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Sexuality in the consulting room embarrasses oncologists

Cancer treatments often have an impact on people’s sexual health, but doctors and nurses do not discuss topics such as sexuality and intimacy with patients as a matter of course. This is what Esmée Krouwel, a physician-researcher at Leiden University Medical Center (LUMC), has discovered. With her research she wants to show how important it is that this changes. She will defend her thesis on Thursday 12 May.

‘When it comes to sexuality and cancer, breast or prostate cancer often come to mind, but treatments for all sorts of cancer can have a negative impact on intimacy,’ says Krouwel. ‘Surgical interventions, for instance, can damage certain nerves. Chemotherapy can dry out mucous membranes in the vagina and mouth. And various treatments can affect a person’s hormones, appearance and self-image. A mastectomy and hair loss are well-known examples, but what about a stoma?’

Esmée Krouwel

Sexual health

According to Krouwel, the extent to which sex is discussed with patients varies greatly: ‘There is plenty of room for improvement.’ She researched how healthcare workers throughout the country talk to cancer patients about the effects of their treatments on their fertility and sexual function.

Krouwel asked oncological and plastic surgeons, radiotherapists, medical oncologists and nurses why they prefer not to talk about sexuality. They gave different reasons for not broaching the subject. Krouwel: ‘You’d be surprised how often age plays a factor, as if older people no longer have sex! Lack of time was mentioned most often because if you want to talk to a patient about sexuality it can be a can of worms. And then? Doctors often say they don’t have the expertise to offer the right treatment. They need specialists that they can refer patients to.’


Krouwel also did research among patients and care providers about having cancer at a fertile age: ‘Fertility preservation treatments can delay cancer treatment.  But patients sometimes say that having a child is just as important as surviving,’ she explains. ‘This makes it all the more important for doctors to discuss fertility with patients and not make assumptions. It also appears that people’s desire to have children can change after treatment, with chemo for instance. This makes it important that patients are referred beforehand to a fertility clinic, regardless of their wishes at that moment.’

Stichting Sick and Sex

Following on from her research Krouwel is working to bring the topic to the attention of a wider audience. She is one of the editors of the Sick and Sex Foundation website (in Dutch). This site is full of advice on various diseases and how they affect sexuality. ‘It’s an accessible site with general, reliable information. We use videos, for example, to make information accessible to people with low literacy levels.’ She believes the site is a success: ‘There are doctors who are already using it in the consulting rooms to help make patients better!’

Krouwel expects to complete the specialisation in urology by mid-2023.

Banner photo: Unsplash

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