Sex Is an Important Dimension of Cancer Psychosocial Care That We Need to Stop Neglecting

July 26, 2019
Justin Louie Camacho
Justin Louie Camacho, BSN, RN, OCN®

By Justin Louie Camacho, BSN, RN, OCN®

My charge nurse approached me and told me that I am getting an admission from the emergency department who presented with high blood pressure and shortness of breath. She told me that the patient is on concurrent chemoradiation therapy and has a rectal cancer.

As I started my admission questions, I reviewed his home medications. One of them is tadalafil, so, I asked him, “Are you still taking your Cialis? If yes, when was the last time?”

The patient jokingly asked his significant other, who is at the bedside: “Hey babe, was it last night?” He smirked and added, “I think I might need one tonight.” He laughs as the significant other smiles, but I can tell she’s a little embarrassed. I mouthed, “It’s okay” to her. The patient gives her a big hug and kisses her forehead.

Sex and Cancer

Sexuality is an important component of quality of life (https://doi.org/10.1188/10.ONF.E186-E190). As the number of cancer survivors continues to increase, oncology nurses need to be aware of the long-term effects of cancer and its treatment on sexuality (https://doi.org/10.1016/j.ejca.2010.11.004).

Across all cancer types, 66% of patients reported (https://doi.org/10.1002/pon.1947) that patient-oncology provider conversations on sexual issues were important. With interventions provided by healthcare providers, 70% of patients with cancer (https://doi.org/10.1188/11.ONF.E87-E96) can have their sexual function return to baseline. Without interventions, functioning decreases over time (https://doi.org/10.1188/11.ONF.E87-E96).

No Excuses

Nurses may have beliefs that inhibit their proactivity (https://doi.org/10.1188/10.ONF.E186-E190) in discussing patients’ sexual concerns (https://www.ascopost.com/issues/april-15-2013/sexual-health-after-cancer-communicating-with-your-patients/):

When nurses do not initiate the conversation, patients can believe that (https://doi.org/10.1200/JCO.2012.41.7915):

Sexual Dysfunction Assessment and Treatment

ALARM (https://www.ncbi.nlm.nih.gov/pubmed/2145004), BETTER (http://dx.doi.org/10.1188/04.CJON.84-86), and PLEASURE (https://www.ons.org/books/core-curriculum-oncology-nursing-fifth-edition) are three commonly used models to assess current sexual activities and practices, sexual attitudes and desire, and current medical issues.

The PLISSIT (https://doi.org/10.1080/01614576.1976.11074483) model for sexuality counseling offers levels of nursing interventions based on nurses’ comfort and expertise with the subject of sexuality and helps with making referrals to another provider if a nurse reaches a level beyond his or her ability or comfort. Approximately 80%–90% of sexual problems patients identify (https://doi.org/10.1188/11.ONF.E87-E96) may be solved with the use of the first three levels.

Example: “We’ve talked about how chemotherapy can affect your body, but another important aspect to consider is how it can affect how you feel about yourself as a man and how it may impact your role as a husband.”

Example: “You asked a very good question about what type of birth control to use to prevent pregnancy while on chemotherapy. With Hodgkin’s lymphoma, you can use birth control pills or other hormonal methods, but an intrauterine device or diaphragm could increase your risk for infection, so perhaps it is better not to use one of those.”

Example: “You mentioned experiencing pain during sex. Using pillows to cushion your joints and taking pain medication prior to sexual activity may help reduce that pain.”

Oncology nurses are dedicated to providing holistic care to our patients addressing every aspects of their human needs to enhance their quality of life. That involves providing education and anticipatory guidance to our patients, including addressing sexuality through open communication and demystifying myths and misconceptions. Patients with cancer need validation that their sexual concerns are not uncommon and do not make them different from a healthy person.

Sexuality is a complicated and sensitive matter, but did we ask our patients about it? Did we ask her how her husband reacted to her alopecia and mastectomy? Did we asked him how his wife reacted to his diminished whispering ability because of the presence of tracheostomy? Did we asked him how his boyfriend reacted to his colostomy?


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