Q & A - Communication with a healthcare provider
These questions were suggested by people in Ireland who have been impacted by cancer. The answers were collected from experts based in Ireland.
“How can I raise the issue of wanting sex without being dismissed?”
Emily Power-Smith Sexologist & Educator
“This can be tricky. Most oncology professionals are lacking in any meaningful training around how to talk to patients about sex. It’s starting to change, but we have a long way to go. Frame the conversation by asking if they are okay for you to discuss sex in an open way, because this is an important subject for you. Ask them for a clear response so you know where you stand before opening up. Usually dismissal is a defensive behavior from a person who is not comfortable with the topic. You have a right to speak to someone who is willing and able so if the professional in front of you can’t provide that, you have a right to speak to someone who will not dismiss you. You may need to hold your ground and insist which isn’t easy. Bringing someone with you to your appointment can be a support.”
Mary Rogan Retired General Practitioner & Psychosexual Therapist
“All too often sexual dysfunction as a result of cancer or cancer treatment is the elephant in the room. If it's in the context of a healthcare visit my experience is that both the healthcare professional and the patient or relative are reluctant to open the topic. Don't be afraid to ask a gate opening question like ‘can I ask about intimacy?’ or ‘I have some problems around intimacy, can you help me/us?’. Once the question is answered, the healthcare professional should either be able to give you advice or refer you to someone who can - this could be an oncology nurse or radiology specialist nurse or a psychosexual therapist. If the doctor can't answer the question they won't mind if you ask to be referred to someone who can.”
“What questions should I ask my Oncologist?”
Yvonne O’ Meara Psychosocial Oncologist & Systemic Psychotherapist
How will my fertility be affected?
What is being done to protect my reproductive system?
How will my sex life be impacted?
Is it safe for me to have sexual intercourse during treatment?
Do you address or who in your team can talk me through how my sex life/drive will be impacted as a result of the treatment?
“My surgeon focuses on the infertility fallout as a result of my treatment and whether I will be able to have children or not. I am more concerned about my sex drive and sexual function and how they will be post operatively. Having kids is not even important to me. If they can talk to me about something as personal as having kids, why can’t they address that my sexual desire levels might be important to me?”
Yvonne O’ Meara Psychosocial Oncologist & Systemic Psychotherapist
“Each patient is different and it can be challenging for your surgery/oncologist to interpret the individual needs of every patient and get the timing right of the delivery of that information. If you feel comfortable, tell them the main issues that are important to you. If they cannot address your questions, they will advise you of a member of the allied health team that will be able to.Having children may not be important for you now, but from experience, your surgeon knows that it maybe an issues in the future and has to prioritize this conversation now as there are often fertility sparing interventions that take precedent due to time constraints.”
Mary Rogan Retired General Practitioner & Psychosexual Therapist
“For many of us speaking about sex is difficult . It might not have been discussed when we were children growing up and discussion of or instances of the the topic being mentioned was often accompanied by feelings of shame and embarrassment. We unfortunately tend to internalize these feelings and are embarrassed to mention or discuss sex when we are an adult . Again, sex is often the elephant in the room and as I have said in a previous question, you need to ask the question to open the door for them to either advise and help you r refer you to someone who is able to discuss the subject with comfort and give you any advice you need?”
Emily Power-Smith Sexologist & Educator
“Often this is because the professional is uncomfortable to talk about sex. Having kids is a sanitised topic that can be discussed (weirdly) without talking about sex. Once you’re into sexual libido, functioning and pleasure, many HCPs clam up as they feel out of their depth or just too uncomfortable themselves.”
“I’m considering treatment options for prostate cancer but my consultant hasn’t mentioned sexual side-effects. Should I ask? I’m uncomfortable bringing it up but I’m worried about it.”
Emily Power-Smith Sexologist & Educator
“Definitely bring it up. Bring an ally if you think it might help to get a bit of back up. This is so common and it just isn’t good enough. You have every right to discuss this in detail and to learn what they will offer you in the way of rehabilitation for your sexual functioning. If they talk about sorting out any incontinence before addressing sexual functioning, ask them what they base this approach on. Because usually this approach would be considered outdated now.”
Mary Rogan Retired General Practitioner & Psychosexual Therapist
“Most urologists would mention sexual side effects of treatment. They are not all comfortable with the topic, but are only too well aware of the side effects . Urology specialist nurses have a wealth of information about side effects, including sexuality - don't be afraid to ask. Bottom line is you shouldn't have to ask, but sometimes it's the only way you can open the conversation.”
“Nobody talked to me about life after cancer or about my sex life. It was just all focused on survival. Who should I talk to if my GP and consultant won’t discuss my options for improving sexual pleasure and function?”
Emily Power-Smith Sexologist & Educator
“You can find some psychosexual therapists are well equipped to help with this area of your life and may even help you to have conversations with your HCP if needed. You absolutely deserve support in this area and it should be provided pre treatment to anyone who wants it. There is so much you can do to help, once you have the right supports.”
Yvonne O’ Meara Psychosocial Oncologist & Systemic Psychotherapist
“I am sorry this is your experience. You will be pleased to hear that there are many disciplines within an acute and community setting that would happily talk to you about life after cancer and your sex life. I suggest starting with your oncology team and ask to speak to one of the following disciplines: Medical Social Worker, Oncology Nurse Specialist, Psycho-Oncologist.”
Mary Rogan Retired General Practitioner & Psychosexual Therapist
“Oncology or radiology specialist nurses have done extra training in this area and will be able to help you. They also have a referred pathway to psychosexual therapist or andrologists in the case of male cancer.”
“My healthcare providers use the idea that “everyone is different” as an excuse to not discuss Menopause. Why won’t they talk about it?”
Emily Power-Smith Sexologist & Educator
“In this day and age, there is no excuse for that response. If that is the best they can do, it’s time to find another professional who has training in menopause. There is no need to accept this approach any more. Focus on finding someone who can talk about it, rather than trying to understand the reasons for them not. It’s just really poor service.”