Approaching a Taboo Topic: Sex During Cancer

Sex. There, I said it. The subject is uncomfortable for many under normal circumstances. When it comes to an adult cancer patient, the subject is often neglected, positioned far down on the priority list of things to be addressed. With childhood cancer patients, the subject is almost forgotten in the midst of the chaos of treatment. Who ever said that cancer patients, young or old, don’t have sex? Why, as health care professionals, do we often make that assumption and/or fail to address the subject? They are still human, right? Dispelling that myth is the first step in being able to provide the most comprehensive care possible during their cancer journey.

Adolescents and young adults often engage in risky health behaviors in general, and risky sexual behavior is no exception. For survivors of childhood cancer, though, the importance of abstaining from or at least limiting risky sexual behavior is of utmost importance. Risky sexual behavior among childhood cancer patients/survivors can be associated with disrupted physical development, as a means to feel “normal” like their peers, and because of the misconception that because they received chemotherapy, they are infertile.

First, we should address whether it’s “safe” to have sex during treatment so we can provide the most accurate answers when the subject is addressed. I can honestly say, that until my recent change in jobs, I never took the time to research the subject, in part because I was so focused on the acute side of cancer care. St. Jude Children’s Research Hospital has published some safe “guidelines” in regards to sex during treatment:

· Platelet count should be at least 50,000

· ANC should be at least 1000

· Wait at least 72 hours after chemotherapy to have sex, whether that be vaginal, oral, or anal

Now that we know that it is “safe” as long as the above guidelines are followed, we should also address the need for precautions to reduce the risk of pregnancy during treatment. We all know that chemo and radiation attack fast growing cells, whether cancerous or not. This includes sperm and eggs, which could lead to significant birth defects in a baby. Some patients assume that they are infertile since they’ve had chemotherapy and/or radiation. It’s important to stress to your patients that they should assume they are fertile unless proven otherwise. We must also educate them on the importance of protecting themselves from infectious diseases, as they are at increased risk of developing HPV-related malignancies as adults. This can be attributed to the treatment they received.

Unless proven that the individual is infertile, education and counseling regarding short and long term side effects from the treatment received should be provided, ideally starting during treatment. Patients often find it difficult to start the conversation with their provider about physical and psychological sexual issues they may be having as a result of cancer treatment, thinking it is far down on the list of priorities. We as oncology healthcare providers need to become comfortable with bringing up the subject so our patients don’t have to. We are doing them a disservice if we don’t help educate them on possible sexual-related side effects from their treatment and what steps can be taken, if any, to preserve their fertility.

Talk about what no one wants to talk about. Let’s help make this subject not so taboo and more just a routine conversation we have with our patients and survivors, whether adult or pediatric.