Although not all cancer patients will experience a sexual health crisis during treatment, every cancer patient will experience some form of sexual health change, according to Sage Bolte, PhD, LCSW, CST. Therefore, it is important for oncology nurses to establish that they are someone a patient can turn to if and when they want to discuss issues related to their sexual health.
“Each of them will have sex changes,” said Bolte, director of philanthropy and president of the Inova Health Foundation. “They will have questions, whether during the treatment, after the treatment or 3 years after the treatment. [Nurses] will be the one they turn to so they don’t feel scared, isolated and confused when these issues arise.
“[With some populations]it is still not necessarily appropriate to the generation [to have these conversations], and it can be uncomfortable for them,” she added. “So it’s [often] our service providers [who need] be the ones who keep the conversation going.
During a presentation at the ONS’s 47th Annual Meeting, Bolte, along with Elaine Wittenberg PhD, FACH, associate professor at California State University, and Joy Goldsmith, PhD, professor of health communication at the University of Memphis , discussed effective communication strategies for oncology nurses discussing sensitive topics with their patients.
To better engage with their patients, oncology nurses may need to ask themselves, “How comfortable am I with discussing sexual health? and “What are my particular strengths in helping patients and their partners reclaim their own bodies?”
Nurses may also need to reflect more and ask themselves how comfortable they are with their own body and sexuality, their own positive image, and whether they themselves are in a place of peace to overcome their own personal barriers and engage in those conversations.
“It’s okay if you’re not comfortable with those words,” Bolte noted. “We are taught to be a little uncomfortable with these words. [But]we need to examine what triggers this discomfort so that we can present ourselves to our patients without showing this discomfort.
Additionally, nurses can help promote more meaningful dialogue by keeping the conversation patient-centered and positive. For example, Bolte says it’s best to tell a patient, “Cancer and its treatments have such a huge impact on every aspect of our lives, including our sexual health – that’s okay. I would like to provide you with information” rather than telling them: “You can discuss sexual failure with me” or “I am trained not to laugh”.
Overall, Bolte recommends looking for “very simple, non-threatening ways to open a conversation with the information that [the patient] provides. »
Methods of communication
To best address these issues, Bolte recommends the “Ex-PLISSIT model” as the ideal approach. The ex-PLISSIT model calls on healthcare providers to:
- Ask ppermission at every step and at every visit to assess and inquire about a patient’s sexual health;
- For patients with Ilimit Iinformation, directing them to resources such as written information and available education;
- Offer sspecific ssuggestions, such as tips,
- And refer Iintense youtherapy, if necessary, as well as maintaining an up-to-date network for patient referrals.
Additionally, Bolte also highlighted the following helpful conversation starters to help oncology nurses who may feel uncomfortable starting these discussions:
- Is there anything that would be important for us to know about your sexual history or sexual health to better support you during the time we are caring for you?
- What concerns or questions do you have about changes or continuation of your sexual needs?
- How has your sexual relationship(s) with your partner(s) or yourself changed?
- What information or resources can I provide to help you improve your sexual health?
It is important to note that the impact of cancer on sexual health is not always transparent. Beyond the cancer itself, there is often pressing psychological distress related to diagnosis and treatment for both the patient and their partner. Different treatments also cause different side effects and impairments, and can impact relationships during and after treatment, Bolte said.
Some common physiological changes due to treatment-related adverse events (AEs) experienced by male cancer patients include chemo-brain, joint discomfort, neuropathy, and hair loss, among others. Neurovascular damage resulting from chemotherapy, radiation therapy, or surgery is also common and can lead to erectile dysfunction (ED). Endocrine changes can reduce testosterone levels and lead to reduced libido, osteoporosis and flushing, and physical endurance can also be affected.
Finally, penis length may be reduced, infertility may occur, and body image changes may occur.
Bolte advised proactive conversations with patients and making sure they know what to expect so they don’t feel frustrated with their care team. She explained that, for example, many men don’t realize that penile length reduction is a possibility until it happens.
“The power of information is so important in preparing our patients for what to expect,” she said. “[This patient] managed and adjusted, but not knowing [what to expect] created more distress and frustration with his medical team.
In contrast, cancer patients can experience many of the same treatment-related side effects, including chemo brain, joint discomfort, and more. However, these patients may also experience acute or premature ovarian failure and experience consequential problems related to ovarian failure, including decreased libido, infertility, “natural menopause”, osteoporosis, hot flashes and mood changes. Fatigue and decreased physical endurance, as well as changes in body image, may also occur.
“For women, the #1 complaint is changes in vaginal strength or changes in natural moisture -[issues] that can be resolved,” she said.
For patients who need specific information for their vaginal health, counseling and education is important to address the following concerns: For those with genitourinary symptoms of menopause, advice on stretching, strengthening and staying hydrated are important. Additional treatment options including vaginal laser therapy and hormone treatments.
If the patient notices an increase in infections, this could indicate that their Ph balance is impaired and should be treated as such. Additionally, changes in vaginal wetness should be discussed with partners as well as with the patient.
For male patients who need specific information for their penile health, counseling and education are important, as well as sexual expectations and practices (oral, vaginal, anal). Nurses caring for patients who experience these problems should consider other contributing factors such as age, prior erectile dysfunction, distress, and transplant, as well as other co-occurring health conditions such as diabetes , heart problems, etc. to a physiotherapist or urologist may be appropriate. The wishes and desires of the partners should also be part of the conversation.
Finally, sexual health information should address ways to make sexual activities more pleasurable, such as time of day, partner/patient expectations, positioning, lubricants, lidocaine and dilators, as well as extended foreplay. Desire is also an important thing to address, as creating a sensual environment can help improve certain conditions.
Key points to remember
Overall, nurses can have a major impact by giving patients permission to discuss concerns about their sexuality, Bolte said.
“Yes [the only change] you [make] leaving today with your patients is giving them permission, you are doing a phenomenal job,” she said, noting that permission means allowing them to feel safe having these conversations – which opens up the door to specific informative conversations when questions arise – and acknowledging that the issues these patients face are both difficult and normal.
Conversations about sexual health should be as comfortable as conversations about any other cancer-related symptom, she concluded.
Bolte S, Goldsmith JV, Wittenberg E. Tools of the trade: communicating on sensitive topics. Presented at: 47th Annual Meeting of the Oncology Nursing Society; April 27-May 1, 2022; Anaheim, California.