General Factors Affecting Sexual Functioning Evaluated in Assessment
Once a possible sexual problem has been identified, the most important assessment tool for the oncology health provider is a clinical interview with an individual man or woman, or with a couple. The following brief list of factors known to impact current sexual functioning should be included in an assessment; the patient's specific sexual concerns or needs at the time dictate the approach and content of the discussion.
Current sexual status
In the evaluation of an individual's sexual function, the initial phase of assessment serves to clarify the nature of the individual's problem and/or complaint. A variety of aspects of current sexual function should be addressed, including the frequency of experiencing spontaneous desire for sex; ease of feeling subjective pleasure with sexual stimulation; energy for sexual activity; and signs of physiological arousal, including the ability to achieve and maintain a firm erection for a man, and vaginal expansion and lubrication for a woman. The ability to reach an orgasm is another important measure of sexual function. It is helpful to ask what types of sexual stimulation can trigger an orgasm (i.e., self-touch, use of a vibrator or shower massage, partner caressing, oral stimulation, or intercourse). Pain in the genital area that occurs with sexual activity should be described in detail: "Where is the pain? What does it feel like? What kinds of sexual activity trigger it? Does it happen every time? How long does it last?" When these lines of inquiry elicit a sexual problem, the interviewer should ask when the problem began, especially whether a cancer diagnosis or particular treatment occurred close in time to onset of the problem. Because many people who have cancer take prescription medications that can interfere with sexual function, including antihypertensives, antidepressants, or psychotropic medications, the interviewer should find out whether a new medication or change of dosage was prescribed at the problem's onset.
Premorbid sexual functioning
An individual's past (pre-illness) sexual development, preferences, and experience are vital to assessment of sexual status. The level of sexual functioning before diagnosis and treatment, interest, satisfaction, and importance of sexual functioning in the relationship all influence the patient's potential distress related to current sexual status. Individuals who have already experienced sexual difficulties may be especially vulnerable to the effects of treatment. Clinicians should be careful not to make assumptions regarding the patient's previous sexual experience or the importance of sexual expression.
Psychosocial Aspects of Sexuality
The patient may or may not have an available partner at the time of diagnosis. Sexuality should be taken no less seriously by the clinician or the patient if there is no partner. For patients with a partner, the clinician should consider and discuss the duration, quality, and stability of the relationship before diagnosis. Additionally, as many patients fear rejection and abandonment, the clinician should inquire about the partner's response to the illness and the patient's concerns about the impact of treatment on the partner.[15,16,17] Partners share many of the same reactions as patients in that their most significant concerns typically relate to loss and fear of death. Moreover, the partner's physical, sexual, and emotional health should be considered relative to his/her previous and current sexual status in a complete assessment. A clinician should recognize that most couples experience difficulty discussing sexual preferences, concerns, and fears even under ideal circumstances and that sexual communication problems tend to worsen with illness and threat of death.