Sexual health is a significant concern for many patients with graft-versus-host disease (GVHD) following allogeneic stem cell transplantation (alloSCT), yet it is often overlooked in clinical discussions. A common barrier is the assumption that other healthcare team members will address the topic. Oncology nurses are uniquely positioned to bridge this gap by assessing patient needs, addressing sexual concerns, and connecting patients with appropriate resources. They play a vital role in normalizing sexual health as part of alloSCT care, especially regarding the impact of GVHD. The PLISSIT communication model can help oncology nurses confidently initiate these important conversations.
Sexual dysfunction affects roughly 50% of men and up to 80% of women after stem cell transplantation. GVHD complicates sexual health further, particularly when genital involvement occurs. Physical changes such as vaginal dryness, erectile dysfunction, altered body image, and fatigue can impair libido, arousal, and orgasm. Additionally, GVHD symptoms, immunosuppressive treatments, and medications like narcotics or antimicrobials can negatively affect sexual function. Psychosocial and intimacy challenges may also increase distress and reduce quality of life.
A cross-sectional secondary analysis of two randomized clinical trials involving 185 adults more than three months post-transplant found that greater sexual satisfaction correlated with higher quality of life and fewer symptoms of depression and anxiety. Most participants (79%) had undergone alloSCT. The study emphasized the biopsychosocial nature of sexual health, which encompasses physical, practical, emotional, social, and spiritual factors rather than solely physiological changes.
The PLISSIT model offers a four-step framework—permission, limited information, specific suggestions, and intensive therapy—that oncology nurses can use to address sexual health concerns in patients with GVHD.
The first step, Permission, involves inviting patients or their partners to discuss sexual concerns. For example, nurses might say, “Many patients with GVHD experience intimacy or sexual challenges. I’m here to discuss any questions or concerns you have.” This approach normalizes the topic and validates the patient’s experience while reducing embarrassment.
The second step, Limited Information, entails providing brief, tailored information. An example would be, “Some women with GVHD experience vaginal dryness; using vaginal moisturizers or lubricants can provide relief.” The goal is to avoid overwhelming patients with excessive details.
The third step, Specific Suggestions, includes offering practical advice or coordinating additional support. For instance, a nurse might say, “Let’s connect you with our transplant social worker to explore ways to discuss body image concerns with your partner.” Oncology nurses’ comfort with this step may vary depending on their knowledge and experience.
The final step, Intensive Therapy, involves referring patients to specialists such as mental health professionals, sexual health therapists, or gynecologists/urologists. A typical referral statement could be, “I’d like to refer you to our gynecologist, who helps patients manage GVHD-related pain or scarring.” While not every patient requires specialist intervention, oncology nurses should be familiar with local resources to support patients effectively.
Discussing sexuality can be uncomfortable for both oncology nurses and alloSCT survivors, particularly when GVHD causes genital changes, painful intercourse, or intimacy difficulties. However, normalizing these conversations—similar to routine education on other GVHD side effects like skin, liver, or gastrointestinal issues—can help reduce anxiety for patients and caregivers alike. The PLISSIT model provides a clear structure for oncology nurses to facilitate these discussions, emphasizing the importance of taking initiative in addressing sexual health concerns.
For further information on sexual health after stem cell transplantation and communication strategies, consult additional resources dedicated to this topic.
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