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24 October 2002
Doctors Too Embarrassed To Discuss Sex
by George Atkinson

Concerns over body image, altered moods, pain, and hormonal changes brought on by cancer and its treatment can dramatically affect sexual well-being, said a UK psychologist last week. Yet doctors, nurses, and patients are often too embarrassed to discuss sexual problems.

Professor Lesley Fallowfield, from the University of Sussex in Brighton, United Kingdom, told delegates at the European Society for Medical Oncology in Nice, France, that many aspects related to the physical, social, and emotional life of patients are not identified because of poor communication skills. Discussions about the impact of treatment often neglect a patient's sexual activity. For instance, treatment for prostate cancer may also affect erectile function. Women with ovarian cancer worry whether sex is safe or even infectious. "It is easy for health care professionals to assume that their patients' sex life is irrelevant, particularly if the patient is old or terminally ill," she said. For some patients, of course, sexual activity is not a priority, but they should be given the opportunity to find out how their therapy could affect them. "Doctors should look out for the quiet unheard distress of patients," she said.

It is undeniable that surgery, radiotherapy, hormonal therapy, and chemotherapy have brought great benefits to patients, but some treatments have side effects and increase their distress. Between 25% and 30% of patients have clinical depression or anxiety that requires intervention, but this is rarely picked up. Professor Fallowfield has studied the audio and video recordings of consultations with over 3,000 patients in 34 cancer centres in the UK, which show that psychosocial discussions are often overlooked. "Patients are conscious that doctors are busy in overcrowded clinics so they will not voice their worries. Doctors are under enormous time pressures and with the best will in the world it is necessary to cut corners sometimes, especially with few referral services available for patients who need extra support," she said.

If, however, doctors are able to spend time talking to their patients and their families about their lives, they are more likely to make accurate decisions over the treatment. The patient will then feel more secure and better cared-for. The study demonstrates that training will help doctors and nurses discuss personal and sexual issues comfortably and sensitively.

"The irony is that medical examinations of patients with cancer of the sexual organs are incredibly intimate, but talking about it is still taboo," she said.

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