Impact of sexuality on cancer Prepared by: Diala Dajani & AbdulQadir Nashwan

3. 1. Review primary effect of cancer on sexuality
2. Understand the impact of cancer different therapeutic
modalities on sexuality
3. Assess sexual life and needs based on physical, social,
psychological background.
4. Design a nursing care plan for sexual dysfunction among
patients with cancer.
5. Integrate communication skills with nursing care to
provide healthy solutions for sexual dysfunction among
cancer patients.
6. Arrange right sexual counseling approaches.

12. Risk
Factors
Age < 30
Psychosocial issues
Surgery
Radiation
Medications

13. Treatment
Modalities
Chemotherapy
Cancer-Associated Drugs
Hormonal Therapy
Surgery
Radiation

14. Erectile dysfunction
Penile/testicular atrophy
Decreased libido
Ejaculatory dysfunction
Gynecomastia
Chemotherapy
&
Hormonal
Infertility

15. Urinary issues
Impotence
Bowel dysfunction
Penile/testicular atrophy
Radiation
Infertility

16. Urinary issues
Impotence
Retrograde ejaculation
Disturbed Body Image
Surgery
Infertility
Pain on the site of surgery

17. Treatment
Modalities
Chemotherapy
Cancer-Associated Drugs
Hormonal Therapy
Surgery
Radiation

18. Irregular menses
Decreased libido
Early menopause
Vaginal dryness
Painful intercourse
Chemotherapy
&
Hormonal
Infertility

19. Pelvic fibrosis
Vaginal ulceration
Vaginal atrophy/stenosis
Decreased lubrication
Decreased elasticity
Radiation
Infertility

20. Bowel changes
Changes in vaginal size/sensitivity
Loss of nipple
Pain on the site of surgery
Disturbed Body Image
Surgery
Infertility

21. Drugs
Narcotics
Others
Sedatives
Antidepressants
Steroids

22. Impact of cancer on sexuality: How is the Moroccan patient
affected?
• Cancer affected sexual life of 67% of sexually active persons
• The marital status of 20% changed after the diagnosis
• The main identified causes were absence of demand from patients (50%)
• lack of time (42%)
• difficulties communicating on the subject (42%)
• lack of intimacy (50%)
• All practitioners thought that patients would prefer to discuss this subject
with a person of the same gender (100%)
Pts n= 97
Phy n= 28

24. Assessment Approaches
 General clues to consider during assessment:
Not every nurse can be a sexual counselor , but the
solution is to: listen, listen ,and listen actively to the
patient and the partner's need.
Sexuality is more than the act of intercourse, it
includes intimacy, touching and a multitude activities
to show affection.
Cancer may affect permanently the sexual patterns
and fertility, but it cannot alter the fact that one is a
sexual being.

25. Assessment Approaches (cont.)
1.
• Personal discomfort.
2.
• Fears of embarrassing the patient or the health care
provider.
3.
• Lack of training or knowledge.
4.
• Lack of time.
5.
• Concerns about the appropriateness of this type of
discussion when dealing with a life threatening condition.
6.
• Beliefs that its not a part of the nurse’s job description.

26. cont.))Assessment approaches
 General guide lines for a comprehensive assessment:
1. Nurses must first understand their sexual identity.
2. Nurses must understand what constitutes acceptable
sexual patterns and practices.
3. Having a well based knowledge about sexual issues.
4. Asking about sexual patterns early at the assessment is
considered important.
5. Understand patient’s medical, psychiatric and psychosocial
status.

27. 6. Cultural, religious beliefs and general intimacy should be
incorporated in the discussion.
7. Whenever possible and appropriate the patient’s partner
should be included.
8. Medical jargons should be avoided.
9. Information about the disease, must be provided so the
anxiety and embarrassment decrease.
10. Questions and responses should acknowledge the subject
and related concerns.6.
cont.))Assessment Approaches

28. Sexual Counseling
 All patients should receive information about the
possible side effects of disease and treatment on
sexuality and reproduction :
1. Alteration in
physical function and
libido.
2. Menopausal
symptoms.
3. Problems with
erection and
ejaculation.
4.Problems about
infertility.

29. Sexual Counseling (cont.)
MenWomenCharacteristic
Post pubertyOlder than age 30Age
Prostate, Orchiectomy,
Abdominal pereneal
resection, Pelvic
exenteration.
Gynecologic, Abdominal
pereneal resection,
Pelvic exenteration.
Surgery
PelvicPelvicRadiation therapy
Antidepressants,
Antihistamines,
Narcotics, Estrogen,
etc…
Antidepressants,
Antihistamines,
Narcotics, Sedatives,
etc…
Medications
Alteration in body image
and self esteem,
decrease sense of
masculinity.
Alteration in body image
and self esteem,
decrease sense of
femininity.
Psychosocial issues

30. Sexual Counseling (cont.)
"Yes, I feel like people are staring, and
it is hard to find clothes, and yes, I get
frustrated a lot," ."But ... I had to learn
to love my body again."
One woman wrote on the National Breast Cancer
Foundation Survivor online forum.

31. Sexual Counseling (cont.)
 Research study
 Title: Body image in relation to self-esteem in a sample of
Spanish women with early-stage breast cancer ( 2005).
 Aim: studied to determine the influence that sociodemographic
variables, type of surgery, amount of social support, and quality
of life had on their body image and self-esteem.
 Results and conclusion: married women reported a more
positive body image than non-married women, and so did
women with a lumpectomy versus those with a mastectomy. The
study shown a significant negative correlation between the
deterioration of quality of life after surgery and both body image
and self-esteem.

32. Sexual Counseling (cont.)
 Evaluation methods
1. ALARM model
2. Auchincloss model
ALARM model
Activity(sexual)A
Libido/desireL
Arousal and orgasmA
Resolution/ releaseR
Medical dataM
Auchincloss model
Evaluate sexual status:
1.Present sexual function
2.Past experiences
3.Relationships
Evaluate medical,
psychological and cancer
status.

33. Sexual Counseling (cont.)
 After a holistic assessment interventions are important:
1. To maintain optimal
sexual function and to
promote adaptation
for the side effects of
sexual dysfunction.
2. Improve quality of
life.
3. Remember the
individualism.
4. PLISSIT model for
intervention.

34. Sexual Counseling (cont.)
PLISSIT model for intervention
PermissionP
Limited InformationLI
Specific SuggestionsSS
Intensive TherapyIT

35. Nursing Management
1. Managing for traditional symptoms are important
• Nausea, vomiting, bone marrow depression,
thrombocytopenia, neutropenia, etc…
2.Focusing on the symptoms that affect sexual function
• Peripheral neuropathies, malnutrition, stomatitis, fatigue,
hand-foot syndrome and incontinence.
3.Manage the side effects of treatment as for women
• Difficulty reaching climax, Loss of desire for sex, Reduced
size of the vagina, Vaginal dryness.
4.manage the side effects of treatment as for men
• Erection and ejaculation problems, loss of desire for sex, etc..

36. Nursing Management (cont.)
5.Stress the importance of communication and openness
• Potential alteration in body image and self-esteem, the need
for exercise, rest, adequate nutrition, the use of contraception
and setting the stage for sexual activity, Kegel exercise.
6.Information on the timing of medication is very important
• ???
7.Appropriate referrals as
• Hormonal therapies, medications to manage erectile
dysfunction, sperm banking and reconstructive surgeries.

37.  Ostomy Surgery: Interventions
1. Address issues
of Body Image
2. Concerns about
odor: A. Tight
appliance
B. Avoid foods that
cause flatulence
3. Appliance cover
4.Ostomy
accessories
Nursing Management (cont.)

38.  Don’t forget to tell your patient the important rules :
1.Talk with your
health care team
2.Talk with your
partner
3.Explore other ways
of being intimate
4.Talk with other
cancer survivors
Nursing Management (cont.)

39. Fertility Considerations &
Procreative Alternatives
 Fertility and pregnancy following cancer diagnosis
are fraught with a multitude of concerns.
 patients must be aware of the pregnancy related
issues.
1.Ability to
conceive
2.Carry to
term
3.Deliver a
healthy
newborn

40.  Reproductive counseling (Congenital problems)
Congenital
abnormalities
Mutagenecity
Teratogenecity
Fertility Considerations &
Procreative Alternatives

41.  Other solution for conception and pregnancy:
1. Semen
cryopreservation and
sperm recovery
2.Invitro fertilization/
embryo transfer
Fertility Considerations &
Procreative Alternatives

42. Pregnancy & Cancer
1. In general most cancers do not adversely affect
a pregnancy, nor does pregnancy adversely affect
the cancer outcome.
2.Treatment of cancer will affect the pregnancy as
abortions, congenital abnormalities, etc..
3.Data on risk for fetus exposed to chemo is
limited and related to trimester (1st is greatest
risk)

43. 1.
• Age at treatment (menopausal status)
2.
• Type of drug used
3.
• Dosage
Pregnancy & Cancer

44. 1. Sexuality and reproductive capacity of the individual with cancer may be affected
by a variety of factors, including the biological process of cancer, the effects of
treatment, additional health problems and medications, discuss these factors?
2. Although not every nurse is a sexual counselor, how can you provide a
comprehensive assessment for patients who are receiving cancer treatment?
3. Managing side effects of cancer and its treatment is integral to the nurse's role.
Explain how can you offer suggestions for appropriate managing for signs and
symptoms related to sexual dysfunction?
4. Embarrassment is usually presented during assessment and evaluation of the
sexual life, as an oncology nurse specialist how can you overcome this problem
to avoid false management?

45. • Yabrok, C.H., Frogge, M.H., & Goodman, M. (2005). Cancer Nursing:
Principles and practice (6th Ed). CH 35 (Pages 841 – 869)
• Itano, JK & Taoka, KN. (2005). Core Curriculum for Oncology
Nursing (4th Ed). Oncology Nursing Society.

46. AbdulQadir J. Nashwan, RN
 nursing861@yahoo.com
Diala Dajani, RN
 dialadajanir73@yahoo.com

47.  Although increasingly recognized as consequences of cancer or
cancer therapy, sexual and reproductive dysfunctions often have been
dismissed as normal side effects about which the caregiver can do a
little or nothing.
 Indeed, these dysfunctions frequently have gone underdiagnosed,
underrated, or both because of lack of concern, information, or
knowledge on the part of caregiver, or because of fear, lack of
knowledge, or embarrassment on the part of patient or family.