| Vascular, sensory, and continence |
Vascular scarring—decreased genital blood flow (erection dysfunction; decreased vaginal lubrication) |
Change in senses—taste bud changes; increased sensitivity to smells; peripheral neuropathy changes sensation of touch |
Urinary/fecal incontinence—type of surgery affects risk |
| Skin changes |
Skin changes—texture/color changes can affect body image; can remind partner of patient’s diagnosis. Although tattoos are small, they can be a reminder to the patient or partner of diagnosis |
Skin sensitivity changes—some chemo causes extreme reaction to cold which affects food that can be eaten on dates; neuropathy affects enjoyment of skin touch; hand/foot (palmar/plantar) syndrome can affect enjoyment of activity with partner/affect ease of touching partner if skin peeling off hands; skin rash can occur; affect color of nails |
Surgical scars—body image changes; affect partner’s ease in being with patient |
| Fatigue |
Affects social interaction, libido |
Affects social interaction, libido |
Affects social interaction, libido |
| Vaginal vault changes |
Shortening of vagina; decreased lubrication; risk of dyspareunia; vaginal stenosis |
Decreased lubrication; risk of dyspareunia; increased risk of vaginal infection from tiny tears; Mucositis—can affect oral or vaginal cavity |
Postoperative adhesions if they occur do not usually affect the vaginal vault unless surgery was done in that specific location |
| Sexual pattern alterations |
If fatigue, may need to change usual positions or time of day for activity; affect spontaneity; if decreased lubrication will need to use artificial lubricant to avoid tears and possible infection; if XRT causes diarrhea, will affect usual pattern if apprehensive re: fecal incontinence |
If nausea/vomiting, will decrease desire; affects dating pattern; if taste bud changes, may avoid French kissing/oral stimulation; if fatigue, may need to change usual positions or time of day for activity; affect spontaneity; if decreased lubrication will need to use artificial lubricant to avoid tears and possible infection |
If stoma will need to remember to empty appliance prior to sexual activity; perhaps wear cover on appliance to prevent it ‘sticking’ to body; if patient irrigates, may decide to do prior to activity so can wear smaller ‘security pouch’; change in usual position so appliance can lie to the side; if waterplay activity part of sexual pattern may want to irrigate, prior so do not have to wear appliance; avoid ‘gassy’ food on date or use ‘gas filters’; loss of rectal sexual pleasuring if rectum removed |
| Nerve damage |
Skin sensitivity decreased; decreased vaginal lubrication/erection dysfunction |
Skin sensitivity decreased; decreased vaginal lubrication/erection dysfunction |
Skin sensitivity decreased; decreased vaginal lubrication/erection dysfunction |
| Urethral irritation |
Depends on radiation treatment field |
Hormonal changes may cause thinning and inflammation of tissues around the vaginal opening; if using spermicidal as birth control, can cause urethral irritation |
None |
| Hair pattern |
Alopecia—(only of site of radiation treatment) affects body image; daily reminder of treatment/diagnosis; if loss of pubic hair may be pleasurable OR may be emotionally upsetting to pt or partner if pt feels ‘childlike’ |
Alopecia/hair thinning—affects body image; if single, may affect desire to date; daily reminder of treatment/diagnosis; if loss of pubic hair may be pleasurable OR may be emotionally upsetting to pt or partner if pt feels ‘childlike’ |
Alopecia/hair thinning—none |
| Fertility impact |
Location/dose affect risk; premature ovarian failure |
Type/dose affect risk |
Usually not for colorectal cancer; abdominal adhesions can increase risk of female infertility post-tx; pelvic exenteration (hysterectomy); A/P resection = retrograde ejaculation |
| Fear of recurrence |
Impacts libido of patient and/or partner |
Impacts libido of patient and/or partner |
Impacts libido of patient and/or partner |
| Delayed complications |
Risk of fecal or urinary incontinence due to fibrosis (risk factors for postoperative incontinence included preoperative incontinence, female gender, perioperative blood loss, preoperative bladder emptying difficulties, autonomic nerve damage, and presence of a permanent stoma) |
Peripheral neuropathy may be permanent and it can affect sensations/enjoyment; taste bud changes may be permanent and will affect sexuality |
Adhesions can cause pelvic pain during coitus; nerve damage may be permanent and affect sensations |
