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

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The literature contains a number of articles and resources that address sexual assessment,[2] with many specific to cancer patients.[2,3,4,5] The Kaplan model provides a useful interview guide to evaluate sexual problems in healthy and medically ill individuals, focusing on the chief complaint, sexual status, psychiatric status, family and psychosocial history, relationship assessment, summary, and recommendations.[6] Kaplan's model has been applied to oncology settings, with brief descriptions of the assessment for each part of the interview.[3,7] The PLISSIT (permission, limited information, specific suggestions, and intensive therapy) model [8] is another model of assessment and intervention commonly used as a framework for sexual rehabilitation in cancer care and medical illness.[5,9,10,11,12]

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.[13] The following section describes factors known to impact current sexual functioning .

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. Aspects of current sexual function include 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 may 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 may ask whether a new medication or change of dosage was prescribed at the problem's onset.

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