Sexual health during and after ovarian cancer treatment
Dr Susan Carr – Royal Women’s Hospital, Parkville, Australia
Dr Carr, great to have you with us here in Vancouver all the way from Australia. You’re addressing a very important topic. It was within a session on palliative care.
Yes, that’s right.
What you’ve been focussing on is sex, important to all of us but particularly relevant to cancer patients and apparently not much talked about. What are the big things that came out of your talk in particular?
The main issues are that the good evidence shows that probably about 50% of women with gynaecological cancer at some stage will have a sexual issue; it might come and go, it might not. There’s a little bit of evidence now, hardly any research, showing that even up to the end of life at the palliative care stage some women do have sexual issues that are important to them. So that’s important.
Yes, if we get down to practicalities, sexual issues could be that they’re so concerned about their illness they don’t really want to concern themselves about sex. It could also be to do with their partner, their partner changing their attitude to the woman. What is going on and typically what does happen?
The assumption is that the woman is too ill to think about sex but we don’t know that, that’s an assumption. There’s some very interesting work that has been done in Holland and very sensitive work to show that there are some couples for whom sex, right up to the end of life, is very important. And sex does not mean sexual acts in any ordinary way, it’s just what is sexual to that couple is important to the end of life. But they can’t talk about it; the clinical staff won’t talk about it because they feel it’s a taboo area and in the few couples where they have had a chance to have discussion it has really helped them
So everybody is concerned about sex but nobody wants to be up front and talk about it, least of all, perhaps, the clinicians.
Everybody might not be concerned but it is possible that women who are dying of cancer, of gynaecological cancer, are interested sex, in sexual activity of some sort, in closeness with their partner because we’re talking about sex in the widest sense. And nobody will facilitate it, nobody will help them, because they are too uncomfortable talking about it. Part of most of what I said today was a) to highlight the issue that it exists; that limited evidence shows if you talk about it it can help the patient and a lot of evidence shows that although clinical staff feel that the patient might have sexual issues they won’t discuss it. So there’s complete lack of communication.
What is needed, then, is a way to get through that communications barrier.
What sorts of practicalities do you suggest?
The practical issues, the main thing is just to ask. If you don’t ask, you don’t know. Just ask if there is a sexual issue, if the patient wants to talk about sex or if there’s anything they would like that would help them. That’s all, it’s simple.
You need to ask in a kind of loving way, though, because if you ask in a cold, clinical, medical way they’ll run a mile, won’t they?
Absolutely right. The whole point of this session in palliative care was empathy, was about looking at the person in the middle of all of the medical clutter, taking the person out of the illness, thinking this is a person, this person may be at the end of life, what can I do to help them? And sometimes talking about sex or even giving them privacy to have contact with their partner is all that’s needed.
Yes, they might want to hold hands but in a ward full of people it’s more difficult.
Yes, that’s right. Or the very concerned family and friends, it’s something you don’t want… your children could be there, your grandchildren could be there. So it’s an awareness of the issue and an ability to communicate it. But for clinicians it has to be taught. You can have the empathy but still not know how to do it, how to communicate properly, but you can teach that.
So you can teach it, what are the simple lessons if you were to spell it out for clinicians?
The simple lessons are that sexuality is basically an inherent human right; that clinicians have a duty of care to their patient to deal with sexual issues or to allow the patient to deal with it, and it has to be in mandatory clinical training guidelines, it should not just be an option. Because in most cases clinicians opt out.
And I think you’re particularly concerned in the palliative situation, aren’t you?
That’s an extremely sensitive area and it’s an area that’s one of the last taboos in palliative care. We’re only beginning to talk about it but at least now it has come up. It was an issue in this conference, which is good, and everybody needs to be aware it’s an issue.
So what’s your take home message for clinicians? A difficult area, of course, but important.
Take home message for clinicians, depending, don’t be frightened of your patient, just speak to them, just ask. If it’s not for them, if they’re not interested they’ll just say, “No thank you,” and that’s the end.
And treat sex as an absolutely normal thing to talk about, like watering flowers even.
It should be as normal as saying, “Do you have pain? Do you have discomfort? Do you have problems breathing? Do you have any problems with sex?”
So you need to reassure doctors and nurses not to be embarrassed about these things. I think that’s the difficult area, isn’t it?
It’s very hard because there are also tremendous cultural differences, the age barriers, all sorts of barriers. But if it is properly taught then it can be dealt with sensitively.
Susan, thank you very much for joining us. It’s great to have you on ecancer.tv.