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Sexual Issues

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Background

The effect of cancer and its treatment is complex. Individual responses to the diagnosis and treatment of colon cancer differ in regard to symptoms such as nausea, vomiting, and fatigue—sexual responses can be just as divergent. For the 9 of 10 people with diagnosed colon cancer who are over age 50,1 the issue of reproduction is less important than for patients in their 20s and 30s. However, sexual well-being is a vital quality of life issue at all ages and involves the following:

  • Body image
  • Reproductive ability
  • Feelings of sexuality or sexual functioning2

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Changes in Body Image, Self-Image, and Self-Esteem

Our body image, or the way we see ourselves, can be altered by CRC-related:

  • Surgery
  • Weight loss
  • Pain
  • Alopecia
  • Mucositis
  • Fatigue
  • Changes to the brain resulting from changes in hormone production

The diagnosis of CRC cancer often involves a change in self-image (subjective view of self)—even the simple transition of seeing oneself first as a well person, then as “a cancer patient.” Add surgery (such as colostomy or ileostomy), chemotherapy, and abdominal radiation therapy, and the potential for sexual issues increases. Issues of self-esteem (respect for oneself) are greatest in the first year following surgery.3

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Changes in Hormone Production

Hormone regulation occurs in the brain. In both men and women, 3 hormones affect ovarian and testicular function4:

  • Gonadotropin-releasing hormone, which is released from the hypothalamus
  • Luteinizing hormone
  • Follicle-stimulating hormone, which is released from the anterior pituitary gland

Women, during the premenopausal and perimenopausal years, also produce estrogen and progesterone from the ovaries, and men produce testosterone. Any treatment that affects these levels of hormone production has the potential to alter sexual function. Today, more people are surviving cancer than ever before. Patients should maintain sexual intimacy during treatment and should not be afraid to ask their health care professional for assistance.

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Assessment and Intervention Tools

Several models are available to assist health care providers in asking sensitive questions within appropriate frameworks. A number of assessment and intervention models exist to help nurses in addressing sexual issues with patients. Whereas assessment may be accomplished by a health care provider, intervention might requireconsultation with a sex therapist. The models include

  • ALARM2 (assessment model): Activity, Libido, Arousal, Resolution, Medical information (cancer and health status)
  • BETTER5 (assessment model): Bring up the topic; Explain your concerns; Tell patients you will find information; Timing; Educate; Record assessment An educational tool to help patients understand and explore issues of changing sexuality is published in separate versions for men and women; Sexuality & Cancer is available from the American Cancer Society by calling 1-800-ACS-2345
  • PLISSIT6 (intervention model): Permission to discuss; Limited information; Specific Suggestions; Intensive Therapy

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Clinical Practice Guidelines

The National Cancer Institute
http://www.cancer.gov/cancertopics/pdq/supportivecare/sexuality/healthprofessional

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Patient Care Management Protocols/Algorithms

http://cancersymptoms.org/sexualdysfunction/index.shtml

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References

  1. American Cancer Society. Risk factors for colorectal cancer. Available at: http://www.cancer.org/docroot/CRI/content/CRI_2_4_2X_What_are_the_risk_factors_for_colon_and_rectum_cancer.asp?sitearea. Accessed September 29, 2006. (Click on More Information, Additional Resources, and 2 sites: Sexuality and Cancer for Men and Women)
  2. Krebs L. What should I say? Talking with patients about sexuality issues. Clin J Oncol Nurs. 2006;10:212-215.
  3. Oncology Nursing Society. Site specific physiologic & body image alterations. Available at: http://cancersymptoms.org/sexualdysfunction/colorectalcancer.shtml. Accessed September 29, 2006.
  4. Krebs LU. Sexual and reproductive dysfunction. In: Yarbro CH, Frogge MH, Goodman M, eds. Cancer Nursing. Sudbury, Mass: Jones & Bartlett; 2005:841-869.
  5. Mick J, Hughes M, Cohen MZ. Using the BETTER model to assess sexuality. Clin J Oncol Nurs. 2004;8:84-86.
  6. Lally RM. Use the BETTER and PLISSIT models to assess sexuality in patients with cancer. ONS News. 2006;21:1,4-5. Available at: http://www.ons.org/publications/journals/news/pdf/2109.pdf. Accessed September 29, 2006.

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This page was last modified on 1/5/2007, at 12:16:47 pm ET.