5/3/2016 SEXUALITY: KNOWLEDGE OPENS THE DOOR OBJECTIVES DEFINITIONS CONT. DEFINITIONS

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1 SEXUALITY: KNOWLEDGE OPENS THE DOOR TO COMMUNICATION JILL LIBBESMEIER BSN, RN, OCN OBJECTIVES Understand the differences between sexuality, intimacy, sexual health, and sexual dysfunction Identify how cancer effects sexuality in adolescents and adults Identify barriers of sexual health communication Review and implement use of an assessment model to encourage open communication with patients Apply learning to case studies DEFINITIONS DEFINITIONS CONT. Sexuality WHO defines sexuality as a central aspect of being human throughout life encompasses sex, gender identities and roles, sexual orientation, eroticism, pleasure, intimacy, and reproduction. Sexuality is experienced and expressed in thoughts, fantasies, desires, beliefs, attitudes, values, behaviors, practices, roles, and relationships. (as cited in Lubkin & Larsen, 2016, p.248) While sexuality can include all of these dimensions, not all of them are always experienced or expressed. Sexuality is influenced by the interaction of biological, psychological, social, economic, political, cultural, legal, historical, religious and spiritual factors (as cited in Lubkin & Larsen, 2016, p.248) Intimacy Relationship driven; a feeling of belonging; touch demonstrated in a variety of ways; verbal and nonverbal communication; affection (Lubkin & Larsen, 2016, p.248) Sexual Health A state of physical, emotional, mental, and social well-being related to sexuality (Boltz, Capezuti, Fulmer, Zwicker, & O Meara, 2012). Sexual Dysfunction Impairment in normal sexual functioning (Boltz et al., 2012). 1

2 OVERVIEW SEXUAL HEALTH AND CANCER: AN INTRODUCTION Sexual patterns persist throughout lifespan Nursing is the ideal profession to assess age changes, medical conditions, medications and intervene EFFECTS OF CANCER ON SEXUALITY OF ADOLESCENTS EFFECTS OF CANCER ON SEXUALITY OF ADOLESCENTS CONT. Ages years Affects four major tasks of adolescence Separate from family and achieve independence Identify and pursue a vocational goal Achieve a mature level of sexuality Achieve a realistic and positive self-image Short Term Effects Alopecia Nausea/vomiting Skin changes Pain Weight gain or loss Absence from school/social activities Assistance with ADLs Assistance with treatments and attending appointments 2

3 EFFECTS OF CANCER ON SEXUALITY OF ADOLESCENTS CONT. EFFECTS OF CANCER ON SEXUALITY OF YOUNG ADULTS Long Term Effects Alterations to fertility and sexual function Fertility Sperm banking Ovarian shielding Embryo preservation Cryopreservation Ages Discussion of cancer with mate Fear of recurrence Fertility EFFECTS OF CANCER ON SEXUALITY OF MIDDLE AGED ADULTS EFFECTS OF CANCER ON SEXUALITY OF OLDER ADULTS Ages Physiologic aging Ages 66 and older Physiologic changes Coping mechanism Comorbid diseases Increased cancer incidence 3

4 CANCER SPECIFIC EFFECTS BREAST CANCER Breast Prostate Gynecologic Testicular Colorectal Hematologic Head/neck Bladder Lack of libido, decreased arousal, difficult or painful intercourse, fatigue Breasts are considered sexual organs, daily radiation or exposure of breasts may decrease the sense of privacy Prepare women pre treatment Radiation effects Surgical effects (lumpectomy, mastectomy) PROSTATE CANCER GYNECOLOGIC CANCER Urinary incontinence Erectile difficulties Share information Media portrays pill as easy fix Sexual activity will not stimulate the cancer or spread it to partner Loss of sensation, sensitivity, and sexual desire Shortening and stenosis of the vagina Vaginal atrophy Fatigue Loss of reproductive organs can impact how women view themselves Sensitive assessment of attitudes beliefs and need for information Provide specific suggestions on coping with fatigue, vaginal dryness, vaginal atrophy, etc Or refer to specialist 4

5 TESTICULAR CANCER COLORECTAL CANCER /body image Feeling less of a man Feeling sexually unattractive Lack of libido Provide facts (too much or too little sex or masturbation ti did not cause the cancer) Educate that sexual problems and distress tend to decline in the six months following treatment Type of surgery can change severity of symptoms, however up to complete erectile dysfunction related to scarring about the nerves can occur in men and diminished orgasm in women Ostomy pouch Prepare patients prior to surgery and stoma creation Encourage couples to discuss concerns and provide referral to counseling if needed HEMATOLOGIC CANCER Loss of fertility Nausea/vomiting Fatigue Mucositis Vaginal atrophy/dry ejaculation Educate patients about sexual side effects, including fertility Discuss impact of fatigue, depression, anxiety on sexuality Plan sexual activity when safe (not having intercourse during times of neutropenia or thrombocytopenia) and well rested CANCER OF HEAD AND NECK Pain Mucositis Dry mouth Altered taste Drooling Limitations on how lips, tongue, and jaw move Disfigurement Inability to wear makeup during active radiation Explore concerns in regards to disfigurement Encourage couples to discuss concerns, refer if needed 5

6 BLADDER CANCER EFFECTS OF CANCER ON SEXUALITY OF THE TERMINALLY ILL Profound erectile dysfunction related to surgery Dry orgasm Reduced sensation, orgasm, libido, and painful intercourse for women Stoma Prepare men and women prior to surgery Be sure to follow up post surgery as well to ensure patients and partners have information they need Health care provider assumptions Lack of privacy BARRIERS TO SEXUAL HEALTH COMMUNICATION SO WHY IS IT SO DIFFICULT? Nurse Embarrassed Do not believe sexuality is part of the presenting problem Feel they lack education and do not know interventions for identified problems Feel that asking is an invasion of privacy Feel gender is an issue Do not think patients expect them to ask Believe it is someone else s responsibility Personal history, values, attitudes Comfort level Language Childhood Common/street Medical Embarrassing Fear 6

7 HAVE AN ELEVATOR SPEECH ASSESSMENT MODELS Sexuality means different things to every individual but what we do know is that sexual difficulties are common amongst men and women. Because it is important part of well-being, I talk about sexual health with all my patients. Is there anything about sexuality or intimacy that might be helpful for us to talk about? BETTER PLISSIT (Steffens, 2015) BETTER MODEL PLISSIT MODEL Bring up the topic Explain that you are concerned with the quality-of-life issues, including sexuality. Tell patients that you will find appropriate resources to address their concerns Timing might not seem appropriate, but acknowledge that patients can ask for information at any time Educate patients about the side effects of treatment Record your assessment and intervention in patient medical records Southard & Keller, 2009 PLISSIT Permission Limited Information Specific Suggestion Intensive Therapy Mick,

8 PLISSIT MODEL EXAMPLES OF LIMITED INFORMATION (Newell & Clarke, n.d.) (Shell, 2008) CHECK IN WITH YOURSELF Do patients discuss their sexual concerns with me? Do I ignore or inhibit discussions of sexuality with patients? Do I give non-verbal messages that discourage patients from talking about sexual issues? Do I ask proactively about sexual issues? If a patient has previously said they have no sexual issues, do I check whether anything has changed? Do I ask all patients questions about sexuality regardless of age, culture, relationship status, sexual orientation, disability or level of illness? Do I make assumptions about the types of sexual activity patients engage g in? Do I make assumptions about how often patients want to engage in sexual activity? Am I aware of my own sexual, beliefs and attitudes? Am I comfortable talking about sexual choices different to my own? Do I leave out certain practices when asking patients about their sexual activities? Can I tolerate somewhat uncomfortable conversations? Can I use all sexual terms without embarrassment? Do I refer patients to specialized services for sexual problems? YOUR TOOLKIT Definitions to help define terms related to sexuality Knowledge of developmental stages at different ages in life and how sexuality may be impacted Self awareness of barriers to communication Elevator speech BETTER and PLISSIT models to help guide discussion Self checklist to ensure you are overcoming barriers (Steffens, 2015) 8

9 CASE STUDIES SUMMARY Sexuality, intimacy, sexual health, and sexual dysfunction all have their own definitions but have potential to overlap Throughout the stages of life, sexuality needs change and yet are much the same There are many barriers leading to the lack of sexuality conversations Assessment models exist to help guide nurses through conversations in regards to sexuality Patients expect nurses to ask them about sexuality, do not let them down REFERENCES Boltz, M., Capezuti, E., Fulmer, T. Zwicker, D. O Meara, A. (2012). Evidence-based geriatric nursing protocols for best practice (4th ed). New York, NY: Springer Publishing Co. Lubkin, I.M., & Larsen, P.D. (2016). Chronic illness: Impact and interventions (9th ed). Boston: Jones and Bartlett. Katz, A. (2007). Breaking the silence on cancer and sexuality: A handbook for healthcare providers. Pittsburgh, PA: Oncology Nursing Society. Mick, J. (2007). Sexuality assessment: 10 strategies for improvement. Clinical Journal of Oncology Nursing, 11(5), doi: /07.cjon Newell, R., & Clarke, A. (n.d.). Assisting adjustment following disfigurement: interventions for healthcare professionals [PDF document]. Retrieved from data/assets/pdf_file/0008/382805/2011_rcn_research_fringe_assisting_adjustment_following_disfigu rement.pdf Shell, J. A. (2008). Sexuality and body image concerns after treatment for breast cancer. Cancer Network. Southard, N. Z., & Keller, J. (2009). The importance of assessing sexuality: A patient perspective. Clinical Journal of Oncology Nursing, 13(2), doi: /09.cjon Steffens, J. (2015). Talking about sex an art. Powerpoint presentation, St. Cloud, Minnesota. 9