Sexual & relationship issues and concerns

A diagnosis of myeloma can be difficult not only for patients but also their partners, putting a strain on relationships that can affect intimacy and connection in many ways.

There may be many reasons for this. The physical changes caused by the myeloma and its treatment, such as fatigue, pain, weight loss, height loss and loss of hair can have a huge impact on body image and the way patients feel about themselves: it may affect how attractive they feel; their ability to be aroused and their desire to show intimacy towards their partner (libido).

Equally, coping with emotional stresses of myeloma such as the frustration of the loss of independence, worry and anxiety about what the future holds or role reversal in the home can consume a significant amount of emotional energy, leaving patients with less time and energy to give to their partners.

Many patients find it difficult to discuss their relationships, sex lives and issues surrounding sexuality. However, it is an important concern for many patients of all ages, regardless of whether they are in an intimate relationship or not, which can affect their psychological well-being and quality of life. Therefore, patients require practical information and emotional support to help them fully understand and adapt to relationship and sexual changes after their diagnosis as well as reassurance that these changes or concerns are normal. Through discussions, nurses are well placed to make an assessment of the changes reported, including relationship changes, sexual function and libido, and ensure that all concerns are addressed sensitively and holistically.

Sexual dysfunction can be evaluated using formal assessment tools designed to recognise concerns of cancer patients in general, and is increasingly included in holistic needs assessments. However, more often than not, applying common sense and sensitivity in a timely manner may be more appropriate and the nurse-patient relationship provides an excellent platform for nurses to address any anxieties patients have about the matter.

Importantly, nurses must acknowledge that myeloma and its treatments not only affect patients’ sexuality but can also have an impact on their partners. This may be due to changes in the relationship dynamics; the emotional and physical stresses of being a carer, and the physical and emotional changes in the patients themselves. The relationship and sexual concerns of partners as well as patients should therefore be addressed as well.

Creating the right environment to discuss these issues is imperative. Good communication skills are essential in moving conversations towards more sensitive questions that can determine whether there are issues or concerns. Using terminology that patients may find less uncomfortable/embarrassing can provide valuable information regarding sexuality. For example:

• Has myeloma or its treatment interfered with you being a partner?
• Has myeloma or its treatment changed the way you see yourself as a man/woman/person?

Nurses should then encourage patients and their partners to talk about how they feel, discuss any changes in their libido and confidence, and explore why they feel the way they do. They should explain that intimacy is not just about intercourse and that there are many other ways of expressing intimacy. For some patients, treatments such as sildenafil for erectile dysfunction or options for vaginal dryness, may be an option.

Identifying problems around relationships, sexuality and sexual health is an important part of the overall care of patients with myeloma and their partners but it is often overlooked. Nurses play a key role in ensuring patients and their partners receive the appropriate education and support on relationships and sexual health. However, where issues are underpinned by psychological factors, nurses should initiate a referral to a clinical psychologist, sex therapist or relationship counsellor.