In recent years, it has become increasingly evident that cancer patients may experience changes in their sexual health due to cancer treatments. While most guidelines acknowledge the importance of addressing patients’ sexual health when they undergo cancer treatment, there continues to be a disconnect between the ideal standard of sexual health care and real-world practice. 

Given the demonstrated importance of sexual health in a person’s quality of life, some may wonder why it is so often overlooked during cancer care. The answer is complex and varies from case to case, but there may be some common factors that impede the management of cancer patients’ sexual health care needs.

One study aimed at identifying the sexual health care needs of colorectal cancer patients and pinpointing possible barriers to care arranged eight focus group sessions among 21 patients, nine partners, and ten health care professionals from three hospitals in the Netherlands. Like all cancer patients, colorectal cancer patients have sexual health care needs that are specific to their condition. For example, they may struggle with their sexual self-confidence if treatment requires a stoma, or they may worry about fecal incontinence. These issues are often very personal for patients and may be difficult for them to talk about.

Feeling that the participants would be more likely to speak honestly on the topic of sexual health if they were not in the presence of their providers and/or sexual partners, the researchers created separate focus groups for the patients, partners, and health care professionals. The focus group discussions were guided by a moderator and centered around two key questions: “Which sexual health care needs did you have during the course of treatment or do you still have?” and “During which treatment phase did you need/receive this sexual health care?” In the case that sexual health care was not given or received, participants were asked to explain why they thought that was.

Each session was audio recorded, transcribed verbatim, and analyzed for common themes. In this way, the authors of the study were able to identify the following individual, social, organizational, and societal factors that may frequently impede sexual health care during cancer treatment.

Individual Factors

The focus groups revealed that many of the patients and their partners were unaware that cancer treatments can cause changes in sexual health, which is a major reason why they may not have brought up the topic with their health care providers. As such, some suggested that it would be helpful for providers to bring up sexual health with all patients, providing explicit permission to broach the subject.

Additionally, some of the participants shared that they considered sexual health to be a private matter that is not easily discussed with others. The enduring idea of sex being a taboo subject may be why several of the patients and their partners did not feel comfortable mentioning their concerns to their health care providers. Finally, the participants from the patient and partner focus groups questioned the appropriateness of talking about sexual health when there were more urgent matters to think about, namely the patient surviving the cancer. Partners seemed especially prone to this feeling, and some stated the belief that their needs should take a backseat to the patient’s needs during treatment.

On the other end, many of the health care providers expressed feeling ill-prepared or unqualified to address sexual health issues due to a lack of training and/or expertise in sexual medicine, so they often felt reluctant to start such discussions with patients. They voiced concerns about overstepping boundaries and potentially offending patients who are not interested in or do not require sexual health care, or even embarrassing patients when other family members such as their children are present.

Some of the providers admitted that they have made judgements about whether or not sexuality would be a relevant topic for some patients based on their age, gender, or partner status, but acknowledged that these are stereotypes and are often inaccurate. Like the patients, the providers struggled with the appropriateness of talking about sexual health when survival is the main priority.  

Social Factors

Multidisciplinary health care teams offer many benefits to patients because they allow them access to specialists in various areas of care. However, the authors of this study found that the existence of these teams raised questions of responsibility and professional boundaries when it came to sexual health. Some of the providers felt unsure about whose responsibility it was to address sexual health on a multidisciplinary team – a situation that often led to it not being addressed at all.

Organizational Factors

The patients, partners, and providers also felt that the organizational structure of many hospitals may hinder the management of sexual health care. For example, the couples who lacked a primary contact person in their hospital usually did not know where to direct their questions about sexual health. Furthermore, health care providers were not always aware of the possibility of making referrals to specialists in their organization, and they worried about overwhelming patients with too much information when they were seeing multiple clinicians and specialists.

Societal Factors

Finally, a few societal factors were mentioned in the focus groups as possible barriers to sexual health care. At least one health care provider brought up how health insurance may restrict care, depending on which health care services are not covered or only partially covered by insurance. Some of the patients and partners expressed embarrassment about purchasing products to enhance their sexual experiences, including sex toys and personal lubricants, which demonstrates a greater societal attitude of embarrassment around sexual health.

Conclusion

The authors identified numerous reasons why sexual health may be overlooked during cancer treatment. The information revealed by this study is important because it is necessary to identify barriers to care to find solutions to overcome them. Specifically, the authors of this study call for patient-tailored sexual health care supported by adequate training and referral networks for health care providers.

As for cancer patients and their partners, it is important to know that discussing sexual health concerns with health care professionals is perfectly acceptable and completely normal. With this in mind, patients should feel empowered to bring up sexual health issues with their providers during and/or after cancer treatment.

Resources:

• Traa, M.J., De Vries, J., Roukema, J.A., Rutten, H.J., & Den Oudsten, B.L. (2014). The sexual health care needs after colorectal cancer: the view of patients, partners, and health care professionals. Supportive Care in Cancer, 22(3), 763-772. DOI: https://doi.org/10.1007/s00520-013-2032-z