Sexual Medicine and Medical Collaboration · Survivorship

Nobody Asked Her

One client, two and a half years after treatment, who has never been asked. What her history predicts, how you open the subject she has not raised, and which of her questions are yours to answer.

What this exercise practises

Reading a treatment history for what it predicts rather than for what it has caused so far, raising sexual consequences proactively when the client has not named them, and holding the scope line without declining the question.

The hardest part is the third. Half of what she asks you is outside sex therapy and all of it still needs answering by somebody, which makes routing a clinical act rather than a refusal.

Estimated time to complete this exercise: 25 minutes

1Her course
2The opening
3The scope line
4Close

Before you begin

How this one works

One client, three parts. First her expected course, then how you raise the subject she has not raised, then the eight questions she asks you once it is open.
Part one is a multi-select over statements about her course. Several of them are false, and all the false ones are false in the same way.
Part three is the scope line. Half of her questions are yours and half of them are not, and the ones that are not still have to be answered by somebody.
Nothing is graded and nothing is recorded. Reloading starts it again.

The client, for all three parts

A 44-year-old AFAB client was treated for cervical cancer two and a half years ago: surgery, pelvic radiation, and chemotherapy. She is two years into an aromatase inhibitor prescribed for a hormone receptor-positive breast cancer found during follow-up. She has come to see you about low mood and the strain in her marriage. She has not mentioned sex. When you ask, she says penetration has become painful to the point of being impossible, that she has no interest anymore, and that she assumed this was simply what was left.

Sexual concerns are rarely raised by oncology providers and rarely resolved without dedicated intervention (Reese et al., 2017). The practical reading of that finding is that the conversation you are about to have is probably the first one she has had, two and a half years in.

References

  1. Incrocci, L., & Jensen, P. T. (2013). Pelvic radiotherapy and sexual function in men and women. The Journal of Sexual Medicine, 10(Suppl. 1), 53–64. https://doi.org/10.1111/jsm.12010
  2. Panjari, M., Bell, R. J., & Davis, S. R. (2011). Sexual function after breast cancer. The Journal of Sexual Medicine, 8(1), 294–302. https://doi.org/10.1111/j.1743-6109.2010.02034.x
  3. Reese, J. B., Sorice, K., Beach, M. C., Porter, L. S., Tulsky, J. A., Daly, M. B., & Lepore, S. J. (2017). Patient-provider communication about sexual concerns in cancer: A systematic review. Journal of Cancer Survivorship, 11(2), 175–188. https://doi.org/10.1007/s11764-016-0577-9
  4. White, I. D., & Faithfull, S. (2006). Vaginal dilation associated with pelvic radiotherapy: A UK survey of current practice. International Journal of Gynecological Cancer, 16(3), 1140–1146. https://doi.org/10.1111/j.1525-1438.2006.00453.x