Dr Ros Boa of Vincent Palotti Hospital and Groote Schuur Hospital, addressing the topic of “Sexuality and cancer”, said that cancer profoundly impacts sexual well-being on physical, psychological and social levels, and it’s important for patients to be able to discuss sexuality with health professionals. Studies have shown that patients tend to “struggle in silence” rather than ask their doctor’s advice because 71% felt the doctor wouldn’t be helpful, while 68% thought it might make the doctor uncomfortable. Unfortunately, only 25% of doctors will initiate a conversation about sexuality, and even among gynaecologists, 50% don’t ask if there are problems.
Barriers to these conversations include: lack of time; “not my responsibility”; not enough knowledge; uncertainty where to refer patients; and embarrassment (both their own and not wanting to embarrass the patient). Dr Boa’s experience is that if health professionals open the topic for conversation, patients welcome it and talk without embarrassment.
A holistic approach involves patients and their partners, providing information about the type of cancer, its treatment and effects, and interventions that can be of assistance. Treatment can have both direct and indirect effects, e.g. surgery may damage nerves or result in disfigurement which impacts on body image and / or function. Chemotherapy and radiotherapy may affect the mucous membranes, which may decrease vaginal lubrication, or may cause peripheral neuropathy (pain or a burning sensation in the hands or feet), while side-effects such as nausea or alopecia may contribute to a lack of desire. Cancer survivors need to be informed about the possible effects and to be reassured that help is available.
Normalising the issues makes discussion more natural. Simply raising the topic with an introductory “Most of my patients experience problems with …” enables a more matter-of-fact approach, by encouraging people to feel that their problems aren’t isolated or unusual. It’s important to recognise that sexuality involves intimacy, not just sexual intercourse. Patients and their partners can be encouraged to resume intimate communication, and postpone penetrative sex until later when the patient feels ready. Open communication with partners is essential to express feelings, and use of relaxation techniques and physical touch, when appropriate, are helpful starting points. Lifestyle adaptations, e.g. a healthy diet and regular physical exercise, also assist in promoting general well-being, which has a positive effect on sexual well-being.
To faciliatate sexual health discussions health practitioners can make use of the PLISSIT model, incorporating the four steps: Permission (to discuss sexual topics); Limited Knowledge (sharing what you know about effects of treatment); Specific Suggestions (after evaluation of problems discussed); and Intensive Therapy (referral if appropriate).
Dr Boa concluded by emphasising the need for communication to bridge science and humanity, and hope for a “new normal” where sexuality is addressed as part of treatment.
Presentation at the 5th ICON Conference, held at Century City Conference Centre, Cape Town on 18 August 2018.