Share Those Moments

Intimacy and Sexual Challenges Faced by Cancer Patients and Their Partners

Please Take A Moment To Read Before Beginning.

Please answer as many questions as you like. All questions are optional. All stories are welcome but the focus is on cancer's impact on sexuality and intimacy. It can be a brief mention: "I have no sex life." or "My partner helped make me feel comfortable again." or "It hurts."

Two things to keep in mind for questions 8 and 9:

~Include as much detail as you are comfortable sharing regarding issues surrounding intimacy and sexuality.

~Write candidly, as if you were speaking to a friend. No worries about grammar or spelling, or for that matter, language.

The stories are vitally important to the success of this project. The more information that we, all of us affected by these issues, are willing to share, the better opportunity we will have to reach into the community to those who are embarrassed, afraid or simply to too shy to discuss with anyone.

Include only the contact information you wish to share. If your story requires more space than allotted, please email me. This information will be used as research for a book. No identifying information will be included but direct quotes from your story may be used. If you wish to be identified, include your contact information here **and** email me to let me know. Thank you for taking the time to share your story for this project.

All email may be sent to sharethosemoments@gmail.com.

Again, my most sincere thanks for taking the time to fill out this survey.

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* 1. Are you male or female?

Male

Female

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* 2. Are you the patient or the partner of a patient?

Patient

Partner of patient (Please exit and go to partner survey here. Cut and paste of link doesn't work: https://www.surveymonkey.com/s/H77HM9H)

I've been both a patient and a partner

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* 3. What type of cancer(s) were you diagnosed with and how was it treated? Check all that apply. (Please expand in commnets regarding removal of ovaries, fallopian tubes, cervix-too many combinations to include all in answers!)

Breast Cancer treated with lumpectomy

Breast Cancer treated with mastectomy of affected breast

Breast cancer treated with removal of both breasts

Breast cancer treatment included risk reducing removal of ovaries

Breast cancer reconstructive surgery

Ovarian Cancer including removal of one ovary

Ovarian Cancer including removal of both ovaries

Ovarian Cancer including complete hysterectomy

Cervical or Uterine Cancer treated with vaginal radiation

Cervical or Uterine Cancer with complete hysterectomy including ovaries and fallopian tubes

Other type of cancer (please include type in comment box)

Other health issues you feel might be helpful to include?

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* 4. What is your age?

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* 5. Do you consider yourself to be heterosexual, homosexual, bisexual or something else?

Heterosexual

Homosexual

Bisexual

Prefer not to answer

Prefer to answer using own words

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* 6. Which of the following best describes your current relationship status?

Married

Widowed

Divorced

Separated

In a domestic partnership or civil union

Single, but cohabiting with a significant other

Single, never married

More complicated and prefer to explain

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* 7. What is your current health status?

Currently in active treatment (chemotherapy, radiation, surgical procedures not fully completed)

Completed treatment *including* tamoxifen and/or aromitase inhibitor

Living with metastatic disease

Presently on tamoxifen for up to 2 years

Presently on tamoxifen over 2 years

Presently on tamoxifen for 5 years or longer

Presently on aromitase inhibitor (arimidex, femara) for up to 2 years

Presently on aromitase inhibitor over 2 years

Presently on aromitase inhibitor for 5 years or longer

Started on tamoxifen, then switched over to aromitase inhibitor

Completed treatment, disease was triple negative, tamoxifen or aromitase inhibitor not part of treatement

Took (or are still taking) herceptin

Additional information and prefer to elaborate or add to above response

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* 8. Please share your story, primarily as it relates to intimacy and/or sexual issues.

Note: Box can be expanded but dragging lower right corner to make wider and longer for easier typing. It might be easier to cut and paste from a word doc.

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* 9. Want to add something else you feel might be helpful? For example, did you ever discuss issues regarding intimacy or sexuality with a doctor or other health provider?

Note: Box can be expanded but dragging lower right corner to make wider and longer for easier typing. It might be easier to cut and paste from a word doc.

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* 10.
10. Contact Information (You can include all, some or no answers in this area. General location information would be of tremendous benefit when analyzing responses. "Small Town" or "rural" or "big city" can be put in City/Town box. For anyone outside of the USA, I'd love if you'd consider including your country)

NOTE: If you would like to receive updates regarding progress, please sign up for email notifications or follow website at sharethosemoments.wordpress.com

Name

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Email Address

Phone Number

Question Title

* 1. Are you male or female?

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* 2. Are you the patient or the partner of a patient?

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* 3. What type of cancer(s) were you diagnosed with and how was it treated? Check all that apply. (Please expand in commnets regarding removal of ovaries, fallopian tubes, cervix-too many combinations to include all in answers!)

Question Title

* 4. What is your age?

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* 5. Do you consider yourself to be heterosexual, homosexual, bisexual or something else?

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* 6. Which of the following best describes your current relationship status?

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* 7. What is your current health status?

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* 8. Please share your story, primarily as it relates to intimacy and/or sexual issues.Note: Box can be expanded but dragging lower right corner to make wider and longer for easier typing. It might be easier to cut and paste from a word doc.

Question Title

Question Title

* 8. Please share your story, primarily as it relates to intimacy and/or sexual issues.

Note: Box can be expanded but dragging lower right corner to make wider and longer for easier typing. It might be easier to cut and paste from a word doc.