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Answering important questions about cancer and sexuality

Important questionsCancer patients and their families have questions about their symptoms, their treatment, their recovery – and how all this affects their sexuality.

“Questions about our sexuality and cancer have always been there, but we are talking about it more often and more openly today,” says Dr. Deborah McLeod, a member of the Psychosocial Oncology Team with the Capital Health Cancer Care Program. 

These are important conversations. Up to 50% of people affected by cancer have one or more sexual concerns, and many of these persist for years after treatment. “Most cancer treatments have some impact on sexuality – physical, psychological, emotional, and relational,” notes Dr. McLeod.

“Patient satisfaction surveys suggest that 40% to 50% of people affected by cancer are dissatisfied with how their sexual concerns are addressed,” she adds. “However, less than 10% of those speak to their health professionals about their concerns and only 2 % of health professionals regularly ask about this area of health.”

That’s starting to change. As part of a national initiative, Cancer Care Nova Scotia has developed a screening program to identify areas of concern to patients. One of those areas is sexuality.

There are two types of concerns, explains Dr. McLeod. “Patients may have questions broadly about how cancer and treatment will affect them generally, about how they feel as a person. There may also be questions about sexual function.”

For men, she notes, having cancer can challenge their sense of self as a strong, independent male. Sexual issues may also be tied to loss and grief. Younger men may worry as well about how the disease will affect their sexual development and fertility, and single people may be anxious about the impact on new relationships.

“We can help address these issues,” says Dr. McLeod. “A lot of what is needed is good information and coaching.”

Five main sexual problems can be an issue for men who have cancer: erectile dysfunction, loss of interest or desire, difficulty with orgasm, altered body image, and incontinence. “There are many things we can do to help with these issues,” notes Dr. McLeod. “But even when the problem can’t be completely corrected, support and help with communication always helps.”

More and more health professionals are providing that support. “We’re learning to talk about sex in our conversations with patients,” says Dr. McLeod, “and those conversations are more meaningful.”

Such conversations, she points out, go beyond talking about sexual function. “We need to speak with patients about how this is an element of who they are.”

It’s important for patients to feel comfortable talking about these issues – and to speak out. Dr. McLeod notes, for example, that some erectile dysfunction is common in up to two-thirds of men with prostate cancer. Of those, only one-third will ask for help and only one-third will use what is suggested more than once. “This gives us some indication about how difficult it is to use aides in satisfying ways. It takes time, persistence and coaching to learn how to integrate these things into a sexual relationship.There are health professionals who can help,” says Dr. McLeod.

One way of accessing help is through online education and support groups. “We are offering more sexual health information groups through Cancer Chat Canada,” says Dr. McLeod (www.cancerchatcanada.ca)

It’s also important for both patients and health professionals to raise issues of sexuality, she adds. “Often people are reluctant to bring up the subject. They shouldn’t be. This is important.”

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