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Treatment of Sexual Problems in People With Cancer


    As many patients will experience anticipatory anxiety about re-establishing sexual intimacy with their partner and potential uncertainty of their own sexual response, the potential advantages of self-stimulation can be explored. Self-stimulation has the advantage of allowing the individual to become comfortable with his/her sexual response and arousal without the added pressure of performance anxiety commonly heightened by concern for their partner's pleasure, reactions, concerns, and/or fears. For many individuals, a cognitive reframing of masturbation to self-stimulation or self-pleasuring allows the individual to accept this activity as part of the process in sexual rehabilitation. For others, this behavior may still be a resilient and persistent taboo for cultural and religious reasons.

    For those couples who wish to have sexual intercourse, sexual positions that place no weight on a scar or ostomy and positions that allow better control of depth of penetration can be explored. The side-by-side position (spooning) in which the man is behind the woman, or the L-shaped position, with both partners lying down, torsos at right angles and legs entwined, are two possibilities. Comprehensive pamphlets on sexuality and cancer, for both men [3] and women,[4] provide illustrations of sexual positions and other self-help information.

    For patients with colostomies or ileostomies, pamphlets are available from national organizations related to resuming sexual activity including topics such as sex and the female ostomate, sex and the male ostomate, and gay and lesbian ostomates. Providers can educate patients on limiting food intake before anticipated sexual activity, watching the types of food consumed, and planning times for intimacy when a bowel movement is less likely. Although the ostomy pouch is typically changed when about one-third full, patients should be taught to empty the pouch sooner when anticipating sexual intimacy. Patients may fear that the ostomy bag will interfere with sexual intimacy, become dislodged, or cause damage to the stoma. An empty and flat ostomy bag will not become dislodged from the stoma and can be rolled up or taped down so that it will not get in the way of sexual intimacy. Decorative covers may also be worn.[5,6][Level of evidence: IV] A much greater selection of products for ostomates exists today than in years past, including disposable pouches, reusable pouches that empty from the bottom or top while still attached, pouches with filters to control odors, and pouches that hang sideways instead of down for physical activity. Patients concerned about potential odor can use deodorant tablets or liquids in the bottom of the pouch or as recommended by the manufacturer.[6]


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