Bothersome and distressing sexual dysfunction is common in both men and women living with cancer. Treatments can potentially alter a person’s sexual health in the physical, emotional, mental ,and social well-being realms of care. Literature has shown that time constraints and level of comfort with sexual health content are barriers to addressing patients’ sexual health concerns. On Friday, April 12, 2019, at the ONS 44th Annual Congress in Anaheim, CA, speakers provided an overview of sexual health concerns and strategies to assure a positive and respectful approach to female and male patients with cancer who are experiencing them.
Talking With Patients
A nurse’s comfort level in having a discussion about sexuality and using terms that relate to sexual health can be barriers to quality care, Lisa Astalos Chism, DNP, APRN, BC, NCMP, CSC, FAANP, clinical director at the Women’s Wellness Clinic at Karmanos Cancer Institute in Michigan, said. She encouraged nurses to increase their knowledge base of sexual health and the resources to address it, including theoretical models (e.g., William Masters and Virginia Johnson, Helen Singer Kaplan, Rosemary Basson).
Sexual assessment should start with asking closed-ended questions that can expand to elicit additional information based on the response. Assessment findings help with collaborative care planning, which Chism explained often starts with educating patients about phases of sexual arousal.
Three case scenarios were presented focusing on the assessment and management of common sexual issues of female cancer survivors: hyposexual desire disorder (HSDD), dyspareunia, and frequent urinary tract infections, with an emphasis on the importance of thorough history taking and shared decision making when considering how to treat the problem.
“I often tell patients, we saved your life for a reason!” Chism said. “Quality of life matters, and sexuality is an important part of quality of life.”
Sexual alterations in male patients with cancer can affect biologic functioning, such as libido, erections, ejaculation, and orgasm, and have very important psychological aspects, including loss of masculine identity and self-esteem, Irwin Goldstein, MD, IF, said. Goldstein is the director of San Diego Sexual Medicine, director of Sexual Medicine at Alvarado Hospital in San Diego, CA, Clinical Professor of Surgery at the University of California at San Diego, and editor-in-chief of Sexual Medicine Reviews.
A cancer diagnosis alone might be enough to negatively influence sexual function because of anxiety, depression, and changes in relationship closeness. Research is lacking, but discussions with healthcare providers may help people with cancer better express and understand their feelings and experiences, Goldstein said. These discussions should address the patient’s sexual orientation, involve the patient’s partner whenever possible, and include alternative ways of sharing sexual intimacy.
Goldstein also noted that sexual dysfunction is typically considered a side effect in older men with cancer, but it’s beginning to be identified in adult survivors of childhood cancers and is a significant concern. Nurses should have discussions about sexuality with patients of any age.
For a man with cancer, Goldstein said, “restoration of sexual function in the patient who has sexual dysfunction from cancer treatment helps improve his life quality, his relationships, and his overall health.”