Sexual dysfunction in the gynecologic oncology patient

Abstract

W rlTH THE MANY advances in medicine, cancer is becoming much more of a chronic rather than a terminal disease.l2 Qualityof-life issues have therefore taken a more prominent position in current practice and scientific inquiry. 3 More and more, a comprehensive approach includes the patient, her family, and/or her sexual partner. 4'5 Patient management plans now include issues of body image and self-esteem, sexuality, fertility, and potential sexual dysfunction. 6-I° Cancer patients can experience a sense of guilt, dirtiness, or punishment that may be magnified if the cancer is directly related to a sex organ. 111z Women with gynecologic malignancy usually harbor fears regarding changes in body image, sexual function, and fertility. Both genital structure and function can be affected by gynecologic cancer.13 Body image and self-esteem can be greatly affected by the diagnosis and treatment of a gynecologic malignancy. 14-17 Sexuality, the process of giving and receiving sexual pleasure, is closely linked to body image and self-esteem. 18 Cancer patients often fear rejection, isolation, and unacceptability more than they do disease recurrence, pain, and death. TM Cancer care should include identification and rehabilitation of the patient's impoverished self-esteem, body image, and sexual dysfunction. 17,19 Sexual function and dysfunction, in addition to being indirectly affected by an altered body image and self-esteem, can be directly affected by the disease process, surgery, radiation, and chemotherapy. Gynecologic malignancies inherently affect body parts that are involved in sexual acts. Many patients define the optimal sexual act as conventional intercourse resulting in mutual orgasm. Alternatives to this may be unacceptable or unknown to many patients. Exploring the patient's and partnet ' s knowledge and acceptance of alternate methods of sexual expression and satisfaction is necessary. A thorough understanding of the patient's projected optimal function during and upon the completion of therapy is necessary to achieve this counseling. Counseling should include sexual information and support to optimize posttreatment adjustment. The goal of such counseling should be to help patients re-establish the highest quality of life possible after treatment for gynecologic malignancy. 19 Harris, et al z° found that women newly diagnosed with gynecologic cancer reported a significant decrease in sexual activity and satisfaction. This behavior was due, in part, to misconceptions regarding the etiology of the malignancy. Many felt this disease was a punishment for previous sexual behaviors such as masturbation, abortion, extramarital affairs, venereal disease, or homosexuality. Anxiety over pain, resumed bleeding, recurrence, or physical damage was also felt to be a factor. Mishel, et a121 reported that the psychosocial adjustment of patients newly diagnosed with gynecologic cancer was greatly enhanced when they possessed a clear understanding of their situation. With this knowledge, patients are able to successfully activate their coping resources. The patient's sexual partner can often harbor misconceptions about the etiology and treatment of the disease. Some partners fear that the disease may be contagious, while others may worry that the treatment may affect them. For instance, some partners have voiced concerns regarding radiation therapy rendering the patient radioactive. It is necessary to help the partner share any worries he may have regarding the disease and/or treatment, and rectify any misconceptions. Since the physiologic structure and function are often affected by gynecologic cancer and the attendant treatment, it is essential to assess the patient's sexual functioning prior to the onset of illness. The proposed treatment may improve or diminish sexual functioning? z Wood and Tombrink 23 designed a program to meet the sexual concerns of cancer patients. They identified four objectives for this program: 1. To provide an understanding of self and body and its relationship to sexuality and sexual function after diagnosis.