Sexuality and Intimacy in Cancer Patients, Capstone Project Example

The concept of sexuality is often obscure and hard to comprehend. There have been several definitions of Sexuality over time and it is clear that Sexuality includes intimacy and not merely the mechanics of the sexual act (Cleary & Hegarty, 2011). It is a concept that is multi-dimensional in nature and encompasses relationships, sexual functioning and an individual’s self concept. Additionally, sexuality and intimacy does not pertain to individuals with partners but can also be of significance to single people. Problems with sexual health and intimacy can occur to anyone, even individuals leading normal lives but this can be more pronounced in people who have chronic illnesses. Cancer, in particular, can undoubtedly affect not just an individual’s physical well-being but can also have a strong impact on an individual’s psychological and sexual well-being.

Throughout the past decade, several literatures have highlighted the impact of Cancer on the sexual health of cancer patients and their partners (Hawkins et. al., 2009). Sexual issues facing Cancer patients can include negative body image, infertility, erectile dysfunction, early menopause, painful penetration and depression. It is estimated that sexual dysfunction occur in 40% to as high as 100% in individuals with cancer, irrespective of the type of cancer or the treatment modalities involved (NCI, 2004). Issues with sexuality amongst cancer patients also go beyond sexual functioning and intercourse, and greatly affect intimacy and affection which can lead to feelings of inadequacy, isolation, anxiousness and even depression (Anllo, 2000).

The impact of Cancer on sexuality and intimacy is particularly important as several literatures on the subject state that sexual intimacy makes the struggle against cancer more manageable, assists during the healing and recuperation phase and becomes a fundamental part to maintain quality of life (Schultz & Van de Wiel, 2003; Lemieux et al., 2004). In answer to the growing needs of cancer patients in this aspect, psycho-social guidelines have been developed for the care of cancer patients, focusing primarily on the impact of cancer on sexuality and intimacy (Initiative, 2003). However, these guidelines do not serve any practical purpose within clinical practice and health care professionals rarely address the issue of sexuality. Similarly, these interventions are also aimed at restoring sexual function instead of considering improving the quality of intimacy, physical contact and sexual relationships as well as developing alternative practices (Hordern & Street, 2007).

A study by Flynn et al. (2011) discovered that most patients place importance on sexuality and equally finds it important to discuss this aspect with health care professionals. Based on this fact, it is essential that healthcare professionals utilize a person-oriented approach to address this need. A person-oriented approach relates to quality interaction with patients and becoming aware on how questions are asked or how to respond to the information given by patients. However, healthcare professionals can experience certain barriers when it comes to this matter as they are besieged with time constraints and the need to prioritize care as well as personal issues such as culture and negative experiences. Moreover, some healthcare professionals admit to feelings of inadequacy or lack of capability to address sexual issues and that they do not feel qualified to do so. Some also state that they lack the affinity to make authentic, face-to-face interaction within their professions to discuss issues relating to sexuality and intimacy. De Vocht (2011) puts forth that a team approach or “Stepped Skills” is a more realistic and practical means to address issues in sexuality amongst cancer patients. He states that by developing complementing roles within the team, issues on sexuality and intimacy are more clearly addressed. Each team member has a role comprising of spotters and skilled companions. Spotters aim to identify potential and actual issues that relate to sexuality and intimacy. They provide the initial discussion about sexuality including side effects of cancer treatments and highlighting the importance of sexuality and intimacy for the patient and his partner. Meanwhile, skilled companions’ role includes supporting patients and their partners in all areas of sexuality that related to the effects of cancer and its treatment. Areas of sexuality include sexual relationships, self-concept and sexual function. Skilled companions need to have the confidence and be comfortable enough to discuss sexual issues in order to adopt a person-oriented approach.

With the growing number of individuals diagnosed with cancer, it cannot be denied that it has a significant impact on quality of life both for patients and their intimate partners. Sexuality and intimacy is one aspect of an individual’s quality of life that can be of importance to patients and their partners but is not fully addressed by healthcare professionals. It is important to understand the crucial role of healthcare professionals to help cancer patients and their partners to understand the effects of the disease and provide information to help them adjust. The Stepped Skills approach can truly provide more support to address issues on sexuality and intimacy through clear referral pathways, thereby improving the care that cancer patients receive.

References

Anllo, L. (2000) Sexual life after breast cancer. Journal of Sex and Marital Therapy, 26, pp. 241-248.

Cleary, V. & Hegarty, J. (2011) Understanding sexuality in women with gynaecological cancer. European Journal of Oncology Nursing, 15(1) pp. 38–45.

De Vocht, H. et al. (2011) Stepped Skills: A team approach towards communication about sexuality and intimacy in cancer and palliative care. Australas Med Journal, 4(11), pp. 610-619

Flynn, K.E et al. (2011) Patient experiences with communication about sex during and after treatment for cancer. Psycho Oncol. 10(1002)

Hawkins, Y. et al. (2009) Changes in sexuality and intimacy after the diagnosis and treatment of cancer: the experience of partners in a sexual relationship with a person with cancer. Cancer Nurs. 32(4), pp. 271-80.

National Cancer Institute (2004). Sexuality and reproductive issues. Bethesda

Hordern, A.J & Street, A.J (2007) Constructions of sexuality and intimacy after cancer: Patient and health professional perspectives. Social Science and Medicine, 64, pp. 1704-1718

Initiative (2003) Clinical practice guidelines for the psychosocial care of adults with cancer. National Breast Cancer Centre, Camperdown, NSW.

Lemieux, L. et al. (2004) Sexuality in palliative care: Patient perspectives. Palliative Medicine, 18, pp. 630-637.

Schultz, W. & Van de Wiel, H. (2003) Sexuality, intimacy and gynaecological cancer. Journal of Sex and Marital Therapy, 29(s), pp. 121-128.