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November 2016 VOL 7, NO 10
Call to Action: Address Patients’ Sexual Health
Sexual dysfunction is a common problem for cancer survivors, and nurses can be a part of the solution by addressing this issue, educating themselves, and joining with other health professionals who care about patients’ sexual health, says Don Dizon, MD, a medical gynecologic oncologist and Director of the Oncology Sexual Health Clinic at Massachusetts General Hospital in Boston.
A presenter at the 2016 Annual Meeting of the American Society for Radiation Oncology (ASTRO), Dr Dizon told JONS, “Nurses and nurse practitioners can be the ones who make a difference in their patients’ lives. Nurses can be proactive. Oncologists are often disease focused and treatment focused, and sexual issues get pushed to the side.”
Patients should be told before treatment that a diagnosis of cancer and its treatment can affect their sex life. Then when they experience problems, it won’t be a surprise.
“Nurses need to be proactive about asking patients about their sexual health. Patients will not volunteer this information if not asked,” he continued.
When raising the issue, normalize it, Dr Dizon advised. “Say something like, ‘Sexual problems are common among cancer survivors. What is your experience?’” he suggested. “Once you show interest and normalize the discussion, it can be very powerful for patients. I’ve heard many patients say they experience a huge relief and don’t feel so isolated. It’s good for them to know they are not the only ones facing these issues,” he said.
The obvious problems that arise with cancer treatment include vaginal dryness and pain on intercourse for women and erectile dysfunction for men. However, there are also some not-so-obvious problems, such as a loss of sensation in the residual breast (or the chest wall) for breast cancer survivors. The breast is an erogenous zone for most women, and they may not be prepared for this effect. Men with prostate and other cancers may also struggle with arousal.
“In fact, cancer disrupts the normal cycle of desire, arousal, and fulfillment, which may not make sense to patients,” Dr Dizon said. And these changes can lead to a lack of intimacy. Male partners can be frightened by the journey of a female with cancer. Once the partner’s treatment is over, men may need to move forward, and part of that includes restarting their sex lives. Men experience intimacy through sexual intercourse, while for women, intimacy is not tied solely to intercourse. The process of rediscovery and finding a “new normal” can take a year or longer for women, which is something their partners may not recognize. So men and women are often not on the same page at the end of active treatment, Dr Dizon explained.
“One of the most important things to talk about with a couple is to define what intimacy means to that couple,” Dr Dizon stated.
At the very least, any cancer center can have a library of books and articles on sexual health in cancer survivors. Nurses who are interested in helping patients can read this literature, and patients may want to read books and articles as well. Some authors who have written about this topic, in addition to Dr Dizon, include Anne Katz, PhD, RN, and Michael Krychman, MD.
If possible, nurses should attend conferences on the subject and attend sessions at large cancer meetings that are devoted to sexual health, Dr Dizon advised.
Patients can also take advantage of web-based tools, including a new website called will2love (https://will2love.com/) developed by Leslie Schover, RN, PhD, formerly at MD Anderson Cancer Center in Houston, TX. The American Society of Clinical Oncology’s website Cancer.Net also has some information. Counselors versed in cancer-specific sexual health may not be easy to find in most areas of the country except in academic or comprehensive cancer centers.
In his ASTRO presentation, Dr Dizon suggested the PLISSIT approach for nurses and other healthcare professionals: P—give the patient permission to discuss sexual health; LI—provide limited information; SS—give specific suggestions; and IT—refer patients who require intensive therapy.
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