Sexuality: The Final Frontier for Oncology Nurses

"You don't have to be able to do it to talk about it."

In the very well attended "Mara Morgensen Flaherty Memorial Lectureship: Sexuality and Cancer: The Final Frontier for Oncology Nurses," Mary Hughes, MS, RN, UT MD Anderson Cancer Center, Houston, discussed the importance of addressing sexual matters with patients who have cancer. These patients deal with many issues that affect their sexuality, including physical changes from surgery, radiation, chemotherapy, and hormone therapies; the side effects associated with these treatments, such as fatigue, nausea, vaginal dryness, erectile dysfunction, and a multitude of others; and psychological issues, including fear, depression, guilt, and shame about their disease. All of these issues can affect a patient's libido and their sense of sexual identity, especially in the setting of breast or a genital cancer. In many cases, oncology nurses can help patients overcome these issues if they muster up the courage to talk about them.

Side Effects and Misconceptions

Hughes noted that patients suffering from nausea, fatigue, and other treatment-related side effects won't feel much like engaging in sexual activity, even if they'd like to. Some patients may be on antidepressives, which, too, can affect their libido. Hughes encouraged nurses to find out which medicines their patients are on. In some cases, a change in medication may do the trick. For instance, when it comes to antidepressives, she noted that Wellbutrin has no sexual side effects and that Cymbalta has no such side effects in women; thus, there are alternatives that may make a difference.

Misconceptions about cancer may also prevent many patients from engaging in sexual activities. Hughes relayed a story about a man who did not kiss his wife as she was dying from lung cancer because he was afraid that he was going to catch it. Patient and caregiver education are incredibly important to prevent such misconceptions, which can have a considerable impact on quality of life.

Assessing Sexual Dysfunction

Before one assesses sexual dysfunction, one needs to define it. Hughes made the definition simple by rooting it in the "Sexual Response Cycle," which includes desire, excitement, orgasm, and resolution (though she cautioned with her good humor that this cycle is not necessarily linear in women). Sexual dysfunction occurs when one or more of these elements is absent or impaired. Interestingly, Hughes noted that in 90% of cases, sexual dysfunction has psychological roots and in 75% of cases it has physiological roots.

So, how does one assess for sexual dysfunction? Hughes provided nurses with some great tips for taking a patient's sexual history:

(1) Never assume anything. For instance, even if a patient is elderly, don't automatically assume they are not interested in sex.

(2) Make the environment comfortable for the patient. Asking a patient about any sexual matters when they are sitting half naked on the examination table is not good timing.

(3) Set aside enough time to discuss "it." Don't bring this up as the last topic of discussion right before you're ready to leave the room and check on the next patient.

(4) Show the patient respect and genuine interest and concern. They need to know that you care about them and consider this a serious matter. (5) Avoid any facial expressions, as these can make the patient uncomfortable or embarrassed.

(6) Use open-ended questions, such as "How are things going for you sexually?"

(7) Use correct anatomical words to show that this is a serious matter that deserves attention.

Barriers to Talking About "It"

There are both patient- and provider-related issues that result in barriers when it comes to sex talk. Patient factors may include fear, anxiety, depression, frustration, misinformation, body changes, role changes, performance anxiety, religion, marital status, and a feeling of being the only one with the disorder. When it comes to nurses and other health care providers, it may result from a lack of education on such matters, discomfort in bringing it up, and misconceptions about how important this topic is for the patient and their families. Hughes indicated that in some cases it may not matter to patients, and that is perfectly fine, but in many cases, patients simply suffer in silence. She concluded by saying that "you don't have to be able to do it to talk about it," indicating nurses talk about all kinds of other personal health issues with their patients, such as their bowel habits and how to use their catheters, and that this should not be viewed any differently. Patients with cancer are still sexual beings and talking about sex may just return some normalcy to their lives.

Disclosures Hughes had no conflicts of interest to disclose.