Analysis

Nothing to be embarrassed about at sex therapy clinic

A cancer nurse who established a sex therapy clinic has been named runner up in the cancer nursing category of the Nurse Awards 2015 in recognition of her internationally renowned work

A cancer nurse who established a sex therapy clinic has been named runner up in the cancer nursing category of the Nurse Awards 2015 in recognition of her internationally renowned work.

Isabel White (pictured right, with a patient) developed the service to address the rehabilitation and support needs of individuals and couples experiencing the sexual consequences of cancer and its treatment, including those affected by breast and pelvic cancers. The service supports men and women experiencing organic and psychogenic sexual and relationship difficulties.

Picture credit: Nathan Clarke

Dr White, who is clinical research fellow in psychosexual practice at London’s Royal Marsden NHS Foundation Trust, first assesses each person’s unique adjustment and rehabilitation needs. This enables her to work with them, and their partner, to develop coping strategies, introduce behavioural and/or biomedical interventions to overcome sexual difficulties, or move towards adjustment to a permanent change in sexual expression.

Interventions range from advice on sexual positions, use of lubricants and dilators after pelvic radiotherapy in women, medication or vacuum devices for men experiencing erectile dysfunction to behavioural or cognitive behaviour therapy interventions for desire, orgasm or sexual avoidance difficulties.

Deserving support

Dr White explains: ‘All people affected by cancer deserve support from health professionals to improve self-care and management of sexual consequences, overt permission to share their concerns, and support in the belief that the assessment and management of treatment-induced sexual difficulties are a legitimate part of their care.’

The consequences of cancer treatment are experienced by an estimated 400,000 survivors in the UK. These effects are often difficult to identify and are insufficiently understood by patients, the public and healthcare professionals.

According to a Macmillan survey (Macmillan Cancer Support 2006), 26% of people with cancer said they experienced difficulties in their relationship with their partner as a result of their diagnosis. It also found that 43% of those living with cancer said that their sex life had suffered as a result of the illness.

Research

Dr White’s own research found that women were embarrassed to talk about sexual concerns during or after their cancer treatment, with many feeling it was not important enough to discuss with busy clinicians.

In response to patients’ concerns that the sexual effects of cancer were not being addressed, the Royal Marsden appointed Dr White in 2010.

She set about improving patients’ sexual confidence by establishing a clinic and developing new management pathways for those with sexual rehabilitation needs. She also supports colleagues to develop confidence and skills in talking to patients about sexual concerns, training them to conduct systematic sexual assessments and make appropriate onward referrals to services in and beyond the cancer centre.

New patients

Between 2010 and 2012 the service set up by Dr White saw 82 new patients, mostly from the breast and gynaecological units, followed by urology and lower gastrointestinal (GI) services. In 2013/14, there were 44 new patients who had had breast, gynaecological, urological and haemato-oncology cancers.

In the year to March 2015 the service received 56 new referrals, mostly from the urology unit, followed by gynaecology, breast and lower GI units. It has delivered 187 hours of psychosexual therapy to individuals and couples, compared with 60 hours in the first year of the service.

‘Advanced practice by clinical nurse specialists, nurse consultants, allied health professionals and medical specialists offers specialist assessment, biomedical interventions such as hormone replacement therapy, medication for erectile dysfunction and limited information on sexual behaviour adjustments,’ Dr White says.

Emotional vulnerability

‘I usually see people experiencing more complex or enduring sexual difficulties that have not responded to biomedical strategies alone, including those with multiple comorbidities, couple difficulties and people with emotional vulnerability before their cancer diagnosis.’

Royal Marsden chief nurse Shelley Dolan says Dr White’s achievements in ensuring that people with treatment-induced sexual difficulties have access to expert psychosexual therapy are renowned internationally.

‘Isabel’s tireless work in lobbying and promoting this area of care, while managing her own clinical practice, means that she thoroughly deserves this recognition,’ says Dr Dolan.

'Personal impact'

The judges commended Dr White for addressing ‘a tough area for people to talk about and making a very personal impact on people’s lives’.

Chief nursing officer for Wales Jean White says: ‘Isabel’s work brings much to an area that is not well explored and that isn’t comfortable for people to talk about. There is a lot of potential in her research findings.’

RCN chair of nursing research at Cardiff University Daniel Kelly agrees. He nominated the ‘highly respected clinical academic nurse researcher’ for ‘spearheading the need for more support for a previously neglected clinical problem’.

‘One of the most valuable aspects of Isabel’s service is that she allows people to talk about private issues in a safe and professional manner,’ says Professor Kelly, who is also director of research and innovation at the university.

Energy and drive

‘She has used her enthusiasm, energy and drive to shape the need for this initiative. The numbers being referred to the service are rising, indicating that it is highly regarded by patients and colleagues.’

He adds that she has ensured the cancer survivorship agenda considers what some might say are the taboo subjects of sexuality, relationships and partner support.

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