Nurses Shouldn't Skip the Sex Talk With Patients


Healthcare providers are quick to bring up side effects like nausea and neuropathy, but are far more apprehensive to talk about sexual issues.

It’s natural for members of a healthcare team to discuss side effects like neuropathy and nausea with their patients. But when it comes to sexual dysfunction—another common side effect of cancer treatment—providers often shy away from initiating a conversation.

“We know that this is not talked about a lot,” Anne Katz, PhD, RN, FAAN, said during a presentation at the 2017 Palliative and Supportive Care in Oncology Symposium.

In fact, Katz, who is a certified sexuality counselor, said that about half (45%) of patients with cancer never had a discussion with their healthcare providers about sexual issues. In addition, Katz revealed that men were twice as likely to bridge the topic than women (49% versus 23%).

Broken down by cancer type, the percentage of patients who had a conversation with their providers about sexual health is as follows: 21% in lung cancer, 33% in breast cancer, 41% in colorectal cancer, and 80% in prostate cancer.

Discussions about sexual side effects are important because they can have a significant impact on patients’ quality of life. They can affect patients and their partners physically and psychologically.

“It’s not always about penis-in-vagina sex. It’s about touch. It’s about connection,” Katz said. “In every other area [of side effects], we raise the topic with our patients, which means it’s important.”

That same level of importance should be given to sexual issues, Katz emphasized.

But providers may be apprehensive to discuss sexual issues for many reasons. First, sexual dysfunction is not a life or death matter. Healthcare workers might also fear reaction from their colleagues or even their patients about discussing a highly personal topic.

When clinicians do talk about sexual dysfunction, they may do it in a way that is very medical and not patient-friendly, Katz said.

“I frequently tell my patients that when someone starts talking Latin to you, it means that they’re uncomfortable,” Katz said.

But there are ways that nurses and other healthcare providers can bridge those uncomfortable conversations and help patients get access to helpful resources. To do this, establishing trust and confidence with the patient is key, Katz mentioned.

Methods of Treating Sexual Dysfunction

To help patients cope with sexual concerns, there are 3 methods that can be applied. They include: the BETTER model, which was derived from nursing literature; PLISSIT and EX-PLISSIT models, which are psychology-based; and the 5 A’s, which nurses might be familiar with from smoking cessation sessions that use similar tactics.

The BETTER model is an acronym for the 6 steps that can be used: bring up the topic, explain concern, tell patients that you will find appropriate resources, timing (patients can bring the issue up at any time), educate patients, and record assessment.

Although in many ways similar to the BETTER model, the PLISSIT models start by asking permission to discuss the topic. Then, healthcare professionals should provide patients with limited information—essentially, what patients want and need to know, which Katz said is usually as simple as telling patients that the side effect is not uncommon and it can be improved. Specific suggestions should be given by the healthcare team to help the patient and, if needed, provide the resources for intensive care.

Finally, patients’ sexual difficulty can be addressed by nurses and other care providers with the 5 A’s: ask, assess, advise, assist, and arrange.

The 3 methods have common themes. It is vital that the treatment team listen and validate or normalize patients’ concerns. Interdisciplinary teams that involve psychological support are often a key component, as well.

“We know that this is really important to our patients and their partners across the cancer journey,” Katz said.

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