Dear nursing colleagues,
I’m writing to you about a topic often avoided in cancer care – SEX
I love talking about sex! And it’s something I do a lot in my role as Sexual Health Nurse Consultant. I talk with patients experiencing sexual changes from illness or injury, and with health care providers about how they can (and why they should!) include these conversations in clinical practice.
Having worked in this space for almost a decade now I’d like to share some key things I’ve learnt with you:
Sex is an important part of life
Sexuality is a fundamental part of being human, deeply personal and diverse. Our sexual wellbeing is inseparable from our overall sense of self. Consensual sexual activity can offer some of the best rewards, from pleasure and relaxation to pain relief and strengthening of emotional connections. For individuals diagnosed with lung cancer, expressions of love and closeness can provide immense comfort during a challenging time. But conversely, concerns or changes in intimacy can negatively impact personal wellbeing and relationships.
Myths, misconceptions & assumptions
We need to dispel the myth that there is an age-limit on sexuality. In reality, we are all sexual beings but how we express ourselves sexually changes across our lifespan. Our sexuality is also impacted by significant events such as cancer and medical treatments. Unfortunately, assumptions are often made based on a person’s age, disability, illness or relationship status. These assumptions can be very harmful, especially in health care.
A more expansive view of ‘sex’
Sex is so much more than just ‘intercourse’. A broader view of sex through the lens of pleasure and physical connection, allows people to stay connected with partners though challenging times of illness. I often liken sex to a grand buffet of experiences, rather than a single item on the menu! It’s essential to understand that sex should never be viewed as a ‘should’ or ‘have to’. It’s meant to be fun, playful, enjoyable and often quite silly!
(Nearly) Everyone finds it hard to talk about sex – we don’t ask and they don’t tell
If you’re thinking ‘gosh I’d feel so embarrassed to bring this topic up with a patient’ rest assured, you’re not alone! Although nurses may agree that sexual wellbeing is an important part of healthcare, most of us feel very awkward about our role in this. We all hope that someone else will broach these conversations, but I can tell you that in in many cases this doesn’t happen.
On the other side, patients have their own apprehensions about raising questions regarding sex and intimacy. Even though the changes they are experiencing might be a result of their cancer treatment, they’re often unsure if it’s an appropriate topic to discuss. It’s our responsibility to create an environment where patients feel comfortable to share their concerns.
We can normalise these conversations and provide opportunities
We can normalise conversation about sex and intimacy by including questions within routine assessments. If possible this is best undertaken in a private space, with time available for discussion.
Starting with phrases like ‘Many people in your situation…’ or ‘Often patients’ ask me about…’ tells patient’s that they are not alone in their concerns. This approach helps reduce stigma and creates a supportive atmosphere where patients will feel more comfortable to share thoughts and concerns
“Many people with lung cancer find that it impacts their sexual wellbeing and intimate relationships – do you have any concerns that you’d like to discuss?”
Don’t be dissuaded if the patient chooses not to answer. You’ve done a great job by letting them know that this is a valid topic. Encourage them to talk to a member of their health care team if any concerns arise.
Nurses are perfectly positioned to have these conversations
I really believe that nurses already have many of the skills necessary to navigate these sensitive conversations. We’re used to talking about potentially embarrassing topics.
Remember when you first started in the profession and had to ask people about the consistency of their stool, or talk about inserting a suppository? But now you probably don’t think twice about this. It’s the same with sex and intimacy – it feels hard at first but the more you practice, the more comfortable you will start to feel.
Nurses are also the professionals that patients often feel most comfortable with. As oncology nurses you understand the impact that a diagnosis of lung cancer can have. You have seen the emotional and physical impacts of treatment on patients and are comfortable providing support in these areas.
You don’t have to have all the answers!
I often hear health care providers say that one of the main reasons they don’t bring up the topic of sex and intimacy is that they’re worried about not having all the answers.
It’s hard to sit in a space where we can’t ‘fix’ what’s going on for someone. But it’s reassuring to see the support you can provide by creating a space for people to talk about their concerns. There’s a sense of relief that can come from saying something out loud. And if your response is validating and supportive, they will be much more likely to talk to someone again in the future.
‘Thank you for sharing that with me – these are really valid concerns and I’d like to help you get support. I’m not a specialist in this area but I can talk with my team. There’s also some great resources that you might find helpful’
If the issue is something they haven’t discussed with their partner/s – you can encourage open communication and help them workshop ways to speak about the topic. You can also talk with the broader health care team about what support or referrals can be provided.
Building your own knowledge will help!
Seek out relevant resources, attend webinars, and read books – the more you learn the more at ease you will be with these conversations. And you can recommend these resources to patients as well. A great starting point is the Cancer Council booklet Sexuality, Intimacy and Cancer
Remember something as small as a single question or brief conversation can make a world of difference to your patients and their partners.
Let’s continue to break down the barrier surrounding discussions of sexuality and intimacy in lung cancer care. Share this letter with your colleagues and if you have any questions or want to talk more about this topic please reach out.
Sexual Health Nurse Consultant