Department of Public Health Science, University of Miami, Miami, FL 33146, United States.
Miller School of Medicine, University of Miami, Miami, FL 33146, United States.
J Sex Med. 2023 May 26;20(6):813-820. doi: 10.1093/jsxmed/qdad041.
Sexual dysfunction is a known side effect of pelvic radiotherapy, resulting from a complex intersection of physiologic and psychosocial factors. Maintaining sexual function is relevant to long-term quality of life and is an important aspect of survivorship. Many female patients report being insufficiently informed before treatment about the potential sexual side effects of radiation therapy.
To elucidate how radiation oncologists communicate sexual function side effects with their female patients and how discussing sexual side effects of cancer treatment can positively affect patient-physician rapport.
Semistructured interviews in English and Spanish were conducted with 20 female participants who received pelvic radiation as part of their cancer treatment. Patients responded to advertisements or were referred by physicians. All interviews were conducted virtually between June and October 2021. Thematic analysis was conducted with NVivo. Patients also completed an online demographics survey in REDCap.
We found 4 primary themes addressing patient perspectives on patient-physician communication of sexual dysfunction and how it affected the cancer care experience.
Theme 1: This may be expected, but I didn't expect it! The participants who were not properly informed about sexual side effects felt blindsided and embarrassed about their symptoms. Theme 2: I do not feel like a woman anymore . . . The psychological impact included lower self-esteem and no longer feeling sexy nor like a woman. Theme 3: Fine, I'll deal with this myself! Patients turned to the internet rather than their doctors for answers once they began experiencing symptoms, and they found information, normalization, and community online. Theme 4: Ask me about my sex life and find out if sex is a priority for me. Participants emphasized that their radiation oncologist should take a sexual history early to monitor sexual dysfunction and to identify individual patient priorities surrounding sex posttreatment.
This evidence provides a guide to patient-physician communication that may help to mitigate the impacts of radiotherapy on female sexual function as well as the negative impact that the absence of communication about sexual dysfunction may have on patient-physician trust.
While this project did have a small sample size, there is considerable diversity in race, education level, and age, with interviews conducted in Spanish and English.
Overall these findings provide physicians with important information about the unmet information needs of patients and their preferences for how to help them feel more prepared and less distressed when sexual dysfunction occurs.
性功能障碍是盆腔放射治疗的已知副作用，其源于生理和心理社会因素的复杂相互作用。保持性功能与长期生活质量相关，也是生存质量的一个重要方面。许多女性患者在治疗前报告称，她们对放射治疗的潜在性副作用了解不足。
阐明放射肿瘤学家如何与女性患者讨论性功能障碍副作用，以及讨论癌症治疗的副作用如何积极影响医患关系。
采用英语和西班牙语对半结构访谈的方式，对 20 名接受盆腔放疗的女性参与者进行了研究，这些患者是癌症治疗的一部分。患者通过广告或医生转介做出回应。所有访谈均于 2021 年 6 月至 10 月期间通过虚拟方式进行。采用 NVivo 进行主题分析。患者还在 REDCap 中完成了在线人口统计学调查。
我们发现了 4 个主要主题，这些主题涉及患者对医患之间性功能障碍沟通的看法，以及这些沟通如何影响癌症治疗体验。
主题 1：这是意料之中的，但我没想到！那些没有被告知性副作用的患者感到措手不及，并对自己的症状感到尴尬。主题 2：我不再像个女人了……这种心理影响包括自尊心下降，不再觉得自己性感，也不再觉得自己像个女人。主题 3：好吧，我自己来处理！一旦出现症状，患者就会转而在互联网上而不是向医生寻求答案，他们在网上找到了信息、正常化和社区。主题 4：询问我的性生活，了解性生活对我是否重要。参与者强调，他们的放射肿瘤医生应该尽早进行性史评估，以监测放疗后的性功能障碍，并确定个体患者对治疗后性生活的优先事项。
该证据为医患沟通提供了指导，可能有助于减轻放疗对女性性功能的影响，以及缺乏性功能障碍沟通可能对医患信任产生的负面影响。
尽管该项目的样本量较小，但在种族、教育程度和年龄方面存在很大的多样性，访谈采用西班牙语和英语进行。
总的来说，这些发现为医生提供了有关患者未满足的信息需求以及他们对帮助自己做好更充分准备和减轻性障碍困扰的偏好的重要信息。
