An Intimate Conversation: Cancer and Sexual Health

When a cancer diagnosis is made, patients immediately ask many questions: What’s the prognosis? What will treatment involve? What are the adverse effects of treatment? Although the questions may not always have sim­ple or concrete answers that patients want, oncol­ogy nurses must be prepared to respond.

But what about the questions that patients are too embarrassed or afraid to pose or may not even know to ask? A cancer diagnosis is life altering in many ways, but one subject that often may be over­looked or avoided entirely is sexuality.

WHAT IS SEXUALITY?

Body image, self-esteem, sexual dysfunction, repro­duction, pleasure, and intimacy are all part of the broad subject of sexuality. This is a challenging topic because it involves so many factors, including a patient’s willingness to discuss sexual concerns, a nurse’s lack of knowledge or comfort level with the topic, religious implications, cultural norms, gender differences, and sexual preferences. Increasing your awareness of sexuality and being proactive in addressing related concerns can greatly affect your patients’ quality of life and psychosocial well-being.

WHEN SHOULD I ADDRESS SEXUALITY WITH MY PATIENTS?

Although sexuality may not top a patient’s concerns upon initial diagnosis, it’s important to address it early on. A pre­treatment sexual assessment will identify a baseline against which posttreatment changes can be measured. Along with the assessment, the nurse should provide education regard­ing treatment-specific adverse effects and late effects related to sexuality. Continue the discussion throughout and after treatment to ensure continuity of care and comprehensive patient support.

HOW DO I BRING UP THE TOPIC?

The Oncology Nursing Society offers several helpful tips to ease communication when discussing sexual health with patients:

• Open with a normalizing statement like, “Many patients have questions about sexual activity during cancer treat­ment” or “The treatment you’ll be receiving can influence sexual function.” This invites the patient to continue the discussion and may help you gauge the patient’s willing­ness to discuss sexuality.
• Ask the patient’s permission to discuss sexuality. If it’s not an appropriate time to talk, the discussion won’t be productive.
• Use neutral language when referring to the patient’s sig­nificant other (eg, “partner” versus “husband” or “wife”).
• Respect the patient’s privacy; this is imperative. Ask vis­itors to step out, or elicit from the patient whether the discussion should take place with their partner present.
• Provide only the information the patient needs. Find out what specific issues your patient might be experiencing, and limit education to those topics or concerns.
• Emphasize the importance of addressing sexual health concerns, and encourage your patients to ask questions at any time.¹

The PLISSIT Model, created by Jack S. Annon in 1976 and outlined below, also provides a framework to help nurses dis­cuss sexual health with patients:

• Permission: Allow patients to share their feelings by pro­viding an open and trusting environment.
• Limited Information: Provide education limited to the specific sexual adverse effects of the patient’s medication and treatment.
• Specific Suggestions: Offer these after performing a thor­ough sexual health assessment that includes the patient’s beliefs, attitudes, and baseline sexual function.
• Intensive Therapy: This is indicated when severe psycho­social or sexual issues are identified that are outside the scope or comfort level of the nurse.

WHAT IF I’M UNCOMFORTABLE DISCUSSING SEXUALITY?

A vital step toward addressing this important topic with your patients is recognizing how you feel about it and assessing your knowledge level. Acknowledge that you may have differ­ent personal beliefs than your patients do. Most important, if you recognize that you simply can’t bring up the subject, know your resources. Discuss strengths and weaknesses regarding sexual considerations with your colleagues, and reach out to those who demonstrate interest and knowledge regarding the topic. A referral to a social worker, fertility specialist, sexual health specialist, or gynecologist may be indicated.

REFERENCE

Baron RH. Psychosocial management. In: Gobel BH, Triest-Robertson, Vogel WH. Advanced Oncology Nursing Certification Review and Resource Manual. 2nd ed. Pittsburgh, PA: Oncology Nursing Society; 2016:737-773.

Melissa A. Grier, MSN, APRN, ACNS-BC is a clinical nurse specialist at Via Christi Health in Wichita, Kansas, where she supports the Via Christi Cancer Institute, as well as the medical/surgical cardiac, resource pool, emergency department, and oncology.