Sexuality in Palliative Care

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Sexuality in Palliative Care
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What is Sexuality?

• Sexuality is intrinsic to a persons sense of
  self
• Related to ones need for closeness, touch,
  caring, pleasure and relationships with others
• Sexuality is not merely sexual intercourse

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Definition

• WHO defines human sexuality as
• A central aspect of being human throughout
  life and encompasses sex, gender, identities and
  roles, sexual orientation, eroticism, pleasure,
  intimacy and reproduction. Sexuality is
  experienced and expressed in thoughts, fantasies,
  desires, beliefs, attitudes, values, behaviours,
  roles and relationships.

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From www.advocatesforyouth.com
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Sexual Expression

• Importance of physical expression may change
  throughout the course of illness
• More emphasis on verbal, emotional connectedness.
• Understand how the patient views sexual
  expression
• Essential aspect of their being or unimportant
• May be an affirmation of life
• A means to maintain a relationship
• Expression of passion.

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Factors affecting sexual expression

• Physical Symptoms
• Attitudes of Health Professionals
• Institutional Barriers

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1. Physical Symptoms

• Fatigue
• Pain
• Neutropenia and Thrombocytopenia
• Dyspnea
• Incontinence
• Mobility issues
• Body image disturbances
• Anxiety and depression
• Sexual dysfunction (erectile or dyspareunia)

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2. Health Professionals

• Few health care providers willing to engage in
  open discussions
• Ageist assumptions predominate
• Embarrassment
• Lack of knowledge

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3. Institutional Barriers

• Lack of Privacy
• Shared Rooms
• Intrusion by Staff, visitors
• Bed Size
• Uninviting physical space

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Sexual Assessment

• Address the topic early on.
• Use good communication techniques
• Create atmosphere conducive to open discussion.
• Introduce the topic, assess readiness for
  discussion
• You look so tired, and it must be hard to feel
  good about yourself after all that you have been
  through. This illness may have impacted on your
  relationship and other intimate areas of your
  life.

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Assessment

• Use open-ended questions
• Some people who have an incurable illness are
  frustrated by their lack of private time with
  their spouse/sexual partner. Is this a concern
  for you?
• Non-judgemental approach
• Make no assumptions about the patients
  relationships, sexuality, intimacy or knowledge
• Gender and age may affect comfort level

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P-LI-SS-IT Model

• P Permission phase
• Opening the discussion
• LI Limited information
• Answering questions, dispelling myths, providing
  validation
• SS Specific suggestions
• Usually pertain to the areas of communication,
  symptom management and alternate physical
  expression
• IT Intensive therapy
• (not usually in EOLC)

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Final Considerations

• Incurable illness and end of life care may
  compromise a couples intimacy and a persons QOL
• Individuals may appreciate the opportunity to
  discuss issues of sexuality and intimacy
  especially early in the disease trajectory
• HCP need to take an active role in initiating
  discussions and advocating for privacy