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Survivorship Care Plan: Sexual Dysfunction

Sandra Kurtin, RN, MSN, AOCN, ANP-C, Assistant Professor of Clinical Medicine, University of Arizona College of Medicine; Adjunct Assistant Professor of Nursing, University of Arizona College of Nursing, Tucson, AZ, discusses survivorship care plans to address sexual dysfunction in patients with multiple myeloma.

Video Transcript

Hello. I’m Sandra Kurtin, and welcome to the Multiple Myeloma Center for Nurses video: Survivorship Care Plan: Sexual Dysfunction.
In this video, we’ll review the survivorship care plan to provide information on causes of sexual dysfunction and sexual assessment practices, and to promote discussion with your patients living with multiple myeloma to help them manage sexual dysfunction.¹

Sexual dysfunction is characterized by a physiologic or psychological change that has a negative impact on sexuality. It has been reported to affect approximately 43% of women and 31% of men in the United States.^1-4
Incidence in patients with hematologic cancer has not been well-characterized. However, one cross-sectional descriptive study collected data using 5 self-report instruments to define sexual dysfunction and menopausal symptoms.^5,6
The study included 48 women with malignant hematolymphoid disease who had received at least 1 treatment. Prior to their next treatment, 73% of the women reported a decreased libido and 48% reported dissatisfaction with their overall sex life.⁶

Sexual dysfunction is not part of normal aging, but patients may experience it due to their disease or treatment side effects. Patients with multiple myeloma, for example, may be susceptible to sexual dysfunction resulting from treatment, nerve root compression, or comorbid diseases, such as hypertension, diabetes, coronary artery disease, and hormonal or thyroid conditions. Other contributing factors can include fatigue, pain, depression, and alterations in body image. ^1,5
The sexual dysfunction survivorship care plan aims to define sexual dysfunction, discuss risk factors for the development of sexual dysfunction, provide tools that can help assess sexual dysfunction, and describe interventions that may benefit patients and their partners.⁷

Practice recommendations include providing an environment that promotes discussion of sexual dysfunction.^1,5
To counteract embarrassment or hesitation, nurses and other practitioners should employ effective communication strategies and interpersonal skills.^1,5
Framing sexual health as an integral component of overall health may reduce the stigma associated with sexual dysfunction.⁵

Bridge statements—such as “Has anyone talked with you about how your illness can affect your ability to have sex?”—can help patients feel more comfortable expressing concerns related to sexual dysfunction.⁵

Assessments of sexual dysfunction should include a thorough medical history, including sexual and psychological history, and a full physical examination. Patients should receive a genital examination to evaluate for sexually transmitted disease, swelling, discoloration, masses, or tenderness.^5,8
Additionally, laboratory testing may be required to evaluate for thyroid and hormone levels. If hormonal issues are identified as a possible causative factor, referral to a specialist in that area may be needed depending on the exact cause and healthcare provider level of expertise.^1,5

The International Myeloma Foundation Nurse Leadership Board website has developed a tool to help guide you through the assessment and discussion of sexual dysfunction at initial visits.⁵

This concludes the Multiple Myeloma Center for Nurses video: Survivorship Care Plan: Sexual Dysfunction. To find out more on this and other topics related to multiple myeloma, please see additional videos and resources on this site.
Here you will find a number of valuable tools to help you discuss these topics with your patients, answers to common questions, and other downloadable materials. Thank you.

1. Catamero D, Noonan K, Richards T, et al. Distress, fatigue, and sexuality: Understanding and treating concerns and symptoms in patients with multiple myeloma. Clin J Nurs Oncol. 2017;21(5 suppl):7-19.
2. Ganz PA, Greendale GA. Female sexual desire—beyond testosterone. J Natl Cancer Inst. 2007;99(9):659-661.
3. Laumann EO, Paik A, Rosen RC. Sexual dysfunction in the United States: prevalence and predictors. JAMA. 1999;281(6):537-544.
4. Lewis RW, Fugl-Meyer KS, Corona G, et al. Definitions/epidemiology/risk factors for sexual dysfunction. J Sex Med. 2010;7(4):1598-1607.
5. Richards TA, Bertolotti PA, Doss D, McCullagh EJ; International Myeloma Foundation Nurse Leadership Board. Sexual dysfunction in multiple myeloma: survivorship care plan of the International Foundation Nurse Leadership Board. Clin J Oncol Nurs. 2011;15(suppl 4):53-65.
6. Tierney KD, Facione N, Padilla G, Blume K, Dodd M. Altered sexual health and quality of life in women prior to hematopoietic cell transplantation. Eur J Oncol Nurs. 2007;11(4):298-308.
7. Bilotti E, Faiman BM, Richards TA, Tariman JD, Miceli TS, Rome SI; International Myeloma Foundation Nurse Leadership Board. Survivorship care guidelines for patients living with multiple myeloma: consensus statements of the International Myeloma Foundation Nurse Leadership Board. Clin J Oncol Nurse. 2011;15(suppl 4):5-8.
8. Srivastava R, Thakar R, Sultan A. Female sexual dysfunction in obstetrics and gynecology. Obstet Gynecol Surv. 2008;63(8):527-537.