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  • 40-100% of cancer patients experience some form of sexual dysfunctionIssues do not always resolve after therapyAlmost all cancer treatments have the potential to alter sexual function (surgery, chemotherapy, radiation, hormones)Represents major quality of life (QOL) issueWith intervention, up to 70% of patients can have improved functioningKrychman ML. Sexual rehabilitation medicine in a female oncology setting. GynecolOncol. 2006;101:380–384.
  • Azoospermia
  • SummaryPurpose.—To investigate the sex life of the Moroccan patient affected by cancer and the levelof communication within medical staff.Subjects and methods.—Transversal study with a descriptive aim. Participants were assessedprospectively using a questionnaire. A second study conducted in parallel concerned the medicaland nursing staff.Results.—The sample included 97 patients, 84% of whom were women. Mean age was 45 years,81% were married. Cancers involving a genital organ represented 58%. Cancer affected sexuallife of 67% of sexually active persons. The marital status of 20% changed after the diagnosis.Twenty-eight practitioners were approached (n = 28). All practitioners believed that patientssuffer from sexual problems (100%). They also thought that improvement in sexual life wouldimprove the overall quality of life for patients (97%). Doctors rarely broached the subject withpatients. The main identified causes were absence of demand from patients (50%), lack of time(42%), difficulties communicating on the subject (42%); lack of intimacy (50%). All practitionersthought that patients would prefer to discuss this subject with a person of the same gender(100%).Conclusion.—Cancer seriously affects the sexuality of patients. Lack of communication is relevant.The first stage towards resolution of problems is to ‘‘open the dialogue’’ within themedical staff.© 2009 Published by Elsevier Masson SAS.


  • 1. 1. Review primary effect of cancer on sexuality 2. Understand the impact of cancer different therapeutic modalities on sexuality 3. Assess sexual life and needs based on physical, social, psychological background. 4. Design a nursing care plan for sexual dysfunction among patients with cancer. 5. Integrate communication skills with nursing care to provide healthy solutions for sexual dysfunction among cancer patients. 6. Arrange right sexual counseling approaches.
  • 2. Age 30 Surgery Risk Radiation Factors Medications Psychosocial issues
  • 3. Chemotherapy Hormonal Therapy Treatment Surgery Modalities Radiation Cancer-Associated Drugs
  • 4. Erectile dysfunction Decreased libido Chemotherapy Ejaculatory dysfunction & Hormonal Gynecomastia Penile/testicular atrophy Infertility
  • 5. Urinary issues Impotence Radiation Bowel dysfunction Penile/testicular atrophy Infertility
  • 6. Urinary issues Impotence Surgery Retrograde ejaculation Disturbed Body Image Pain on the site of surgery Infertility
  • 7. Chemotherapy Hormonal Therapy Treatment Surgery Modalities Radiation Cancer-Associated Drugs
  • 8. Irregular menses Early menopause Chemotherapy Vaginal dryness & Hormonal Painful intercourse Decreased libido Infertility
  • 9. Pelvic fibrosis Vaginal atrophy/stenosis Radiation Decreased lubrication Decreased elasticity Vaginal ulceration Infertility
  • 10. Bowel changes Loss of nipple Surgery Pain on the site of surgery Disturbed Body Image Changes in vaginal size/sensitivity Infertility
  • 11. Narcotics Sedatives Drugs Antidepressants Steroids Others
  • 12. Impact of cancer on sexuality: How is the Moroccan patient affected? • Cancer affected sexual life of 67% of sexually active persons • The marital status of 20% changed after the diagnosis • The main identified causes were absence of demand from patients (50%) • lack of time (42%) • difficulties communicating on the subject (42%) Pts n= 97 • lack of intimacy (50%) Phy n= 28 • All practitioners thought that patients would prefer to discuss this subject with a person of the same gender (100%)
  • 13. Assessment Approaches  General clues to consider during assessment: Not every nurse can be a sexual counselor , but the solution is to: listen, listen ,and listen actively to the patient and the partner's need. Sexuality is more than the act of intercourse, it includes intimacy, touching and a multitude activities to show affection. Cancer may affect permanently the sexual patterns and fertility, but it cannot alter the fact that one is a sexual being.
  • 14. Assessment Approaches (cont.) • Personal discomfort. 1. • Fears of embarrassing the patient or the health care 2. provider. • Lack of training or knowledge. 3. • Lack of time. 4. • Concerns about the appropriateness of this type of 5. discussion when dealing with a life threatening condition. • Beliefs that its not a part of the nurse’s job description. 6.
  • 15. Assessment approaches cont.)  General guide lines for a comprehensive assessment: 1. Nurses must first understand their sexual identity. 2. Nurses must understand what constitutes acceptable sexual patterns and practices. 3. Having a well based knowledge about sexual issues. 4. Asking about sexual patterns early at the assessment is considered important. 5. Understand patient’s medical, psychiatric and psychosocial status.
  • 16. Assessment Approaches cont.) 6. Cultural, religious beliefs and general intimacy should be incorporated in the discussion. 7. Whenever possible and appropriate the patient’s partner should be included. 8. Medical jargons should be avoided. 9. Information about the disease, must be provided so the anxiety and embarrassment decrease. 10. Questions and responses should acknowledge the subject 6. and related concerns.
  • 17. Sexual Counseling  All patients should receive information about the possible side effects of disease and treatment on sexuality and reproduction : 1. Alteration in 2. Menopausal physical function and symptoms. libido. 3. Problems with 4.Problems about erection and infertility. ejaculation.
  • 18. Sexual Counseling (cont.) Characteristic Women Men Age Older than age 30 Post puberty Surgery Gynecologic, Abdominal Prostate, Orchiectomy, pereneal resection, Abdominal pereneal Pelvic exenteration. resection, Pelvic exenteration. Radiation therapy Pelvic Pelvic Medications Antidepressants, Antidepressants, Antihistamines, Antihistamines, Narcotics, Sedatives, Narcotics, Estrogen, etc… etc… Psychosocial issues Alteration in body image Alteration in body image and self esteem, and self esteem, decrease sense of decrease sense of femininity. masculinity.
  • 19. Sexual Counseling (cont.) "Yes, I feel like people are staring, and it is hard to find clothes, and yes, I get frustrated a lot," ."But ... I had to learn to love my body again." One woman wrote on the National Breast Cancer Foundation Survivor online forum.
  • 20. Sexual Counseling (cont.)  Research study  Title: Body image in relation to self-esteem in a sample of Spanish women with early-stage breast cancer ( 2005).  Aim: studied to determine the influence that sociodemographic variables, type of surgery, amount of social support, and quality of life had on their body image and self-esteem.  Results and conclusion: married women reported a more positive body image than non-married women, and so did women with a lumpectomy versus those with a mastectomy. The study shown a significant negative correlation between the deterioration of quality of life after surgery and both body image and self-esteem.
  • 21. Sexual Counseling (cont.)  Evaluation methods 1. ALARM model 2. Auchincloss model ALARM model Auchincloss model A Activity(sexual) Evaluate sexual status: 1.Present sexual function L Libido/desire 2.Past experiences A Arousal and orgasm 3.Relationships R Resolution/ release Evaluate medical, M Medical data psychological and cancer status.
  • 22. Sexual Counseling (cont.)  After a holistic assessment interventions are important: 1. To maintain optimal sexual function and to 2. Improve quality of promote adaptation life. for the side effects of sexual dysfunction. 3. Remember the 4. PLISSIT model for individualism. intervention.
  • 23. Sexual Counseling (cont.) PLISSIT model for intervention P Permission LI Limited Information SS Specific Suggestions IT Intensive Therapy
  • 24. Nursing Management 1. Managing for traditional symptoms are important • Nausea, vomiting, bone marrow depression, thrombocytopenia, neutropenia, etc… 2.Focusing on the symptoms that affect sexual function • Peripheral neuropathies, malnutrition, stomatitis, fatigue, hand-foot syndrome and incontinence. 3.Manage the side effects of treatment as for women • Difficulty reaching climax, Loss of desire for sex, Reduced size of the vagina, Vaginal dryness. 4.manage the side effects of treatment as for men • Erection and ejaculation problems, loss of desire for sex, etc..
  • 25. Nursing Management (cont.) 5.Stress the importance of communication and openness • Potential alteration in body image and self-esteem, the need for exercise, rest, adequate nutrition, the use of contraception and setting the stage for sexual activity, Kegel exercise. 6.Information on the timing of medication is very important • ??? 7.Appropriate referrals as • Hormonal therapies, medications to manage erectile dysfunction, sperm banking and reconstructive surgeries.
  • 26. Nursing Management (cont.)  Ostomy Surgery: Interventions 2. Concerns about odor: A. Tight 1. Address issues appliance of Body Image B. Avoid foods that cause flatulence 4.Ostomy 3. Appliance cover accessories
  • 27. Nursing Management (cont.)  Don’t forget to tell your patient the important rules : 1.Talk with your 2.Talk with your health care team partner 3.Explore other ways 4.Talk with other of being intimate cancer survivors
  • 28. Fertility Considerations & Procreative Alternatives  Fertility and pregnancy following cancer diagnosis are fraught with a multitude of concerns.  patients must be aware of the pregnancy related issues. 3.Deliver a 1.Ability to 2.Carry to healthy conceive term newborn
  • 29. Fertility Considerations & Procreative Alternatives  Reproductive counseling (Congenital problems) Mutagenecity Teratogenecity Congenital abnormalities
  • 30. Fertility Considerations & Procreative Alternatives  Other solution for conception and pregnancy: 1. Semen 2.Invitro fertilization/ cryopreservation and embryo transfer sperm recovery
  • 31. Pregnancy & Cancer 1. In general most cancers do not adversely affect a pregnancy, nor does pregnancy adversely affect the cancer outcome. 2.Treatment of cancer will affect the pregnancy as abortions, congenital abnormalities, etc.. 3.Data on risk for fetus exposed to chemo is limited and related to trimester (1st is greatest risk)
  • 32. Pregnancy & Cancer • Age at treatment (menopausal status) 1. • Type of drug used 2. • Dosage 3.
  • 33. 1. Sexuality and reproductive capacity of the individual with cancer may be affected by a variety of factors, including the biological process of cancer, the effects of treatment, additional health problems and medications, discuss these factors? 2. Although not every nurse is a sexual counselor, how can you provide a comprehensive assessment for patients who are receiving cancer treatment? 3. Managing side effects of cancer and its treatment is integral to the nurse's role. Explain how can you offer suggestions for appropriate managing for signs and symptoms related to sexual dysfunction? 4. Embarrassment is usually presented during assessment and evaluation of the sexual life, as an oncology nurse specialist how can you overcome this problem to avoid false management?
  • 34. • Yabrok, C.H., Frogge, M.H., & Goodman, M. (2005). Cancer Nursing: Principles and practice (6th Ed). CH 35 (Pages 841 – 869) • Itano, JK & Taoka, KN. (2005). Core Curriculum for Oncology Nursing (4th Ed). Oncology Nursing Society.
  • 35. AbdulQadir J. Nashwan, RN  nursing861@yahoo.com Diala Dajani, RN  dialadajanir73@yahoo.com
  • 36.  Although increasingly recognized as consequences of cancer or cancer therapy, sexual and reproductive dysfunctions often have been dismissed as normal side effects about which the caregiver can do a little or nothing.  Indeed, these dysfunctions frequently have gone underdiagnosed, underrated, or both because of lack of concern, information, or knowledge on the part of caregiver, or because of fear, lack of knowledge, or embarrassment on the part of