by KATIE KOSKO
Sexual health can be an uncomfortable or embarrassing topic to discuss for many people, and for patients with cancer and survivors it can feel even more awkward. Nevertheless, sex ranks among the top 5 unmet needs of survivors, and the good news is, proactive oncology practitioners can help fill that void.
Sixty percent of cancer survivors—9.3 million individuals in the United States alone—end up with long-term sexual problems, but fewer than 20% get professional help, according to Leslie R. Schover, PhD, founder of the digital health startup, Will2Love. Among the barriers she cited are overburdened oncology clinics, poor insurance coverage for services related to sexual health, and an overall lack of expertise on the part of providers, many of whom don’t know how to talk to patients about these issues.
And, oncologists and oncology nurses are well-positioned to open up that line of communication.
“At least take one sentence to bring up the topic of sexuality with a new patient to find out if it is a concern for that person,” Schover explained in a recent interview with Oncology Nursing News. “Then have someone ready to do the follow-up that is needed,” and have other patient resources, such as handouts and useful websites, on hand.
Sexual issues can affect every stage of the cancer journey. Schover, who hosted a recent webinar for practitioners on the topic, has been a pioneer in developing treatment for cancer-related problems with sexuality or fertility. After decades of research and clinical practice, she has witnessed firsthand how little training is available in the area of sexual health for healthcare professionals.
“Sex remains a low priority, with very little time devoted to managing sexual problems even in specialty residencies,” said Schover. “I submitted a grant four times before I retired, to provide an online interprofessional training program to encourage oncology teams to do a far better job of assessing and managing sexual problems. I could not get it funded.”
In her webinar, she offered tips for healthcare practitioners who want to learn more about how to address sexual health concerns with their patients, like using simple words that patients will understand and asking open-ended questions in order to engage patients and give them room to expand on their sex life.
Schover suggests posing a question such as: “This treatment will affect your sex life. Tell me a little about your sex life now.”
Sexual side effects after cancer treatment vary from person to person, and also from treatment to treatment. Common side effects for men and women include difficulty reaching climax, pain during sexual intercourse, lower sexual desire and feelings of being less attractive. Men specifically can experience erectile dysfunction and dry orgasm, while women may have vaginal dryness and/or tightness, as well as loss of erotic sensation such as on their breasts following breast cancer treatment.
Sexual dysfunction after cancer can often lead to depression and poor quality of life for both patients and their partners.
According to Schover, oncologists and oncology nurses should provide realistic expectations to patients when they are in the treatment decision-making process.
“Men with prostate cancer are told they are likely to have an 80% chance of having erections good enough for sex after cancer treatment,” Schover says. “But the truth is it’s more like 20 to 25% of men who will have erections like they had at baseline.”
To get more comfortable talking about sex with patients, Schover advises role-playing exercises with colleagues, friends, and family—acting as the healthcare professional and then the patient. When the process is finished, ask for feedback.
Brochures, books, websites and handouts are also good to have on hand for immediate guidance when patient questions do arise. But Schover is hoping for a bigger change rooted in multidisciplinary care and better patient–provider communication to find personalized treatments tailored to each individual’s concerns and needs.
Cancer treatment can impact hormonal cycles, nerves directing blood flow to the genitals, and the pelvic circulatory system itself, she explained. In addition, side effects like prolonged nausea, fatigue, and chronic pain also can disrupt a patient’s sex life.
“Simply to give medical solutions rarely resolves the problems because a person or couple needs to make changes in the sexual relationship to accommodate changes in physical function,” Schover stressed. “That kind of treatment is usually best coming from a trained mental health professional, especially if the couple has issues with communication or conflict.”
Schover wants to make sure that those resources are easily accessible to patients and survivors. Thus, she has created the startup, Will2Love, which offers information on the latest research and treatment, hosts webinars, and provides access to personalized services.
“Sexual health is a right,” concluded Schover, and both oncology professionals and patients need to be assertive in getting the conversation started.
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