#PassItOn: Getting support from your healthcare team for your sexual wellbeing

Tracey Privett is Lead Colorectal Specialist Nurse at Oxford University Hospitals.

In this blog, Tracey talks about why it’s important to speak with your healthcare team about intimacy and sexual wellbeing if it matters to you.

Bowel cancer and sexual wellbeing 

Being diagnosed with bowel cancer can be an incredibly stressful time. While sex may not be the first thing on your mind in the initial stages of diagnosis and treatment, for many people intimacy and sexual wellbeing is an important consideration later on throughout their treatment and beyond. 

As healthcare professionals, we know every patient is an individual, with unique values and beliefs. Intimacy and sexual wellbeing may be very important to some and less so to others, and how it’s expressed is different for everyone too. We need to know what’s important to you, so we can personalise the information and support we give to you. 

Talking about bowel cancer treatment and sex is important 

With the different treatment options available, more people are living with and beyond bowel cancer. Often the treatments can be intense, which can mean some people have side effects that carry on for more than six months (long-term effects) or that start months or years after they’ve finished treatment (late effects). The side effects can be physical or psychological and either can have a significant impact on sexual wellbeing. 

It’s important to talk about sexual wellbeing early in your treatment pathway, as some treatments can affect sexual function, especially those that are aimed at the rectum (the lower part of the large bowel). Your healthcare team can then discuss the likely impact of treatment and can have a more informed conversation with you about treatment options. 

How bowel cancer treatment can affect your sex life 

Treatments for rectal cancers can cause damage to the pelvic nerves. This can lead to erectile dysfunction for men and vaginal dryness for women. If the cancer is very low in the rectum or anus, this area may need to be removed which would affect anal sex. 

There are other physical effects that can have an impact on sexual wellbeing after treatment. These can be side effects like your bowel or stoma function is unpredictable, you have delayed healing, a hernia, experience post-treatment fatigue, or have changes in sensation. 

Having cancer can affect your general wellbeing and mental health. Your thoughts and feelings about your body image and the changes in your body function can have a huge impact on how you feel about yourself and sex. 

Often talking to someone about how treatment has impacted you can be helpful. You could speak to someone close to you, ask for support from your stoma care nurse specialist or ask your GP or healthcare team to refer you to a sexual health specialist or psychosexual therapist. 

Having conversations about your sexual wellbeing

Many people find it embarrassing to talk about their sex lives. It can be helpful to go to appointments with notes on what’s important to you and any questions you’d like to ask. 

Some healthcare professionals are better than others at starting conversations about sexual wellbeing. Some find it easier to talk about it when there’s a direct link between treatment and physical sexual difficulties (for example, pelvic nerve damage in a male which may lead to erectile dysfunction), rather than intimacy and emotions. 

But we know that sexual wellbeing is important for all genders and those with or without a partner. Sexual pleasure and function for female and LGBTQ+ patients can be more complex, needing detailed conversations. Older patients or those with other medical conditions may also require more discussion because of medications and ageing. But everyone’s sexual wellbeing should be considered if it matters to them. 

Remember your healthcare team are used to answering questions and want to support you.  

Tracey’s #PassItOn tips from a healthcare professional 

• Consider a phone call or email to your named clinical nurse specialist (CNS) prior to appointments to discuss any concerns and complete a Holistic Needs Assessment (HNA). An HNA can involve answering some questions or having a discussion with someone in your healthcare team, then agreeing on a plan for your care and support needs. 

• Go to appointments prepared with some notes about what’s important to you, so that your healthcare professional can give you tailored information. For example, do you want to aim for a cure no matter the impact of the treatment, or would you want to consider a different treatment if there was less impact?

• Ask direct questions, like, “How will this affect my sexual function?” 

• If you attend an appointment with a friend or family member, consider asking them to step outside while you discuss personal matters if you feel uncomfortable raising some topics with them in the room. 

• If you have a partner, you should both try to openly discuss how you’re feeling. You can ask them to think of questions for your healthcare team too. 
• Please ask your healthcare team for advice and support if your wellbeing is affected by treatment
  
  

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