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[cancer] A little bit more on sex and chemo - Lakeshore — LiveJournal
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Jay Lake
Date: 2009-12-24 15:01
Subject: [cancer] A little bit more on sex and chemo
Security: Public
Tags:cancer, health, personal, sex
Several further email exchanges with the oncology nurse provided some interesting clarifications. I was advised to be careful about "sloppy" kissing. Also to note that tears, saliva, urine, et cetera would all have traces of the drugs.

5-FU, part of my FOLFOX chemo cocktail, interferes with RNA transcription, and is notably teratogenic, i.e., capable of generating horrendous birth defects. So I wrote back and asked how much of this precaution is diligence to avoid conception with this crap in play, and how much of it is related to drug half life and breakdown products. I pointed out that I have had my vasectomy, I don't bareback anyone who is fertile in her own right, so the odds of a defective pregnancy approach those required for divine intervention.

She wrote me back and commented that she thought that most of the science around chemotherapy and sex was about teratogenecity.

I understand this from a liability point of view. I understand this from a conservative medicine point of view. I do not want to introduce cytotoxins to my loved ones through sex, kissing or even excessive sweating. I truly will be the Toxic Avenger, as will anyone who goes through this process. I will not be cowboying my way through my intimate life against all medical advice.

But I find it amusing, and frustrating, that the focus is so overwhelmingly on fertility and its risks that there doesn't seem to be a clear-eyed view, or available information, on the chemo risks in nonfertile sexual environments. Which would of course apply to gay/lesbian couples, the elderly, and anyone of reproductive age who's been medically or surgically rendered infertile. That has to be a fair amount of people, all working under this fertility management regimen.


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Perdix: silence
User: perdix
Date: 2009-12-24 23:46 (UTC)
Subject: (no subject)
Isn't it curious also that teratogenic literally means "monster-producing"?
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Fiction Theory
User: fiction_theory
Date: 2009-12-24 23:56 (UTC)
Subject: (no subject)
There's a lot of medicine that centers around the protection of fertility even though it affects people for whom fertility is not an issue. Even more so for medicine that involves women.

I have PCOS/Insulin Resistance and I'm childfree, so I have no interest in my fertility except in getting rid of it - but I do have an interest in managing the other symptoms (weight issues, dry skin, hormone imbalances, etc) but it seems that most support communities I find are focused on fertility protection or TTC (trying to conceive) and doctors I've gone to have focused on that when I frankly could care less. I want information on how to manage the other things.

Which is all to say I have A LOT of sympathy for the frustration in trying to find medical advice when you're not fertility-centered - and I think it's a sad statement about our society that we tend to think so much of a person's sexuality only in reproductive terms but not in terms of quality of life. Because sex absolutely is vital to quality of life, same as being able to eat, exercise, and sleep well.

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User: supersniffles
Date: 2009-12-25 04:35 (UTC)
Subject: (no subject)
I have PCOS and have had a tubal ligation and I run into the same problems. In fact, it took me 20 years to get diagnosed with PCOS because fertility wasn't my issue.
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russ: venus im pelz
User: goulo
Date: 2009-12-25 00:19 (UTC)
Subject: (no subject)
Keyword:venus im pelz
Society is very oriented toward the concept of parenthood in so many ways. This example of medical advice is a good example of what is in some sense discrimination against people who aren't fertile and aren't trying to have kids but simply want to have safe sex.
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User: janellelohr
Date: 2009-12-25 00:32 (UTC)
Subject: (no subject)
While I imagine that some of the bias is our cultural (excessive?) concern with protecting children, I bet that teratogenic effects are also more obvious, and therefore easier to document and have studies about. They probably make guesses about likely effects on sexual partners from this, but it might be pretty hard to study those effects alone.
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When life gives you lemmings...: Faces: Bucky the human
User: danjite
Date: 2009-12-25 01:05 (UTC)
Subject: (no subject)
Keyword:Faces: Bucky the human
As - to the best of my knowledge and a check of a few websites - "barebacking" refers only to unprotected anal sex, fertility is not typically a concern.

Though we all know you are not typical, there are some things that I think even you can't do!
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Peter Hollo
User: frogworth
Date: 2009-12-25 01:27 (UTC)
Subject: (no subject)
NO! DON'T COME NEAR ME! My sweat... it's toxic!
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User: klwilliams
Date: 2009-12-25 01:45 (UTC)
Subject: (no subject)
They're just terrified of getting another Miles Vorkosigan.
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User: cathshaffer
Date: 2009-12-25 02:36 (UTC)
Subject: (no subject)
It's a liability thing. Birth injuries are the highest paying medical malpractice suit possible, and the drug companies could incur a malpractice suit if they don't make strenuous warnings about possible birth defects. This is why I was forced to sit through a totally unnecessary educational video about sex and pregnancy on my mother's behalf.

I am guessing there are probably not that many concerns about contact with the drug in bodily fluids. You are receiving the drug intravenously. If it were easily absorbed through the skin or by mouth, then they wouldn't have to put in a vein. Drug companies could always rather put something in a pill form than have it infused or injected. Additionally, we are talking about metabolic breakdown products that would be present in residual amounts in your fluids, which again would probably be relatively low. The teratogenic effect would be on your sperm, not your partner's ovum, and the reason they want you to wait three months after is because that is about how long it takes to make new sperm that would not have been affected by the chemo.

The drug manufacturer would be the ultimate authority for any questions your doc can't answer. The companies usually have a hotline you can call for questions. Unfortunately, nurses are not really that knowledgeable about the drugs they administer, and sadly are sometimes not able to go off script in answering patient questions.
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User: cathshaffer
Date: 2009-12-25 02:46 (UTC)
Subject: (no subject)
I tried to find some information about the drug. It's 5'fluorocil, right? The package insert is here: http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=12355

It sounds like the concern is just about pregnancy.
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User: fjm
Date: 2009-12-25 10:18 (UTC)
Subject: (no subject)
This is why I recommended the Terence Higgins Trust or other such organisation. An organisation that works with people it accepts will be not only sexually active but enthusiastically so.

While the cancer specialists *should* know this stuff, they are often as squeamish as the rest of the population and concerned to be "sensitive". And as you know, I have my own issues with someone who prescribed an anti-depressant to a person experiencing grief over the death of a partner, but didn't mention it prevented ejaculation. 'Cos you know, no one *ever* wanted sex for comfort, yes?
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Lawrence M. Schoen
User: klingonguy
Date: 2009-12-26 00:33 (UTC)
Subject: (no subject)
I'd been wondering about that. You talked about the obvious stuff that could be chemically compromised (i.e., your ejaculate), but I was wondering about saliva and even sweat. Hypothetically, could someone giving you an enthusiastic tongue bath be at risk? Not that I'm volunteering (admit it, you pictured it, even if just for a moment); I said hypothetically.
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Jay Lake: graffiti-shirley_you_jest
User: jaylake
Date: 2009-12-26 01:28 (UTC)
Subject: (no subject)
Mmm, the bearded middle aged men of unusual size tongue bath club.

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User: joycemocha
Date: 2009-12-27 01:01 (UTC)
Subject: (no subject)
I'm not surprised that there's not a lot of information about nonfertile sexual environments. My own adventures through the nonfertile sexual environment of menopause are boggling my mind about what is/isn't discussed even by the Our Bodies Ourselves collective (and I bloody well know I'm not the only female who thinks like me/with my type of sensitivities going through it and dealing with an active sexual life--though it also boggles me the number of women my age who have given up sex).
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