A person’s sexual health is a vital component of their overall well-being. Sexual health is defined by the World Health Organization as “a state of physical, emotional, mental and social well-being in relation to sexuality.” Sexual side effects that patients experience relate to all of those components of sexual health.
Unfortunately for patients, they are placed with the task of initiating a discussion about their sexual health. Sexual side effects are common in patients undergoing stem cell transplant but, unfortunately, often go unaddressed. Patients during the pretransplant phase consistently ask when they will go “back to normal.” Sexuality is a component of the normalcy that these patients are seeking, but often their providers do not initiate a discussion on that topic. Nurses are in a unique position to be able to provide education and support to patients experiencing changes to their sexual health during the transplant process.
Sexual Side Effects, Physical and Beyond
Patients undergoing stem cell transplant undergo intense preparative regimens, which include high-dose chemotherapy and sometimes TBI (total body irradiation). Due to the nature of these regimens, patients who undergo stem cell transplant are at risk of side effects in addition to those experienced by patients with cancer as a whole. These treatments can cause:
- Hormone changes and early menopause
- Ovarian damage
- Decreased lubrication
- Pain during intercourse
- Genital graft-versus-host-disease, which can affect both penile and vaginal tissue
- Erectile dysfunction
- Increased risk of infection due to prolonged immunosuppression
- Increased risk of bleeding
- Post-transplant infertility
Sexual health goes beyond physical side effects. Emotional and mental side effects both arise from and contribute further to physical changes. These can include:
- Decreased interest in sexual activity or desire
- Depression or anxiety
- Changes to a person’s perception of their body or sexuality
- Lack of time to dedicate to sexual activity or intimacy
- Societal pressure to return to pre-transplant sexual activity
Nursing Discussions About Sexual Health
Nurses come in contact with patient undergoing stem cell transplant at multiple points throughout the transplant journey, which presents many opportunities to get ahead of some sexual side effects. It is important to educate ourselves as nurses regarding changes to sexual health that patients experience so we are able to provide education and to advocate.
Because patients can be hesitant to discuss sexual side effects or their overall sexual health, take advantage of moments where you can speak with the patient alone. A patient may be more comfortable asking questions when they do not have their partner, parent or other caregiver with them. When discussing sexual side effects, encourage the patient to speak with their providers during their follow up visits. Patients can be referred to different specialists in gynecology, urology, fertility, or see a counselor, sex therapist, and/or licensed social worker to further assist in treating sexual side effects.
A person’s sexual health continues to be perceived as taboo but is a crucial component of overall quality of life after stem cell transplant. As nurses, we are here to care for our patients as whole people, not merely lab values, which is why we as nurses should foster an environment where their sexual health is a priority.
References
American Association of Sexuality Educators, Counselors and Therapists
World Health Organization – Sexual Health
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