It’s always the last thing that comes up in the consultation. You’re sort of winding up and your patient says “I’ve just got one more, um, question”……followed by a pregnant pause. “Well it’s been 3 months since the operation and I haven’t been able to get an erection”. This is basically how recent conversations with some of my rectal cancer patients has started. Unfortunately for many of these patients – after cancer, chemoradiation and then pelvic surgery there might never be a recovery and pharmaceutical aids like Viagra may not help. Some get a slow recovery over time as their pelvic nerves recover. The problem affects both young an old.
The reasons for sexual dysfunction are many and varied and range from physical incapacity to altered body image. In my peritonectomy patients has shown that men can experience erectile dysfunction and women can experience pain, difficulty lubricating an achieving orgasm. Many patients are concerned about sex when they have a stoma bag and women are often concerned about urinary leakage. In some cases patients have heard myths about it being unsafe to have sex after cancer or their health carers have given them overly cautious instructions about intercourse whilst on chemotherapy.
My communication skills training never covered this scenario. It’s even worse when the discussion is not just about the ability to perform sexual intercourse but also the issue of fertility. For younger people we do often discuss implications for fertility and might recommend sperm banking in men or various fertility treatments for women but more often than not sexual ‘side-effects’ are an afterthought. We aren’t actually taught much about how to treat these side effects nor are we instructed how to deal with the issues between couples. I’m sure part of the problem is society as a whole isn’t great at talking about these things so doctors are behind the eight ball to start with.
Talking to patients about sex is something we have to learn after medical school and the best way to do it is just try and relax and be frank about the issues.
For more on this topic see the NY Times blog post by Suleika Jaouad Life, Interrupted: Crazy, Unsexy Cancer Tips