same way, but more importantly, if something is different and distressing in any way after cancer treatment, then it is valid and worthy of attention. Finally I would also emphasize that under any circumstances, sexual function changes over time. Sexual function looks different at age 20 versus age 40 or age 60 even without cancer. The goal is always to optimize sexual function yet acknowledge that sometimes things change and they can never be exactly how they used to be. That said, when cancer treatment causes disruption, this can present an opportunity for an individual or couple to “expand the repertoire”; instead of trying to regain a sex life that looks exactly the same as before, a couple can actually broaden their experience. For example, sometimes couples learn to communicate more honestly and directly about both physical and emotional intimacy. Often before cancer, many couples never really have to talk about sex that much because things worked well enough. This kind of change in communication can itself bring a new level of closeness that is very satisfying.
New answer by SharonBoberPhD (Physician - Psychiatry (Verified))
1
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9 months ago
It is an interesting to note that it may be more challenging for women to bring up this topic. Perhaps there are social or cultural dynamics that play a role here including the assumption that ‘being polite’ includes not making other people uncomfortable, especially one’s doctor! Although we live in a culture that is saturated with sex, the vast majority of women (and probably men too) don’t receive much guidance about communicating about sexual health and sexual problems in a frank manner. Because talking about sex often feels taboo, and because most providers don’t bring up the topic, I imagine that women partly don’t ask because they assume the topic is not welcome and they want to be ‘polite’. The World Health Organization has been very clear that sexuality is a fundamental quality of life issue like any other and there is nothing embarrassing or shameful about bringing up the topic. I always encourage women to be vocal about advocating for help with this issue.
New answer by SharonBoberPhD (Physician - Psychiatry (Verified))
1
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9 months ago
Psychological or behavioral intervention can be enormously helpful. Optimal sexual function is really at the intersection between mind/body/relationship and when any one of these aspects is disrupted, intervention is called for. For example, when a survivor is struggling with feeling a sense of being comfortable in his or her body after going through intensive and/or invasive cancer treatment, a variety of strategies that address thinking, feeling and behavior can be used to help a person renew a sense of body integrity. Another example is thinking about the relational aspect of sexuality. Sometimes counseling can be very helpful for couples who are struggling to renew intimacy after a long time has passed. Partners are often very worried about not wanting to hurt each other and sometimes the transition from being a patient or a caregiver to being a romantic partner feels awkward. Some brief couples counseling may be very useful in such a situation.
New answer by SharonBoberPhD (Physician - Psychiatry (Verified))
1
Answer |
9 months ago
There are a number of medical treatments that we consider when addressing women’s sexual problems after cancer. For example, if a woman has undergone sudden treatment-induced menopause, she may be suffering from very intense and unpredictable menopausal symptoms that directly affect sexuality such as severe vaginal dryness. From a medical point of view, one example is consideration of using vaginal estrogen to deliver moisture and enhance the health of the vaginal tissue. Other medical options might include medications to help manage severe hot flashes. Another medical option that is very effective for managing treatment-related vaginal atrophy involves the use of vaginal dilators. These are a set of smooth tapered cylinders that women can use to slowly stretch the vaginal walls so penetration is more comfortable. They come in a wide variety of sizes so all women can start with a size that is comfortable.
New answer by SharonBoberPhD (Physician - Psychiatry (Verified))
1
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9 months ago
There are actually a growing number of resources available for both male and female survivors. The American Cancer Society offers a lot of information (hard copy booklet or on linehttp://www.cancer.org) as does the Lance Armstrong Foundationhttp://www.livestrong.org. There are also numerous books available such as Dr. Leslie Schover’s book Sexuality and Fertility after Cancer as well as the series of books about sex and cancer by Dr. Anne Katz (http://drannekatz.com). Fortunately, there is growing interest in this topic and several medical centers are now also beginning to offer clinical resources for cancer survivors. Also several professional organizations such as the Society for Sex Therapy and Research (www.sstar.net) and the International Society for the Study of Women’s Sexual Health (http://www.isswsh.org) also offer listings of providers that are knowledgeable in this area on their websites.
New answer by SharonBoberPhD (Physician - Psychiatry (Verified))
1
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9 months ago
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