The Importance of Addressing Sexual Health After Illness: A Call for Responsibility from Healthcare Professionals

“What will this mean for my sex life?” Bente Træen asked the doctor as she lay with the ostomy bag on her stomach after surgery. Due to bowel cancer, she had had her bowel removed.

She was told that vaginal penetration and oral sex are perfectly fine, as usual.

“How about anal sex, then?” she followed up.

The tree says that she has received praise from gay friends for daring to ask the doctor that very question.

– You can say I took one for the team, she laughs to Forskning.no.

The answer was that it depends on how you are cut, sewn together and how much of the rectum is left.

Illness has consequences for sex life

Bente Træen has a regular column on Forskersonen, forskning.no’s debate page. In its latest article, Træen advocates that doctors, nurses and nursing assistants have a responsibility to inform patients about their sex life after treatment.

– Patients expect healthcare personnel to take the initiative, says Træen. She is now on sick leave from her job as a researcher at the Department of Psychology at the University of Oslo.

The tree calls for healthcare professionals to open up to patients’ questions about their sex life after cancer treatment.

– All possible health challenges can also have consequences for sex life, she points out.

There is a gap between the patients’ expectations of information, and what they get in hospital or with a GP, she believes.

As a patient, perhaps newly operated, you are down in many ways, she points out.

And not everyone dares to ask.

Held a course for stoma nurses before she became ill herself

Before she became ill, she ran a course for stoma nurses on how to talk to patients about sex.

– Little did I know then that I myself would end up as an ostomy patient. It was very strange to end up in that situation myself, where I became a patient and expected information, but that I had to take the initiative myself, she says.

But it has been instructive to gain insight into it from the inside, she thinks.

The fact that she fell ill herself meant that she ended up in what she calls involuntary fieldwork within a topic she has been researching for a long time.

Patients expect information

A few years ago, together with colleagues, she surveyed elderly patients’ expectations of information about their sexual life from healthcare professionals.

– Patients want healthcare personnel to raise questions about the sexual consequences of illness, she says.

If doctors and nurses do not address the topic, it becomes a barrier that is difficult for patients to overcome.

The participants in the study were between 60 and 75 years old, and almost 70 percent responded.

– It is the highest response rate I have experienced. It shows that there is great interest in the topic, even among well-to-do adults, says Træen.

The study is part of a large international project called Healthy sexual ageing.

Diversity makes healthcare professionals insecure

But there has been a shift towards more openness in recent years, and that is gratifying, Træen believes.

– At the same time, we see that the diversity of sexual expression has become much greater. This can make healthcare personnel feel they have too little knowledge, she says.

She herself suspects that sexuality was overlooked by healthcare professionals, because she is single.

– Health personnel may think it is more necessary to bring it up if they see that you have a partner, she says.

Trying to raise the topic in campaigns

– We think it is incredibly wonderful that Bente Træen is addressing this topic, and that she is calling for more transparency and better help from healthcare personnel. It was tough for her, says Ingrid Stenstadvold Ross to Forskning.no.

She is general secretary of the Cancer Society.

– We try to raise the issue through actions, campaigns, information on the website, through the Counseling Service, the Ward Center and themed cafes, she says.

The Norwegian Cancer Society agrees with Træen that it is the health personnel’s responsibility to ask.

In the various settings, the association emphasizes how important it is that healthcare personnel address the topic.

– The most important thing is that the patient receives information from healthcare personnel that is adapted to him and his situation, says Stenstadvold Ross.

For many people, sexuality linked to spinal injuries is hugely relevant, and thus there is a great need for information, she emphasises.

Weak psychological approach

Bente Træen had an operation last autumn, and has a temporary stoma before she will have another operation which means she will not have a bag on her stomach.

The information you get, if you ask, is very technical and factual. Health personnel often have a weak psychological approach to patients, she believes.

– You get ghosts in your head that you are less attractive, and that sex feels excluded, she says.

Camouflages the bag

Small moves can make the ostomy bag camouflage, so you get the focus away from the bag, she advises.

There are smaller bags that last a few hours, for example. The most common ones last a day.

– And there are stomach belts that camouflage the bag, and which can take your mind off the diagnosis, says Træen.

And why not make a black lace belt that looks like a suspender, she suggests.

Two out of three women with tendon injuries have problems in their sex lives

– If the patient takes the initiative themselves, there are several ways to get help, points out Ingrid Stenstadvold Ross.

During the Pink Ribbon campaign in 2018, the Norwegian Cancer Society carried out a survey which showed, among other things, that two out of three women with late damage after breast cancer experience challenges in their emotional and sexual lives. And seven out of ten have less sex drive.

– It is important for us that these women know that they are not alone in their problems, says Stenstadvold Ross.

Many claim support from Nav to improve the problems, but few know about it.

Can get aids from Nav

Nine out of ten women have not received information that they can get support from Nav for the purchase of sexual technical aids after cancer treatment. Only 7 percent have received information about this.

Late damage can be dry mucous membranes, psychological reactions, hot flushes, night sweats, lack of energy, changed self-image. The list of problems is long.

– For many, there is help to be had, but in order to get help, the problems must be on the table, she emphasizes.

Many cancer nurses have knowledge

There are few positions that have been created to deal only with sexual late injuries after cancer treatment. But most cancer nurses in the country know a lot about this.

Some hospitals have sexologists attached to the cancer department.

– It is also important to involve the GP, because many GPs have knowledge of this, says the general secretary of the Cancer Association.

Sexuality holds so much

Bente Træen has dated a bit since she was treated for cancer. But she spends time mapping out whether the other sides of the person match, before she informs about her situation right now.

– I am concerned that there are so many more things that should be included in sexuality than just intercourse, she says.

Even if you are undergoing cancer treatment and may not be able to have sex, it is still good to be caressed and have sex in other ways.

– Sex is much more than penetration, especially for women, emphasizes Træen.

Reference:

S. Schaller, B. Træen IL Kvalem: Barriers and Facilitating Factors for Help-Seeking: A Qualitative Study on How Older Adults Experience Talking About Sexual Issues with Healtcare Personnel. International Journal of Sexual Health, 10. april 2020.

(This case was first published on Forskning.no).