Cancer and its treatments can cause sexual side effects, and oncology nurses are often in the best position to bring up the topic and provide useful information as well as emotional support. The most important thing a nurse can do to help patients is to initiate the discussion.
“Just ask at some point in your interactions with patients. This opens the door for sexual questions and concerns, and most concerns are easily addressed by the nurse,” stated Anne Katz, RN, PhD, clinical nurse and sexuality counselor at CancerCare Manitoba, Winnipeg, Canada. Dr Katz spoke about sexuality at the Oncology Nursing Society 12th Annual Institutes of Learning in Salt Lake City, Utah.
Although specific cancers may be associated with specific sexual issues, in general, the major sexual issues facing male cancer patients include erectile dysfunction, loss of libido, and changes in orgasm; and the major problems facing females include loss of libido, vaginal dryness and painful intercourse, body image issues, and orgasmic changes.
All oncology nurses should be aware of 2 models that are helpful in assessing patients’ sexuality, Dr Katz said: PLISSIT (permission, limited information, specific suggestions, and intensive therapy) and BETTER (bring up the topic; explain you are concerned with quality of life issues, including sexuality; tell patients you will find appropriate resources to address their concerns; timing may not be appropriate now, but tell patients they can ask for help at any time; educate patients about the side effects of their cancer treatment; and record your assessment and intervention in the patient chart).
In her practice as a sexuality counselor, Dr Katz prefers to use the PLISSIT model because it speaks more directly to her training, but she said that the BETTER model is more applicable to nurses. “Whatever model they use, the most important thing to do is to ask about sexuality,” she said.
She presented four common sexual problems that cancer patients can face. Case 1 is a patient with breast cancer who is unhappy with her breast reconstruction and finds that this interferes with her sexual response. She has thought about leaving her husband so that he can find someone to fulfill his sexual needs. Patient 2 is a man with prostate cancer who had nerve-sparing surgery and cannot have a sufficient erection for sexual intercourse. He does not want to include his wife in the discussion. Patient 3 is a woman with cervical cancer who had a total hysterectomy 3 months ago. She attempted to have sexual intercourse after 6 weeks and she had no feeling, although prior to surgery she was multiorgasmic and really enjoyed sex. Patient 4 is a man who had a stem cell transplant 1 year ago and now has loss of libido.
The nurse can help by asking patients additional questions, identifying the major issues, and making suggestions. General principles include bringing up sexuality and making the patient comfortable in discussing sexuality, which is an important part of quality of life (ie, normalizing the sexual concern). Let the patient know that you will help him/her find adequate resources for treating the problem, and if it is beyond your scope, you will refer the patient to an expert. Another important issue is timing of the intervention. Patients may not be ready now to deal with the sexual issues, but let them know they can call on you any time in the future. It is important to educate patients about possible side effects of treatments, making sure to tell them that not everyone gets these side effects. Also, it is important to record brief details about the discussion of sexuality and side effects in the patient’s chart.
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