Sexuality in palliative care
- Timothy J Moynihan, MD
Timothy J Moynihan, MD
- Associate Professor of Medical Oncology
- Mayo Clinic College of Medicine
- Sharon L Bober, PhD
Sharon L Bober, PhD
- Assistant Professor of Psychiatry
- Harvard Medical School
Palliative care is an interdisciplinary medical specialty that focuses on preventing and relieving suffering and on supporting the best possible quality of life for patients and their families facing serious illness. The primary tenets of palliative care are symptom management; establishing goals of care that are in keeping with the patient’s values and preferences; consistent and sustained communication between the patient and all those involved in his or her care; psychosocial, spiritual, and practical support both to patients and their family caregivers; and coordination across sites of care. Palliative care aims to relieve suffering in all stages of disease and is not limited to end of life care. (See "Benefits, services, and models of subspecialty palliative care".)
Sexuality is an important issue for some patients nearing the end of their life as well as their sexual partners, and yet this is a subject that health care professionals often do not address [1-3]. Sexuality is intrinsic to a person's sense of self throughout the lifespan [4,5], and it can be a vital form of expression that helps to relieve suffering, offer meaning, and maintain interpersonal connection in the face of life-limiting illness . Sexuality does not refer to just a physical act but more broadly encompasses identity, gender roles and orientations, eroticism, pleasure, and intimacy. It is experienced and may be expressed through thoughts and feelings in addition to behavior . This topic will review issues related to sexuality in palliative care. A more in depth discussion as to the general approach to patients with sexual dysfunction is presented elsewhere. (See "Overview of male sexual dysfunction" and "Evaluation of male sexual dysfunction" and "Sexual dysfunction in women: Epidemiology, risk factors, and evaluation".)
SCOPE OF THE PROBLEM
Although there are few data on sexuality for patients who are undergoing palliative care, there appears to be a high prevalence of sexual dysfunction in this population [8-11]. In addition, the frequency and type of sexual dysfunction among patients in palliative care appears to vary by the underlying disease process [10,12-17]. Representative findings on the scope of this issue are given below:
●In one study of 65 patients admitted to an acute pain and palliative care unit, 86 percent considered sexuality important enough that they wanted to talk about it with a knowledgeable clinician .
●In another study of over 400 patients with heart failure, 59 percent reported sexual dysfunction .
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- SCOPE OF THE PROBLEM
- Partner's perspective
- PERCEIVED BARRIERS
- TAKING A SEXUAL HISTORY
- EVALUATING SEXUAL DYSFUNCTION
- Addressing sexual health
- Issues specific to end of life care
- ADDRESSING THE PARTNER'S NEEDS
- TREATMENT OF SEXUAL DYSFUNCTION
- Specific interventions
- - Hormonal manipulation
- - Discontinuing medications
- - Addressing range of motion
- - Importance of privacy
- - Multidisciplinary care