I was writing a proposal for grant funding to train physicians, nurses, and mental health professionals to be more comfortable and knowledgeable in discussing sexuality with cancer patients. I read journal article after journal article surveying health professionals about their attitudes and practices on talking to patients about sexual side effects of their illness and treatment. Whether researchers had interviewed a few professionals in depth or surveyed larger groups, and whether those questioned were physicians, psychologists, social workers, or nurses, the conclusions were always the same.
- Yes, I know sex is important to patients and I agree it should be discussed.
- No, I don’t routinely bring up sex when I see a patient, unless he or she raises the topic.
- I’m not really uncomfortable talking about sex. I just don’t have time.
- Anyway, it’s not my job unless I have to discuss it as part of the informed consent for a particular cancer treatment. The [fill in the blank with another type of health professional] should be doing that.
In contrast, patients who were surveyed on the same topic said they wanted their health care team to take the initiative to bring up the topic of sexuality and would not be offended by such discussions. They did not just want the facts about whether erections would be possible or if a cancer treatment could lead to vaginal dryness or painful sex. They wanted to talk about feeling attractive to a partner, how to keep a relationship from breaking up, and whether having sex could somehow bring on a cancer recurrence.
Why are health professionals so reluctant to give a little basic sex and cancer counseling? It is not typically because they are uncaring. Rather, they are being pressured to see more and more patients in the same amount of clinic time. They need to explain to patients and families how to choose between increasingly complex cancer treatments, each with its unique potential benefits and side effects.
Despite their protests that it is not embarrassing to discuss sex, most health professionals get little or no training or practice in asking about sexual health. They sometimes worry that patients will think they are trying to flirt if they bring up the topic. Even more commonly, professionals are aware of their own ignorance on how to manage sexual problems after cancer. If they work outside of a major cancer center, especially if their practice is not in a city, they may have no idea how to find specialists to help with male or female sexual problems.
The bottom line? In 2013 the National Comprehensive Cancer Network (a coalition of all major cancer centers in the United States) published a “survivorship” practice guideline, saying that sexual issues should be mentioned and managed from the time of cancer diagnosis, all the way through to long-term survivorship. Yet, only about 20% of men or women with cancer-related sexual problems ever try to get professional help–and because of lack of training in this special area for health care professionals, the results are often disappointing. Urologists prescribe pills, penile injections, or vacuum erection pumps, but less than a third of men use these treatments for more than several months. If one treatment is not successful, patients often give up. Gynecologists are even less likely to make a correct diagnosis of a sexual problem or to give women a useful treatment. Mental health professionals rarely have experience with both cancer-related issues and treatment of sexual problems, and their sessions may not even be covered by private insurers (who tend to exclude treatment for sexual dysfunction diagnoses in the small print of their policies).
So if you are a cancer patient or survivor, or the intimate partner of one, and you have a concern or problem about sex, you will have to be proactive (or very lucky in your health care team), to find help. Take the initiative to bring up your questions, and do not be blown off easily if your oncology team member ignores you or dismisses the issue as unimportant. Be persistent in asking for a referral to someone who can help you. You have a right to sexual health as one important part of your quality of life after cancer.
Oh, and that grant proposal? I tried four times to get it funded. I think in the end it was the best grant I ever wrote–and it did not even get close to a score from reviewers that would be successful in getting funding. And most of the doctors who headed key clinics in my cancer center let me know that they would be unhappy to have their clinic staff get the training, even though it was planned outside of working hours. They were just too busy with more important things.
This educational material is intended for informational purposes only and is not intended to replace, or substitute for, professional advice, counseling, diagnosis, or treatment. Always seek the advice of a qualified health provider with any questions you may have regarding a condition. Never disregard professional advice or delay in seeking treatment because of something you have read in this educational material.