Let's Talk about Sex: Using Evidence to Promote Safe Sex Practices for Patients Following Hematopoietic Stem Cell Transplants

Abstract

Topic Significance & Study Purpose/Background/Rationale Hematopoietic stem cell transplant (HSCT) patients at Boston Children's Hospital (BCH) are taught sexual activity guidelines that were published in 2011. Current guidelines state that while patients are immunocompromised (generally 3 months for autologous transplants and 9-12 months for allogeneic transplants), no kissing, vaginal, or anal intercourse is permitted. Patients are only allowed to receive oral sex but not offer it to their partners. Anecdotally, nurses find the current recommendations outdated, confusing, and exclusive of all sexual practices, leading to discomfort providing this education. As a result, patients either receive no teaching at all or non-standardized teaching. Providing patients with up-to-date, evidence-based guidelines regarding safe sexual activities is necessary to prevent infection while optimizing quality of life. Methods, Intervention, & Analysis A review of the evidence was conducted using peer-reviewed articles, benchmarking clinical practice guidelines from other pediatric and adult institutions, and obtaining expert opinions. Findings & Interpretation There is insufficient evidence in the literature regarding infection risk related to sexual behavior for patients following HSCT. Until future research provides greater evidence on this subject, institutions will continue to rely on expert opinion to provide recommendations for safe sexual activity in the post-stem cell transplant population. Discussion & Implications For BCH's HSCT program, sexual activity guidelines have been revised to permit kissing, masturbation, oral sex, and intercourse with protection (excluding anal penetration) for all non-neutropenic patients with platelets counts > 20,000 cells/uL and no active cold sores. This education will be provided via a revised written education sheet translated into Spanish and Arabic for patients and families. The creation of revised teaching tools standardizes education and enhances nurses’ comfort discussing sensitive topics related to sexual activity. This work will benefit patients psychosocially as sexual health impacts quality of life.