Sexuality, Fertility and Menopausal symptoms.

Altered body image is common in patients with cancer and has an effect on patients’
perceptions and expression of sexuality. In addition the disease, surgery and side-
effects of cytotoxic chemotherapy can effect fertility and induce menopause.

Find two patient information resources related to these topics. Although there are some
good information obtainable from numerous cancer related sites it is suggested you use
British resources. (Try an advanced search on goggle under the words, sexuality and
chemotherapy you will be amazed what is available.)

1. Compare and contrast the two pieces you have selected.

2. Critical evaluate the information contained in them.

Points to consider:

Sexuality
1. What do you understand about body image and sexuality?

2. Are you comfortable discussing this topic with your patients?

3. Does your comfort level depend on the following?

a. Age of patient
b. Gender of patient
c. Sexuality of patient

4. If not comfortable discussing this issue with your patients, reflect on why this is
the case. As holistic care does require you to address all aspects of patient care
consider what strategies are there to ensure this important aspect of care is
addressed and your patient is not let down?

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 5. What advise would you give your patients about having sexual intercourse while
receiving cytotoxic chemotherapy treatments?
Consider the following:

a. Whether they can maintain their intimate relationship?

b. What they should do about preventing conception?

c. Why should they, and how do they protect partners from exposure to
cytotoxic agents?

Menopausal symptoms

1. Which group of women are more likely to experience menopausal

systems?

2. Why does this happen?

3. What advise can you give you patients relating to?

a. What the actual symptoms may be?

b. How they might deal with them?

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Fertility
1. Consider the cytotoxic regimens you more commonly use and establish the risks
of permanent infertility for men and women.

2. What advise can you give your patients in relation to this? Include consideration
of:

a. What resources are available to your patients in regard to storage of

sperm, ova, and embryo?

b. Which patients are more likely to be able to take up the options of embryo
storage and what issues would need to be considered?

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Resources and readings
Dean A. (2008) Supporting women experiencing sexual problems after treatment for
breast cancer. Cancer Nursing Practice; 7(8): 29-34

Handscombe, K. (2005) The menopause and hormone replacement therapy. In:

Brighton, M., Wood, M., Johnston, S.R.D., Ford, H. & Ross, P.J. ed. The Royal Marsden
Hospital Handbook of Cancer Chemotherapy. Edinburgh: Elsevier: 237-239

Hordern, A. (2000) Intimacy and Sexuality for the Woman With Breast Cancer. Cancer
Nursing. 23(3):230-236.

Hughes, M.K. (2000) Sexuality and the Cancer Survivor. A silent coexistence. Cancer
Nursing. 23 (6): 477-482

Power, S. & Cordon, C. (2008) Chemotherapy-induced alopecia: a phenomenological

study. Cancer Nursing Practice; 7(7): 44-47

Rogers, M. & Kristjanson, L.J. (2002) The impact on Sexual Functioning of

Chemotherapy-induced Menopause in Women with Breast Cancer. Cancer Nursing 25
(1), 57-65

Stephens, M. (2005) Loss of Fertility. In: Brighton, M., Wood, M., Johnston, S.R.D.,
Ford, H. & Ross, P.J. ed. The Royal Marsden Hospital Handbook of Cancer
Chemotherapy. Edinburgh: Elsevier: 233-236

Website of the National Cancer Institute is a good internet resource and has evidence
based articles on various aspects of fertility, sexuality and sexual function which are
worth a read:
http://cancerweb.ncl.ac.uk

Website of The Cancer Council New South Wales (Australia)

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www.cancercouncil.com.au/editorial.asp?pageid=116
This is a presentation of the results of a survey of whether nurses in cancer care discuss
fertility and sexuality with patients.

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