How to talk to patients about sex
Barbara S. Levy, MD (September 2010)
Sex talk is ubiquitous in American culture—except in the doctor’s office.
So observed psychologist Sharon L. Bober, PhD, at the Cancer Survivorship and Sexual Health Symposium, held June 17–19, 2011, in Washington, DC. Dr. Bober is director of the Sexual Health Program in Pediatric Oncology at Dana-Farber Cancer Institute in Boston.
The survivorship symposium, sponsored by the International Society for Sexual Medicine and the Sexual Medicine Society of North America, offered background on the most common problems encountered by cancer survivors, as well as guidance on how to care for them in gynecology, primary care, oncology, and other fields. Sexual dysfunction, urinary incontinence, and fatigue figured prominently among those problems, yet few clinicians are asking about these conditions among cancer survivors—and even fewer are treating them, Dr. Bober said.
One in three women will be diagnosed with cancer in her lifetime, Dr. Bober noted, and the number of cancer survivors will double—from the current number of approximately 12 million—by the year 2016. The bulk of survivors seek care in the community after treatment, she added.
One reason sexual dysfunction is so widespread among cancer survivors: 64% of all cancer patients have a malignancy that directly affects sexual organs, said Stacy T. Lindau, MD, another speaker at the symposium. Dr. Lindau is associate professor of obstetrics and gynecology and of medicine and geriatrics at the University of Chicago.
According to a 2010 survey by the Lance Armstrong Foundation cited at the symposium, 43% of respondents reported problems with sexual function following treatment, with 29% of that group reporting “a lot” of functional impairment.1 Yet, only 13% of respondents who reported problems with sexual function received care. When respondents were asked why they did not receive care for their problem:
- 55% said they had learned to live with it
- 37% said they had been told it was a side effect of treatment
- 20% said they addressed the problem on their own
- 19% said they were told nothing could be done
- 14% said they expected to get care in the future.
“Discomfort around human sexuality is the main reason the issue doesn’t get raised by health-care providers,” Dr. Bober noted.
“If you’re going to wait for your doctor to bring up this topic, it’s like waiting for Godot.”
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