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Sexuality and Reproductive Issues (PDQ®): Supportive care - Health Professional Information [NCI] - Assessment of Sexual Function in People With Cancer

No clear guidelines address sexuality during the stages of disease and its treatment. When therapeutic decisions are being made, providers may offer education and information to patients, ideally with the partner present, regarding known risks of sexual morbidity associated with cancer treatments. Oncology professionals assist patients and their partners by asking specific open-ended questions to validate the importance of sexual health concerns, thus providing an environment in which the patient and couple are encouraged and feel safe to express personal concerns. Assessment should be sensitive to the subtle ways in which changes in sexual function affect men's self-image and masculine identity.[1]

Providers may want examine their own thoughts and feelings regarding sexuality. When providers are not comfortable addressing issues of sexuality, referrals may be offered to alternate resources. Although some patients may not want to discuss their sexual health, providers may offer the option, conveying that sex is an appropriate topic to cover during future visits.

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Because sexual function is one important aspect of quality of life, the follow-up oncology visit is a key opportunity for health care providers to assess whether a cancer patient is experiencing sexual problems. Although it would be ideal if an oncologist carried out the sexual assessment, time constraints and lack of training or comfort in discussing sexual issues often interfere with this goal. Furthermore, many people who have finished their cancer treatment have their routine follow-up care with a primary practitioner rather than an oncology specialist.

At least in oncology settings, it may be helpful to designate and train a member of the team, such as an oncology nurse or social worker, as the expert on sexuality issues. That provider can take responsibility for asking about a variety of quality-of-life issues, including relationships and sexuality. A minimal sexual assessment might consist of asking the following question: "Many cancer survivors notice changes or problems in their sex lives after cancer treatment. Do you have any problems or concerns related to sexuality?" Simple problems can be handled with immediate reassurance or advice, but the oncology team may also build a network of specialists willing to help cancer patients. This network of healthcare professionals includes:

  • Mental health professionals trained in sex therapy and other sexual issues.
  • Gynecologists familiar with women's concerns about hormone replacement or dyspareunia.
  • Urologists who specialize in treating male sexual dysfunction.
  • Infertility specialists who can treat younger patients who are interested in having children.
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