So how do you approach an elephant in the room? Do you sidle up to it, holding your breath, hoping it won’t smack you with its trunk? Or do you make yourself look very big and confront it from a distance of 20 feet? That is often how health care providers attempt to talk about sexuality with adolescent/young adult (AYA) patients. Here are some examples:
- We give hints and talk in innuendo, hoping to address the topic without really talking about it at all.
- We use big words (even Latin!) and when the patient’s eyes glaze over and they stop listening, we think we’ve covered it all, tick it off the checklist, and never raise the topic again.
- We talk TO patients or AT them, rather than WITH them. Big difference. Do you ever actually slow down and LISTEN to them in this situation?
If any of these descriptions sounds even vaguely like you, don’t feel bad – you’re not alone. Most of us have sensitive touchpoints that we just don’t like to address, and many of us have managed to be excellent care providers while at the same time hiding from those pesky elephants that we keep finding in the corner of our patients’ rooms. Sexuality is one of the big ones—but why?
Sexuality has different meanings to all of us. For some it means sexual health. For others, sexual activity. Maybe you think it is mostly about sexual orientation…. See what I mean? We all approach the topic differently because we are ALL sexual beings and our own sexuality—whatever that means!—influences how we think about sexuality in other people.
To appropriately address sexuality with your patients, you need to first understand:
- Your beliefs and biases (“I don’t have to worry about it; my patients are too sick to be doing any of that.”)
- Your excuses (“With the internet my patients know all about this, don’t they?”)
- The barriers to having a conversation about sexuality with your patients (Hovering parents, anyone?)
This year at Critical Mass, I’ll be talking and giving a workshop on the “elephant” of addressing sexuality in the young adult with cancer. I will explore how cancer affects ALL aspects of sexuality, and how it uniquely affects the sexuality of young adults for specific bio-psycho-social reasons. Finally, I will offer practical suggestions about how oncology care providers can address this topic, including opportunities to practice opening lines to get the conversation started as well as suggestions for models and frameworks to keep you on track.
In the 15 years that I have been doing this work, I have pretty much heard it all – even stuff that sometimes has surprised me! I have stories to tell that will break your heart and make it fly right after it breaks. … but you will just have to wait till November to hear more!
Dr. Anne Katz is the certified sexuality counselor at CancerCare Manitoba and Clinical Nurse Specialist at the Manitoba Prostate Centre in Canada. She counsels men and women with a history of cancer who are experiencing sexual and relationship challenges, supports couples through recurrence and treatment decisions, and runs a sexual rehabilitation program for women after radiation therapy. She is the editor of the Oncology Nursing Forum, and maintains a joint appointment in the College of Nursing at the University of Manitoba. Dr. Katz is the author of eight books for health care providers and health care consumers on the topics of illness and sexuality as well as cancer survivorship, including her most recent: “Meeting the Need for Psychosocial Care In Young Adults With Cancer,” and “This Should not be Happening: Young Adults and Cancer.”