Dr Isabel White is a clinical research fellow in psychosexual practice at the Royal Marsden Hospital, London. Here she talks about how she helps men who have had a stem cell transplant to overcome concerns about their sexual health in her clinic.
Why do men come to see you?
Their most common sexual difficulties are persistent loss of sexual desire and erectile difficulties or dysfunction. This is commonly caused by a mixture of physical and emotional reasons such as persistent fatigue, weight gain, body image difficulties, low self-esteem and a loss of sexual confidence. A general anxiety and fear of disease recurrence or low testosterone levels can also play a part in patient’s problems with their sexual function.
In general, the men who visit my clinic have been recovering from their stem cell transplant for at least 12 months. This is because when people feel their life is threatened, or they are coping with significant treatment side effects, any sexual concerns may not be a priority for them at that time. However, as they recover people are more likely to try to resume their sexual relations and may need help to talk about any persistent or distressing difficulties they are experiencing.
What happens before I visit your clinic?
You will probably be referred to my clinic by a member of your treatment team or GP, but I accept self-referrals too. Usually your treatment team will have requested that the level of testosterone (and possibly other hormones too) is measured from a sample of your blood. This is to check that your endocrine system is working properly to stimulate the testes that produce testosterone.
You will be asked to bring a summary of your current medications, so we can check to see if any of the drugs you are taking might affect your sexual wellbeing, such as antidepressants or high blood pressure medication. It is also helpful for us to know your past medical history and if you have had any help for sexual difficulties before your transplant.
Can I bring someone with me?
It is always helpful to meet partners because sexual difficulties usually affect more than one person in the relationship. However, if you are single and would like to bring someone along for moral support that is fine too. The consultation will include questions of a personal or sensitive nature, so make sure you are comfortable discussing this type of information with them in the room.
What will happen?
I try to put men at ease first by reassuring them that what they discuss will be treated confidentially. Specific details about the sexual concern or difficulty will only be shared (with your permission) on a ‘need to know’ basis with your GP or treatment team. I usually ask patients to start talking about things they feel more comfortable with. People normally find it helpful to talk briefly about when they were first diagnosed, how their treatment has affected them and their partner and what is important to them during their recovery. I think it’s important that men know that sexual difficulties are common in the general population, even among younger adults. I help them to understand the factors causing their sexual concerns and together aim to find the best way to manage them.
As a psychosexual therapist I do not perform any physical examination at any point. I take a detailed past medical, sexual health and relationship history only. Some other erectile dysfunction clinics or your GP may ask to perform an examination of your penis and testes if it is appropriate.
What happens next?
I usually arrange to see men for at least three to four sessions depending on the underlying reasons for their sexual difficulties, the treatments proposed (medication alone and/or brief psychosexual counselling) and their response to treatments. Some men may need up to ten sessions to support them while they overcome their sexual difficulties and adapt to changes associated with their transplant or treatment.
Are the needs of single men different to those in a relationship?
Loss of sexual desire and erectile dysfunction can contribute to men losing their confidence and make them feel less masculine because they cannot fulfil aspects of their role in life or in their relationship. Single men are sometimes reluctant to start a new relationship because of the ‘fear of failure’ when it comes to being sexual with a new partner. This can lead to social isolation for some men. Men in a relationship tend to fear how the lack of a sex life will affect the stability of their relationship, which can then cause friction in the couple.
What would be your one ‘take home’ message about sex and relationships during and after a stem cell transplant?
It is understandable that people with sexual concerns are not used to talking about something that is usually a very private aspect of their lives. However, always remember that your sexual recovery after your transplant is just as legitimate an aspect of your recovery as any other.
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