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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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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.[14] Clinicians are careful not to make assumptions regarding the patient's previous sexual experience or the importance of sexual expression.

Psychosocial Aspects of Sexuality

Relationship status

The patient may or may not have an available partner at the time of diagnosis. Sexuality is taken no less seriously by the clinician or the patient if there is no partner. For patients with a partner, the clinician may consider and discuss the duration, quality, and stability of the relationship before diagnosis. Additionally, as many patients fear rejection and abandonment, the clinician may 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 are considered relative to his/her previous and current sexual status in a complete assessment. A clinician recognizes 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.

Psychological status

The affective spectrum during cancer treatment ranges from disbelief to clinical depression and typically changes over time. Anxiety and depression are the two most common affective disruptions among patients with cancer and both have been found to have deleterious effects on sexual functioning.[3,4,5,7,18] A clinician will determine the following:

  • Current mental status and any history of depression or other psychiatric disorder.
  • Previous psychotherapy.
  • Treatment with psychotropic medication, and/or hospitalizations.

Current use of psychotropic medications should also be reviewed with respect to impact on sexual function. Cancer treatment can produce changes to the body that negatively impact body image and self-esteem.[4,5,19] Commonly, patients have difficulty seeing themselves as sexually attractive during and after treatment. Identifying body-image disturbances is important to incorporate into goals of care and rehabilitation. Frequently, the couple experiences changes of social roles during treatment. An individual's identity and sense of worth may be threatened when role changes occur.[4,15] The partner's participation in the patient's physical care often negatively impacts feelings of sexuality. Younger couples, more than older couples, may be vulnerable to problems with playing alternative or new domestic roles and experiencing the myriad life and financial stressors associated with treatment.[4]

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