In oncology, many studies have emphazised on the importance of sexological support beyond the psychological one.
In Belgium, psychological care in cancer centers is well established, becoming almost systematic with the Cancer Plan and the budgets dedicated to cancer psychologists. However, the management of sexual health remains unrecognized, unconsciously or even deliberately ignored by health professionals. The sexual problems linked to both cancer diagnosis and treatments remain underestimated by health care providers and patients do not usually talk about that aspect of the disease.
It is imperative to lift the veil on onco-sexology which responds to a fundamental need and a right of cancer patients throughout their care path, from their diagnosis, towards recovery but also sometimes towards the end of life.
Sexuality, an integral part of the quality of life
For thirty years, beating cancer has been the major goal after the diagnosis of a malignant tumor.
Today, medical and surgical advances have significantly contributed to reducing cancer-related mortality. Cancers heal better and progress to the status of chronic disease, allowing people to live older.
Nevertheless, beside survival the current demand of patients includes quality of life. This latter objective is nowadays pursued by healthcare teams and become one of the priorities in oncology care. Society now recognizes sexual health as a right and an important aspect of well-being in cancer patients who may or may not agree to include care related to their sexuality in their health journey.
“Sexual health is a state of physical, emotional, mental and social well-being associated with sexuality. It is not just about the absence of a disease, dysfunction or infirmity”.
Overall, oncological treatments lead to real impairment of sexuality for two-thirds of cancer patients. One of our research projects proved that cancer had a strong negative effect on sexual health and intimacy. Thus, 44% of cancer patients describe a deterioration in their partner relationship and up to 80% showed a decrease in their sexual life. For patients with breast, urological, gynecological or digestive oncological pathologies, surgical and / or medical treatments inevitably have consequences on their sexual functionalities and repercussions on the couple’s intimacy. According to recent studies, patients want to be informed and talk about their sexual issues. Among them, 30% will ask for simple solutions, and another 30% will ask for specialized supports.
Onco-sexology is a recent field that hinges on sexology and oncology. Its objective is to assess and manage the sexual disorders of oncological patients, in order to maintain and / or improve their sexual health intimacy in the cancer patients. Thus, onco-sexology responds to an epidemiological reality and to strong individual and couple demand. It merges ethical, clinical and humanistic medicine to offer quality care. It aims to integrate oncological, sexological and quality of life objectives to advance the overall well-being of patients and couples.
Since October 2018, the University Hospital of Liège has opened a multidisciplinary outpatient onco-sexology clinic where three onco-sexologists work with medical and paramedical teams to offer personalized counseling when sexual health issues can significantly affect cancer patients’ physical and mental wellbeing. A great step forward for patients!
Several actions have been implemented to reach this objective.
→ establish personalized onco-sexuality care for each patient in the same way as other care;
→ integrate this care throughout the four phases of the patient care path: the cancer announcement phase (diagnosis), the treatment phase, the monitoring phase and the discharge phase;
→ prevent and / or manage sexual dysfunctions induced by the disease and the treatments;
→ propose an onco-sexological solution specific to the patient and his/her sexual partner.
These different actions require scheduling several appointments where enough time is given to the patient to present his/her problem and to the onco-sexologist to assess and address the problem in several ways. In our hospital, 6 free-of-charge appointments will inform the patient about solutions to maintain a sexual potency after illness.
The multidisciplinary team will address the following points and others at the request of the patient and their couple
- Sexual dysfunction: sexual interest / arousal, weak desire, orgasmic experiences, erectile dysfunction, pain during intercourse.
- – Psychosexual issues: changes in body image and reduction of the identity of oneself as a sexual being. Fear and anxiety about sexual activity
- Social sexual issues: challenges in couple communication and fear of not meeting the partner’s expectations.
Ensuring a fulfilling sex life for the patient and his/her partner is at the center of our concerns. A follow-up of the patient onco-sexological evolution should be continued by a trained healthcare team.
Given the increased survival of cancer patients, all healthcare providers should offer their patients a comprehensive treatment to better cope with the impact of cancer on their intimacy and health sexual life.