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. 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.
Across all cancer types, 66% of patients reported that patient-oncology provider conversations on sexual issues were important. With interventions provided by healthcare providers, 70% of patients with cancer can have their sexual function return to baseline. Without interventions, functioning decreases over time.
- Someone else will do it.
- My patients never bring up the subject so they must not be worried about. They may even feel offended if we ask them about it.
- My patients should be grateful to be alive. They should prioritize treatment and not “frivolous” matters like sexual concerns.
- My patients are too old or don’t have a partner, so they don’t need to discuss sexual function.
- I don’t have the knowledge, expertise, time, privacy, or administrative support to discuss sexuality with my patients.
- I am uncomfortable with the topic.
When nurses do not initiate the conversation, patients can believe that:
- Sexuality is not a legitimate topic to discuss.
- Loss of sexual functioning is a “cost” of treatment.
- Sexual dysfunction has no effective treatment, so it’s not necessary to discuss it.
Sexual Dysfunction Assessment and Treatment
The PLISSIT 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 may be solved with the use of the first three levels.
- P = Permission: All nurses can initiate a conversation to convey acceptability that discussing sexual changes caused by diagnosis or treatment is appropriate. To effectively intervene, nurses need to know basic knowledge about sexuality (e.g., anatomy and physiology; how disease, treatments, and age affect sexual functioning; sexual response cycle).
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.”
- LI = Limited Information: Most nurses can provide limited information related to diagnosis and treatment to boost self-image, relationships, and ability to enjoy sex; decrease fear; increase communication; and increase knowledge. This level of intervention addresses concerns, questions, myths, and misconceptions.
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.”
- SS = Specific Suggestion: Experienced or advanced practice nurses are able to intervene at this level. Otherwise, patients are referred to gynecologists for health interventions such as oral contraceptive pills. Factors such as cultural and religious beliefs as well as patients’ and partners’ value system, preferences, and priorities must be considered.
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.”
- IT = Intensive Therapy: This requires an in-depth knowledge level about sexuality and counseling. It is usually needed for long-standing or severe concerns.
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?