Patients with cancer experiencing sexual side effects may turn to the American Cancer Society, which provides this education:
“Don’t assume your doctor or nurse will ask you about these and other concerns about sexuality. You might have to start the conversation.”
Oncology nurses are in a unique position to help patients discuss their concerns about sexual health by acknowledging that sexual side effects from cancer treatment deserve as much attention as integumentary, gastrointestinal, and nervous system toxicities. Addressing the sexual health questions and needs of a patient is a key nursing component in ensuring quality patient care. Before an oncology nurse engages in a conversation about sexuality with patients, it is imperative to have a strong understanding of the concept and terminologies of sexuality and sexual health to avoid confusion.
Sexual Health as a Quality-of-Life Issue
Sexual health is an important quality-of-life issue for cancer survivors. One aspect of sexuality is sexual relationships, referring to those relationships that involve feelings of love, desirability, and sexual attraction as well as pleasure and sexual expression. Other variables that affect sexuality include cultural definitions and relationships and external factors such as past relationships and current state of sexual being. Sexuality exists throughout an individual’s lifespan and attaining harmony in sexuality is what leads to sexual health.
Defining Sexual Health
The World Health Organization defines sexual health as “a state of physical, emotional, mental and social well-being in relation to sexuality; it is not merely the absence of disease, dysfunction or infirmity. Sexual health requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination, and violence.” A newer term is sexual self-concept referring to the totality as a sexual being, including both positive and negative concepts and feelings.
When patients are diagnosed with cancer, reviewing the idea of sexual health becomes just as important as other treatments or side effect management. Furthermore, in this era of increasing cancer survivorship, sexual health is an even more critical topic for nurses to address before, during, and after treatment.
Expanding Your Discussions
During cancer treatments, especially in the ambulatory settings, nurses are the front line when it comes to educating patients about the side effects of cancer treatment and interventions. Often, the discussion of sexuality in the context of a cancer therapy is limited to an overview of the effects on bearing children and the use of contraceptives while receiving ongoing treatment. However, discussions on sexuality and sexual health may be expanded to include multiple topics, such as:
- Anatomical or structural changes resulting from mastectomy, oophorectomy, prostatectomy, penile cancer, hysterectomy
- Physiological changes that radiation treatment causes to the reproductive system
- Side effects of endocrine treatments and the need for vaginal lubricant
- Lack of intimacy stemming from an inability to have an erection for male patients, perception of desirability, or a lack of attraction from mastectomy or having a colostomy
- Side effects of graft-versus-host disease such prevention of sperm recovery or painful intercourse for females with genital involvement
- Physical pain or discomfort
Fatigue from cancer, cancer treatments, or side effects is another complicating factor to sexual health, affecting intimacy and libido.
Sexual health is an important area of cancer survivorship that is often neglected. Addressing patients’ challenges with sexual health is imperative to helping them attain a strong quality of life and is part of providing comprehensive cancer care. As integral care team members, oncology nurses are in a key position to help patients explore their sexuality. Throughout a patient’s cancer journey, nurses can spend time with the patient, discuss sexual side effects, and encourage patients to share their concerns.