3. Cancer Patients Have Sex Lives Too: Recognise Sexuality in Health System Approaches

Sexuality is recognised as an important component of quality of life^59,60,61 and is known to be associated with longer longevity^62,63. In short, cancer patients, survivors, and their partners, have sex lives too^64,65. All of us should be able to enjoy relationships of intimacy. Yet, all too often, discussion on such topics can be hampered by lingering taboo. Any remaining taboo on this must now be broken. Data, for example, shows that cancer patients and survivors suffer from significant dissatisfaction when it comes to their sex lives. This relates both to sexual dysfunction, which affects an estimated half of cancer patients⁶⁶ and a third of childhood cancer survivors^67,68,69, often as a result of cancer treatments rather than from the cancer itself⁷⁰, and to psychological and social elements^71,72. Crucially, sexual dissatisfaction can be encountered by all cancer patients, not only by those suffering from a tumour affecting their sexual organs^73,74. 

Sexuality-related issues are particularly detrimental to the quality of life of cancer patients and survivors. Such issues lead to significant cancer distress^75,76, both for patients and their partners, endangering their mental health and their relationships^{77,78,79,80,81}, and potentially even impacting the cancer treatment itself. Yet, in spite of this, accumulating reports identify sexual medicine as one of the greatest areas of unmet care needs for cancer patients and survivors^82,83,84, especially in younger adults⁸⁵. Sexual medicine can be integral to improved care for cancer patients in respect to a wide range of complications, including body image and fertility challenges. These can be sensitive issues for discussion with patients and too often healthcare professionals do not benefit from substantial training to make the provision of advice and support in these areas a standard part of cancer care. Remaining problems in access to sexual medicine are, in large part, due to long-lasting gaps in training and education of sexual medicine specialists and healthcare professionals as a whole. 

Importantly, sexual minorities are particularly affected by these deficiencies in care provision. Data clearly shows a strong association between sexuality-related issues and long-term mental and physical problems for LGTBQ individuals. These individuals may give different meanings to sexuality-related matters, which may, for example, threaten their sexual identity. Reactions to sexual complications may also differ, such as some individuals being potentially more likely to engage in novel practices as a means of managing sexual challenges^86,87. Healthcare professionals therefore need to be specifically primed to the provision of sexual medicine to LGBTQ individuals, in order to avoid making heteronormative assumptions and to provide them with relevant information and support⁸⁸.

Preservation of sexual function and satisfaction needs to be recognised as an integral part of cancer care and should be addressed as a matter of routine, before, during and after the provision of cancer treatment, even in the case of cancers not physically affecting sexual or reproductive organs.

This should be achieved by ensuring the provision of relevant information and interventions, destined to both cancer patients and their partners. Restoration of sexual function does not ensure restoration of sexual satisfaction⁸⁹. Sexual medicine interventions in cancer need to be multidisciplinary, integrating both specialist medical components, aiming at tackling sexual dysfunction, and professional psychological counselling, in order to support the restoration and preservation of a satisfying sex life.

Simple measures health systems can take include promotion of the great array of well-formed, easy-to-read and digest, information on cancer and sex and sexuality matters that have been made available online by patient associations⁹⁰ and medical societies, at both national and international levels⁹¹.