Talking point: sexual intimacy and cancer
Julie Hoole, psychosexual therapist and winner of last year’s RCNi Excellence in Cancer Research award, reveals how health professionals can initiate conversations to ‘open the door’ for people who are experiencing sexual or intimacy problems during the course of their treatment.
Julie Hoole, psychosexual therapist and winner of last year’s RCNi Excellence in Cancer Research award, reveals how health professionals can initiate conversations to ‘open the door’ for people who are experiencing sexual or intimacy problems during the course of their treatment
Holistic needs assessment is an everyday term in nursing where we pride ourselves on supporting the whole person.
When a patient ticks the box to say they are having sexual problems, what can a healthcare professional do?
I would suggest that sexual health education when discussing the unwanted effects of medication does not happen often enough. How often have you said: ‘The codeine you are prescribed may take your libido away’? Yet, as health professionals we are happy to talk about constipation in detail and how to manage this personal bodily function.
What stops health professionals approaching the subject of intimacy and sexual function?
There is a plethora of reasons why we do not approach the subject, from not knowing what to say, cultural taboos, lack of confidence in knowing what to do if they have a problem, to feeling you are not an expert to help in such a matter.
You do not need to be an expert psychosexual therapist (PST) to offer information that may be helpful. Often it is the case of using simple language that patients can understand. The biggest issue is opening the door to the discussion in the first place.
‘You do not need to feel you have all the answers, but be confident and open in your body language when asking questions’
To help health professionals have a conversation that ‘opens the door’ for a patient to express they are having sexual or intimacy problems exacerbated by their illness or treatment, we have developed a tool in the form of a questionnaire.
It is a myth you need to be a PST expert to open the door – having a meaningful conversation and knowing where to refer someone can be all the patient needs when they are in front of you asking or looking for help.
Simple things, such as knowing where there is help if a person or a couple ask, can be beneficial. The charity Relate take self-referrals. Your patient may have to pay, or for certain illnesses that affect sexual function, such as cardiac disease, diabetes or cancer, a referral by a GP can sometimes be free. Some hospitals have PST services that enable the referral of patients.
- RELATED: Cancer nurses explain how winning an RCNi Nurse Award has helped their patients and practice
You do not need to feel you have all the answers, but be confident and open in your body language when asking questions. You can ‘open the door’ by having a third person conversation, saying for example: ‘Some people in the past who have had this [treatment/surgery] have felt what’s helped them are…’.
‘Do not presume intimacy and sexual function is only for the young’
My earlier example of codeine and its potential impact on libido is a perfect opportunity to offer education and explanations as well as supporting self-management.
Do not presume intimacy and sexual function is only for the young.
Remember, it could be important for the person and their partner to hear it is not that they have lost their partner, but that their medication takes the desire away. The relief to both can be huge.
Conversations about sexual intimacy help the person to make a choice about different medications and are an important part of the holistic care of our patients.
How to give your patients ‘permission’ to open up and discuss intimacy and sex
When prescribing medication or checking its effectiveness, these are some of the things you could say:
‘This medication can reduce your libido, your desire to be close to your partner and even down to not being interested in cuddles.’
‘Just so you know, this medication can take sexual desire away. If this is a problem, please let me know as there may be an alternative.’
‘This medication may dry your mouth and can also dry vaginal secretions so you may want to use a lubricant for everyday pleasure or intimacy.’ You could offer names of lubricant.
Another option could be:
‘How are you and your partner? Are you having time together to be close? To cuddle? To talk?’
About the author
Julie Hoole is a Macmillan strategic partnership manager. She is a psychosexual therapist and has spent 16 years in specialist cancer nursing.
- Read more about the sexuality and intimacy tool developed by Julie Hoole’s MHK tool with her head and neck cancer patients
The Excellence in Cancer Research Award is sponsored by Cancer Research UK