Chapter 10: Sexuality and Cancer

INTRODUCTION

While living with cancer, a person experiences numerous assaults on his or her quality of life. One of these is to a person's sexuality. It is important to remember that the sexual dysfunction is not limited to treatment changes in organs associated with sexual response.¹ Treatments and/or the disease itself can cause changes in sexuality, but health care providers rarely ask about sexuality issues because of concepts about the importance of sexuality in the context of the disease.² This causes patients to think they are the only ones with sexuality issues since they are asked about other intimate issues such as bowel and bladder habits, but not sexuality issues.

All cancers can impact sexuality and intimacy.¹ Unlike other side effects of cancer and its treatment, sexual problems do not tend to resolve after several years of disease-free survival.³ Schover et al⁴ report sexuality to be one of the first elements of daily living disrupted by a cancer diagnosis. Sexual relationships make a significant contribution to the quality of life for almost everyone.⁵ According to Leiblum et al,⁶ all patients regardless of age, sexual orientation, marital status, or life circumstances should have the opportunity to discuss sexual matters with their health care professional. But it is not easy to talk about despite living in a culture that is saturated with overtly sexual images, graphic lyrics, and explicit advertising.⁷ Bruner and Boyd⁸ assert that the promotion of sexual health is vital for preserving quality of life and is an integral part of total or holistic cancer management.

The benefits of discussing sexuality with the patient are numerous, and are listed as follows:

• it demonstrates a desire by the clinician to treat the entire patient, not just the diseased body part;

• it legitimizes the topic for discussion;

• it emphasizes the importance of maintaining normal activities and relationships during and after treatment;

• it may identify patients at risk for sexual dysfunction after treatment.^9,10,11,12

In order for providers to begin assessing sexuality in people with cancer, they must first understand what sexuality encompasses. It is a broad term including social, emotional, and physical components.¹³ It is not just genitals or gender, but includes body image, love of self and others, relating to others, and pleasure.¹³ It is genetically endowed (whether a person has XX or XY chromosomes), phenotypically embodied (how masculine or feminine a person is), hormonally nurtured, not age related, but matured by experience, and cannot be bought, sold, or destroyed despite what is done to a person.^14,15 Sexuality includes affection, sexual orientation, sexual activity, eroticism, reproduction, intimacy, and gender roles, and encompasses feelings of trust.^16,17,18 It also includes:

• the belief that one is capable of attracting the attention and affection of another;

• giving and receiving sexual pleasure;

• feeling of ...