The Elephant of Intimacy

What do you think is the biggest "elephant in the room" for cancer patients? Why is "the elephant" so hard to talk about? Why doesn't someone else bring "the elephant" up? Is "the elephant" making you or the patient uncomfortable?

As a nurse, I believe we hear just about everything, and sometimes that can make us feel awkward. Have you ever been told something by a patient and you just could not get out of the room fast enough? Why is that? Maybe it's because we as healthcare providers believe that in order to talk about a subject with a patient, we should be an expert on it. However, when we are uncomfortable talking about something, those subjects tend to get pushed aside. How do you react and what do you do to help patients address their "elephant in the room"?

I hear it often when talking to survivors that one of the biggest changes they experience after diagnosis is in relationships. Cancer can have an effect on every relationship in their life including their partner, their children, their parents, and even close friends. But I think the one relationship that can be affected the most is the intimate relationship. So, how do we help our patients with this "elephant"?

Intimacy is a fundamental and life-affirming element of human experience, and it's not just intercourse. Intimacy is a multi-dimensional experience. It's the touch of a loved one, a kiss from your partner, or it can be a simple compliment. There is significant evidence that describes the negative impact of cancer treatment on intimacy. It has been associated with anxiety, depression, low self-esteem and relationship distress. And not to mention the barriers that it can have between patient and healthcare workers.

Our culture is saturated with sex, but honest and open conversations about intimacy are rarely encouraged. Most healthcare providers have limited time to spend with patients and some may feel unprepared on this topic. So, that leaves talking about this "elephant" to nurses. Do you have a conversation with your patient and try to help them, or do you ignore "the elephant"? Let's just agree that from this point forward, you're going to have a conversation with your patient. How can we break this cycle of not addressing a patient's intimacy concerns?

The first step is that we must be willing to ask the hard questions! Find a way that makes it comfortable for you to ask about it and stick with it. For example, a simple starter question might be "Many of my patients with similar conditions have questions about intimacy and how their disease impacts it. Do you have anything you would like to ask?"

Second, we need to educate ourselves on how to help our patients. This does not mean that we must be the expert. Many times just acknowledging that this is not a concern that is unique to them and offering some helpful suggestions can go a very long way.

Here are a few simple suggestions to pass on to your patients:

• Start with feeling good about yourself. Be proud of your body it has been through a lot.
• Be patient! It takes time for the emotional roller coaster to end and time to adjust to the new normal.
• Keep the lines of communication open with your partner. Don't let it all get bottled up inside.
• Openly discuss your feelings and concerns. That includes seeking professional help.
• Educate yourself! There are so many great resources out there and many great books to help.

Finally, I might suggest a couple of good resources to read and share with your patients. Some websites that I have found helpful are:

• http://www.macmillan.org.uk
• http://www.cancer.org
• http://www.drannekatz.com
• http://www.dana-farber.org/Health-Library.aspx
• www.nccn.org

The next time you have a patient bring up intimacy just remember you don't have to be an expert to talk about the elephant in the room! The least you can do is offer resources to them.