Sexual Function in Serious Illness: Areej El-Jawahri, Sharon Bober, and Don Dizon

GeriPal - A Geriatrics and Palliative Care Podcast

As Eric notes at the end of today’s podcast, we talk about many difficult issues with our patients. How long they might have to live. Their declining cognitive abilities. What makes their lives meaningful, brings them joy, a sense of purpose. But one issue we’re not as good at discussing with our patients is sexual health.

On today’s podcast Areej El-Jawahri, oncologist specializing in blood cancers at MGH, says that sexual health is one of the top if not the top issue among cancer survivors. Clearly this issue is important to patients. Sharon Bober, clinical psychologist at DFCI, notes that clinicians can get caught in an anxiety cycle, in which they are afraid to ask, don’t ask, then have increased anxiety about not asking. Like any other conversation, you have to start, and through experience learn what language is comfortable for you. Don Dizon, oncologist specializing in pelvic malignancies at Brown, suggests speaking in plain language, starting by normalizing sexual health issues, to paraphrase, “Many of my patients experience issues with intimacy and sexual health. Is that an issue for you? I’m happy to talk about it at any time.” All guests agree that clinicians feel they need to have something they can do if they open Pandora's box. To that end, we talk about practical advice, including:

• The importance of intimacy over and above physical sexual function for many patients

• Common causes and differential diagnoses of sexual concerns in patients with cancer and survivors

• Treatments for erectile dysfunction - first time the words “cock ring” have been uttered on the GeriPal Podcast - and discuss daily phosphodiesterase 5 inhibitor therapy vs prn

• The importance of a pelvic exam for women experiencing pain

• What is “pelvic physical therapy?”

• Treatments for vaginal dryness and atrophy

• ACS links, NCCN links, Cancersexnetwork, and a great handout that Areej created

And I get to sing Lady Gaga, also a first for GeriPal! And let me tell you, there’s nothing like the first time (sorry, I couldn’t help it!).