THE SEXUALI TY OF PATI ENTS W I TH ONCO-HEMATOLOGI CAL DI SEASES
Alex andr a de Souza Melo1 Em ília Cam pos de Car v alho2 Nilza Ter esa Rot t er Pelá3
Melo AS, Car v alho EC, Pelá NTR. The sex ualit y of pat ient s w it h onco- hem at ological diseases. Rev Lat ino- am Enfer m agem 2 0 0 6 m ar ço- abr il; 1 4 ( 2 ) : 2 2 7 - 3 2 .
We int erviewed 20 pat ient s st aying at a hospit al unit , by m eans of a dat a collect ion inst rum ent t hat is based on t he eclect ic m odel, wit h a view t o charact erizing t he biological, psychological and sociocult ural aspect s involving hum an sexualit y which are affect ed in pat ient s wit h onco- hem at ological diseases. The research com plied wit h et hical requirem ent s for st udies involving hum an beings. The result s revealed t hat t hese client s present ed problem s relat ed t o biological aspect s, m ainly wit h respect t o t he phase of sexual desire ( 60% of t he sam ple) , sex u al ex cit at ion ( 7 5 % ) an d or g asm ( 7 5 % ) . Th e p sy ch olog ical asp ect s r elat ed t o sex u al self - im ag e w er e af f ect ed in 6 0 % of t h e sam ple; pr oblem s r elat ed t o social aspect s ( 8 5 % ) w er e m ain ly du e t o t h e f ear of acquir ing an infect ion as a r esult of t he low im m unit y pr ov ok ed by t he disease and t r eat m ent . These client s dem onst r at ed alt er at ions in t heir sex ual funct ion and in t he w ay t hey ex pr essed t heir sex ualit y .
DESCRI PTORS: sex ualit y ; nur sing diagnosis; hem at ologic diseases; m edical oncology
LA SEXUALI DAD DEL PACI ENTE PORTADOR DE ENFERMEDADES ONCO-HEMATOLÓGI CAS
Con el int ent o de car act er izar los aspect os biológicos, psicológicos y sociocult ur ales que inv olucr an la sex ualidad hum ana afect ados en las per sonas por t ador as de pat ologías onco- hem at ológicas, ent r ev ist am os a 2 0 pacien t es in t er n ados en u n a u n idad h ospit alar ia por m edio de u n in st r u m en t o de r ecopilación de dat os basado en el m odelo ecléct ico. La in v est igación cu m plió con las ex igen cias ét icas par a est u dios con ser es hum anos. Los result ados evidenciaron que est a client ela present a problem as relacionados a aspect os biológicos, respect o a la fase del deseo sexual ( 60% de la m uest ra) , de la excit ación sexual ( 75% ) y del orgasm o ( 75% ) . Los aspect os psicológicos que se r efier en al aut o- im agen sex ual se m ost r ar on com pr om et idos en 60% de la m u est r a; la pr esen cia de los pr oblem as r elacion ados a los aspect os sociales ( 8 5 % ) pr in cipalm en t e ocu r r ió debido al m iedo de adquir ir una infección en consecuencia de la baj a inm unidad pr ovocada por la enfer m edad y t rat am ient o. Est a client ela dem ost ró alt eraciones en la función sexual y en la m anera de expresar su sexualidad.
DESCRI PTORES: sex u alidad; diagn óst ico de en fer m er ía; en fer m edades h em at ológicas; on cología m édica
A SEXUALI DADE DO PACI ENTE PORTADOR DE DOENÇAS ONCO-HEMATOLÓGI CAS
Com o pr opósit o de car act er izar os aspect os biológicos, psicológicos e sociocult ur ais que env olv em a sex ualidade hum ana, afet ados nas pessoas por t ador as de pat ologias onco- hem at ológicas, for am ent r ev ist ados 20 pacient es, int ernados em um a unidade hospit alar, por m eio de um inst rum ent o de colet a de dados baseado no m odelo eclét ico. A invest igação at endeu às exigências ét icas para est udos com seres hum anos. Os result ados ev iden ciar am qu e essa clien t ela apr esen t a pr oblem as r elacion ados a aspect os biológicos qu an t o à f ase do desej o sex ual ( 60% da am ost r a) , da ex cit ação sex ual ( 75% ) e do or gasm o ( 75% ) . Os aspect os psicológicos que se relacionam com a aut o- im agem sexual apresent aram - se com prom et idos em 60% da am ost ra; a presença dos problem as relacionados aos aspect os sociais ( 85% ) deu- se, principalm ent e, pelo m edo de adquirir infecção decor r ent e da baix a im unidade pr ov ocada pela doença e t r at am ent o. Essa client ela apr esent ou alt er ações na função sex ual e na m aneir a de ex pr essar a sua sex ualidade.
DESCRI TORES: sex u alidade; diagn óst ico de en fer m agem ; doen ças h em at ológicas; on cologia
1
RN, PhD in Nursing, e- m ail: m [email protected]; 2 RN, PhD, Full Professor, e- m ail: [email protected]; 3 RN, PhD, ret ired Full Professor, e- m ail: [email protected]. Universit y of São Paulo at Ribeirão Pret o College of Nursing, WHO Collaborat ing Cent re for Nursing Research Developm ent
I NTRODUCTI ON
C
a n ce r, ch a r a ct e r i ze d a s a d i se a se t h a ta f f e ct s v a r i o u s b o d y p a r t s a n d r e q u i r e s co m p l e x t reat m ent , wit h som et im es devast at ing effect s for t he
or ganism , hazar ds hum an sex ualit y( 1 ).
I n phy siological t er m s, t he alt er at ions blood
cancer and int ense chem ot herapy provoke in different organic syst em s, m anifest ed by signs and sym pt om s,
j eop ar d ize t h ese p at ien t s’ sex u alit y. Mor eov er, t h is t ype of disease dem ands frequent hospit alizat ions and
incidence lev els ar e higher am ong y oung adult s.
I n t his client ele, t he psy chological effect s of a cancer diagnosis confir m at ion should also be t aken
int o account , accom panied by t he cult ural connot at ion of pain, suffer ing and deat h. This pr ov ok es changes
in sex ual and fam ily r elat ions( 1).
Sex u alit y is con sid er ed as a p er son al an d
hum an dim ension t hat com pr ises not only genit alit y, but goes bey ond t he lim it s of genit al im pulse and is
char act er ized as a pr ofound and all- inclusiv e aspect of hum an per sonalit y, pr esent fr om concept ion unt il
deat h and including ev er y t hing w e ar e and w hat w e
do( 1- 3). I t consist s of t hree int errelat ed and inseparable
aspect s - biological, psy chological and social( 2).
The biological aspect considers an individual’s capacit y t o give and receive sexual pleasure; t hus, it
co v e r s t h e f u n ct i o n i n g o f se x u a l o r g a n s a n d t h e p h y s i o l o g y o f h u m a n s e x u a l r e s p o n s e( 1 , 4 ) w h i ch
com pr ises desir e, ex cit at ion and or gasm( 4- 5).
The psychological aspect refers t o sexual
self-im age, ch ar act er ized by t h e self-im ages people h old of
t hem selves as m en and wom en. These are influenced by t he body im age, which is t he m ent al im age people
hold of t heir physical self( 1).
The social aspect inv olv es t he social gender
role, which is a person’s behavior as expect ed by t he
gr oups t hat per son is par t of, as w ell as t he sex ual role, that is, the way we picture how we feel as m en or
wom en to other persons and to ourselves. I n this relation
w it h t he social environm ent , besides sexual behavior,
sexual relations should also be included(1, 6-7).
Th e N o r t h A m e r i c a n N u r s i n g D i a g n o s i s
Associat ion’s t axonom y ( NANDA) considers alt erat ions
relat ed t o hum an sexualit y in t wo nursing diagnoses: “Alt er ed Sex ualit y Pat t er ns”, defined as “ t he st at e in
w hich an indiv idual ex pr esses concer n r egar ding his/
her sex ualit y”( 8) and “ Sex ual Dy sfunct ion”, conceived
as “ a st at e in which an individual experiences a change
i n sex u al f u n ct i o n t h at i s v i ew ed as u n sat i sf y i n g ,
u n r ew ar din g, in adequ at e”( 8 ).
Based on t h ese con sider at ion s, w e h ope t o
cont r ibut e t o t he const r uct ion of Nur sing k now ledge
about hum an sexualit y, st im ulat ing nurses t o t ake int o
account t hat t he sex ual dim ension of hum an beings
n eeds a sy st em at ic assessm en t .
OBJECTI VE
Charact erize t he biological, psychological and
sociocult ural aspect s involving hum an sexualit y which
a r e a f f e ct e d i n p a t i e n t s w i t h o n co - h e m a t o l o g i ca l
d iseases.
MATERI AL AND METHODS
Th is st u d y w as ap p r ov ed b y t h e Resear ch
Et h ics Com m it t ee at t h e Un iv er sit y of São Pau lo at
Ri b ei r ão Pr et o Col l eg e of Nu r si n g ( Pr ot ocol 0 2 7 0 /
2 0 0 2 )( 9 ). Th e p h a se d e scr i b e d i n t h i s p a p e r w a s
developed at a m edical- clinical hospit alizat ion unit , in
t he hem at ology sect or of a public hospit al in Ribeirão
Pr et o/ SP, Brazil. Th e t ar get popu lat ion con sist ed of
adult pat ient s w it h onco- hem at ological diseases w ho
w er e h osp it alized an d w er e sex u ally act iv e b ef or e
finding out about t heir current m edical diagnosis, who
had been hospit alized m or e t han t w ice due t o t heir
disease, had been under chem ot herapy for m ore t han
t h r e e m o n t h s a n d p o sse sse d a t l e a st o n e o f t h e
nur sing diagnoses on hum an sex ualit y pr esent ed by
NANDA( 8 ).
Dur ing t he six - m ont h dat a collect ion per iod,
58 pat ient s were hospit alized in t his sect or, 34 of whom
did not com ply wit h t he inclusion crit eria and t hree of
whom were excluded due t o HI V since, alt hough t hey
pr esen t ed ev iden ce of sex u alit y pr oblem s, it w ou ld
be difficult t o dist inguish whet her t hese problem s were
r elat ed t o t h e on co- h em at ological disease or t o t h e
pr esence of t he HI V v ir us. One of t he r em aining 21
pat ient s r efused t o par t icipat e.
The dat a collect ion inst rum ent w as based on
t he eclect ic m odel, t hat is, a m ult ifocal approach was
used, based on t he char act er izat ion of indiv iduals as
biological, psychological, social and spirit ual beings( 10).
The sear ch for dat a, t hr ough int er v iew s and phy sical
e x a m i n a t i o n s , e m p h a s i z e d t h e b i o l o g i c a l a n d
psy chological aspect s inv olv ing sex ualit y( 1,10), as w ell
Th e d iag n ost ic p r ocess w as u sed t o d et ect
sexualit y problem s of pat ient s wit h onco- hem at ological diseases, m ore specifically t he phases of dat a analysis
an d sy n t h esis( 1 0 ). Du r in g d at a an aly sis, asp ect s of pat ien t s’ sex u alit y w er e cat egor ized an d t h eir gaps
w er e id en t if ied . Wh en d et ect ed , t h ese w er e solv ed by recurring t o t he dat a source. During dat a synt hesis,
t h ese dat a w er e gr ou ped an d NANDA’s t ax on om y( 8 )
w a s u se d t o e l a b o r a t e t h e n u r si n g d i a g n o se s o n
sex u alit y.
I n or der t o det ect a n u r sin g diagn osis in a
clin ical en v ir on m en t , lit er at u r e r ecom m en ds t h at at
least t w o com pet ent nur se diagnost icians be pr esent t o o b ser v e t h e sa m e cl i en t( 1 1 ). Th u s, b esi d es t h e
r esear ch er, t w o ot h er clin ical n u r ses par t icipat ed in d at a collect ion , w h o ar e act iv e in car e d eliv er y t o
hem at ological pat ient s, ar e specialist s in hem at ology an d d ev elop r esear ch on t h e n u r sin g p r ocess an d
hem at ology. They t ook t urns t o collect dat a according t o t heir availabilit y. The researcher was present at all
dat a collect ion sessions and was always accom panied by one of t hese t w o ot her nurses.
For t he int erviews, t he researcher visit ed t he
pat ient in advance, present ed herself, explained about t he t hem e and t he research obj ect ives and request ed
per m ission t o collect dat a. I f t h e su bj ect accept ed, t h e r e s e a r c h e d i n f o r m e d t h a t s h e w o u l d b e
accom panied by anot her nur se and, nex t , scheduled t h e d at a co l l ect i o n sessi o n o n t h e d a t e a n d t i m e
suggest ed by t he pat ient .
Aft er t he int er view , t he t w o nur ses analyzed
d a t a i n d e p e n d e n t l y, a c c o r d i n g t o l i t e r a t u r e
r e c o m m e n d a t i o n s( 1 1 ). W h i l e a n a l y z i n g a n d sy nt hesizing dat a, t he nur ses ident ified t he pr esence
of t h e n u r sin g d iag n oses “ Sex u al Dy sf u n ct ion ” an d “ Al t e r e d Se x u a l i t y Pa t t e r n s” a n d t h e i r r e sp e ct i v e
def in in g ch ar act er ist ics.
What t he ident ificat ion of nur sing diagnoses
in p at ien t s is con cer n ed , t h e n u r se d iag n ost ician s agr eed in all analy ses, including in pat ient s w ho did
not at t end t o t he st udy inclusion crit eria.
Wit h r espect t o t he ident ificat ion of defining ch a r a ct e r i st i cs f o r t h e st u d i e d d i a g n o se s, i n t e r
-observer agreem ent corresponded t o 98% for “ Sexual
D y s f u n c t i o n ” a n d 9 7 % f o r “ A l t e r e d S e x u a l i t y
Pat t er ns”( 9 ).
A g r e e m e n t l e v e l s f o r t h e t w o n u r s i n g
diagn oses u n der st u dy w er e con sider ed sat isfact or y
for t h is k in d of st u dy( 1 1 ). Th e descr ipt ion of sam ple
ch a r a ct e r i st i cs p r e se n t s co i n ci d i n g d a t a f o r e a ch
pat ient by t he t w o nur se diagnost icians.
RESULTS AND DI SCUSSI ON
The sam ple consist ed of 11 m en ( 55% ) and
0 9 w om en ( 4 5 % ) . Th e pr edom in an t age r an ge w as
f r om 1 8 t o 2 7 y ear s. I n t er m s of civ il st at u s, 5 5 %
w e r e si n g l e , 3 5 % m a r r i e d a n d 1 0 % l i v e d w i t h a
part ner. As t o educat ion level, 50% had eit her finished
basic educat ion or not , charact erizing people wit h low
ed u cat ion lev els. Ten p er cen t of t h e su b j ect s w er e
illit er at e.
Wit h respect t o biological aspect s of sexualit y,
60% of t he sam ple indicat ed problem s relat ed t o t he
sex u al d esir e p h ase, 7 5 % t o sex u al ex cit at ion an d
75% t o or gasm .
Su b j ect s m en t i o n ed a d ecr ea se i n sex u a l
desire aft er t he change in t heir healt h st at us; four of
t h e m r e p o r t e d t h a t , b e f o r e t h e i r cu r r e n t h e a l t h
condit ion, t he st im uli t hat st ar t ed t he sexual r elat ion
cam e f r om t h em selv es an d t h eir p ar t n er an d t h at ,
nowadays, t he relat ion only st art s if t he part ner want s
t o. They also argued t hat , oft en, t hey only part icipat e
in t h e r elat ion t o sat isf y t h eir p ar t n er. Th ese d at a
ev idence t he per cept ion of decr eased sex ual desir e,
an aspect t hat is not dir ect ly ev idenced by NANDA,
a l t h o u g h i t c a n b e c o n t e m p l a t e d i n t h e S e x u a l
D y s f u n c t i o n d i a g n o s i s t h r o u g h t h e d e f i n i n g
charact erist ic: “ act ual or perceived lim it at ions im posed
b y d i se a se a n d / o r t h e r a p y ”( 8 ), h o w e v e r, w i t h o u t
m ent ioning w hat sex ual r esponse phase t he pr oblem
occur s in.
Th e d e c r e a s e i n s e x u a l d e s i r e c a n b e
influenced by organic or psychological fact ors. Organic
f act or s ar e m ain ly ch ar act er ized by low er lev els of
t h e t est ost er on e h or m on e, w h ich is r espon sible f or
sex ual appet it e, due t o chem ot herapy, as w ell as by
t he lack of disposit ion r esult ing fr om sev er e anem ia
ex per ienced by t his client ele and by t he pr esence of
n a u s e a a n d v o m i t i n g . Ps y c h o l o g i c a l f a c t o r s a r e
m arked by const ant suffering, fear and preoccupat ion
due t o t he disease and t reat m ent( 6, 12).
I n t h e g r o u p o f su b j e ct s w h o p r e se n t e d
alt erat ions in t he sexual excit at ion phase, 66.7% were
m en and 33.3% wom en. Fift y percent of m en affirm ed
difficult ies t o m aint ain and 50% t o reach an erect ion;
am ong w om en, t he m ain problem w as relat ed t o t he
l ack o f v ag i n al l u b r i cat i o n , p r o v o k i n g p ai n d u r i n g
sex ual r elat ions. Lik e sex ual desir e, ex cit at ion is not
d i r e c t l y t r e a t e d b y N A N D A , b u t c a n a l s o b e
con t em plat ed in t h e def in in g ch ar act er ist ic: “ act u al
t herapy”, present in t he Sexual Dysfunct ion diagnosis,
as it is one of t he phases of sexual response( 8).
Sex u al ex cit at ion pr oblem s am on g m en ar e
also influenced by t he decrease in t est ost erone levels
and by t he onco- hem at ological disease it self, due t o
t h e f r eq u en t p r esen ce of an em ia, w h ich alt er s t h e
vascular m echanism s of t he erect ion, and t o negat ive
em ot ional fact ors. I n physiological t erm s, t est ost erone
l e v e l s ca n b e r e v e r t e d t w o t o t h r e e w e e k s a f t e r
ch em ot h er apy( 6 , 1 2 ).
For w om en, vaginal lubricat ion problem s can
result from t he reduct ion in est rogen horm one levels,
a l s o d u e t o c h e m o t h e r a p y, w h o s e c l i n i c a l
m anifest at ions include decreased vaginal hum idit y and,
rarely, a reduct ion in t he diam et er of t he vagina( 3, 13).
Wh at t h e or gasm ph ase is con cer n ed, 8 0 %
of t he sam ple perceived alt erat ions in achieving sexual
p l e a s u r e ; h o w e v e r, 7 5 % m e n t i o n e d t h e y w e r e
sexually unsat isfied, even aft er changing t heir sexual
pract ice t o cont inue achieving pleasure. Three subj ect s
in t er r u pt ed sex u al act iv it y becau se of dif f icu lt ies t o
o b t a i n p l e a s u r e . I n N A N D A , t h e s e d a t a a r e
con t em p lat ed in t w o d ef in in g ch ar act er ist ics of t h e
Sex u al Dy sf u n ct ion d iag n osis: “ in ab ilit y t o ach iev e
d e si r e d sa t i sf a ct i o n ” a n d “ a l t e r a t i o n i n a ch i e v i n g
sex ual sat isfact ion”( 8 ).
Alt erat ions m ost frequent ly m ent ioned by t he
subj ect s included t he need for gr eat er st im ulus and
con cen t r at ion t o ach iev e p leasu r e an d ch an g es in
posit ion dur ing t he r elat ion. These changes r efer t o
passiv eness dur ing t he sex ual act , ar guing t hat t he
achiev em ent of pleasur e st ar t ed t o depend on t heir
sex u al par t n er.
Li t e r a t u r e d o e s n o t i n d i c a t e t h a t
c h e m o t h e r a p y p r o v o k e s c h a n g e s i n t h e o r g a s m
phase; t his w ill only occur w hen neur ological effect s
ar e p r esen t , su ch as n eu r op at h ies t h at af f ect t h e
n e r v e s g o v e r n i n g t h e o r g a s m r e f l e x . H o w e v e r,
problem s in t his phase can be caused by pain during
t h e r elat ion or du e t o an em ot ion al block pr ov ok ed
by t he disease it self( 13).
Weakness and fat igue are frequent sym pt om s
in pat ient s wit h onco- hem at ological diseases, result ing
from anem ia and undesirable effect s of chem ot herapy,
such as nausea, vom it ing, int est inal const ipat ion and
diar r hea( 14). I n t ur n, t his sit uat ion influences sex ual
l i f e a n d i n t er f er es i n o n e o r m o r e h u m a n sex u a l
r esp on se p h ases.
Th e p s y c h o l o g i c a l a s p e c t s i n v o l v e d i n
sexualit y, w hich ar e r elat ed t o t he sexual self- im age,
ar e affect ed in 60% of t he subj ect s, w ho m ent ioned
t h a t t h e y d i d n o t f e e l a t t r a ct i v e / se n su a l t o t h e i r
par t ner, due t o phy sical alt erat ions pr ov oked by t he
disease and chem ot her apy, such as changes in sk in
color an d t ex t u r e, b ald n ess an d w eig h t v ar iat ion s.
These aspect s can be cov er ed in one of t he defining
char act er ist ics for t he Sex ual Dy sfunct ion diagnosis,
t hat is, “ seek ing confir m at ion of desir abilit y ”( 8).
These changes provoke concerns about social
accept an ce. I n t h e st u dy sam ple, w om en in dicat ed
t h at , t o av oid feelin g disdain ed, t h ey u sed scar v es,
w ig s, h at s, ear r in g s, m ak eu p an d clot h es t o m ak e
t h e m s e l v e s m o r e a t t r a c t i v e ; m o r e o v e r, t h e y
m e n t i o n e d t h e y w e r e a l w a y s a sk i n g t h e i r se x u a l
par t ner if t hey st ill lik e t hem . One pat ient t old t hat
she liked t o get com plim ent s fr om her par t ner, w hile
an ot h er w om an said sh e w as alw ay s look in g in t h e
m ir r or t o see how differ ent she w as. A m ale pat ient
a l s o r e p o r t e d t h i s b e h a v i o r, w h i l e o t h e r m a l e
part icipant s m ent ioned t hey ask t heir part ners if t hey
st ill f eel t h e sam e w ay abou t t h em , in spit e of t h e
ch an ge in ph y sical appear an ce.
Not f eelin g on eself at t r act iv e is on e of t h e
m o s t n e g a t i v e e f f e c t s o f c a n c e r t r e a t m e n t ,
char act er ized by t he change in how people per ceiv e
t h eir ow n body. For y ou n g an d sin gle pat ien t s, t h is
ex p er ien ce can b e p h y sically an d em ot ion ally h ar d
and can culm inat e in depr ession( 12).
As t o t he social aspect s inv olv ing sex ualit y,
85% of t he sam ple referred t o som e kind of problem
int erfering wit h t heir sexual act ivit y or sexualit y. These
aspect s can be observed in one defining charact erist ic
of t h e n u r sin g diagn osis Alt er ed Sex u alit y Pat t er n s:
“ r epor t ed difficult ies, lim it at ions or changes in sexual
behav ior s or act iv it ies”( 8).
The m ain difficult y or lim it at ion charact erized
as a sou r ce of pr eoccu pat ion t h at af f ect s sex u alit y
w as t he fear of acquir ing an infect ion as a r esult of
l o w i m m u n i t y l e v e l s ( 7 0 . 6 % ) . Ot h e r c o n c e r n s
m ent ioned w er e t he possibilit y of infer t ilit y ( 11.8% ) ,
fear of not sat isfy ing t he sex ual par t ner ( 5.9% ) and
of copin g w it h sex u al r elat ion s ( 5 . 9 % ) ; on e pat ien t
a f f i r m ed sh e f a ced d i f f i cu l t i es b u t co u l d n o t g i v e
specific infor m at ion ( 5. 9% ) .
Due t o frequent cases of neut ropenia in t hese
pat ient s, w hich m ak es t hem v ulner able t o infect ious
p r o ce sse s, p a t i e n t s p r o t e ct t h e m se l v e s b y u si n g
condom s during sexual relat ions and m asks in specific
places and sit uat ions, as w ell as by hospit al isolat ion
Th e s e p r o t e c t i o n m e a s u r e s i n t e r f e r e i n
pat ient s’ sex ual behav ior, not only dur ing t he sex ual
r e l a t i o n , b u t a l so i n t h e w a y t h e y e x p r e ss t h e i r
sex u alit y, w h ich is m an ifest ed b y difficu lt ies t o fin d
people t o r elat e w it h, due t o t he use of m ask s and
isolat ion .
On e of t h e pat ien t s w h o believ e dif f icu lt ies
are relat ed t o t he possibilit y of infert ilit y said he hided
t his fact fr om his gir lfr iend. I n t hese cases, feelings
o f g u i l t a r e c o m m o n , w h i c h c a n i m p a i r s e x u a l
r elat ions( 1 ).
The fear of not sat isfying t he sexual par t ner
and of coping wit h sexual relat ions m ay be relat ed t o
a lack of com m unicat ion bet ween part ners, who should
m u t u ally ex pr ess t h eir sex u al feelin gs an d n ot w ait
for t he ot her person t o discover his/ her anxiet ies and
n eeds( 1 ).
B e s i d e s t h e s e d i f f i c u l t i e s , i t s h o u l d b e
h i g h l i g h t e d t h a t 7 0 % o f t h e s a m p l e m e n t i o n e d
decr eased sex ual act iv it y and ev en int er r upt ion aft er
discov er ing t he disease. Four subj ect s indicat ed t hey
h a d st o p p e d a l l se x u a l a ct i v i t y a f t e r t h e d i se a se
ap p ear ed .
At t h e st ar t o f t r eat m en t , t h ese p at i en t s’
sex ual act iv it y is r elat ed t o t he feeling of w eak ness
and downheart edness, as highlight ed in lit erat ure( 1,14)
and, lat er, t o const ant hospit alizat ions, lack of privacy,
f ea r o f i n f ect i o n a n d o t h er p sy ch o l o g i ca l a sp ect s
r elat ed t o t he disease, w hich ar e also m ent ioned in
lit er at ur e( 15).
Wh at t h e per f or m an ce of sex u al an d social
r oles is con cer n ed , 4 0 % of su b j ect s in t h e sam p le
w er e concer ned about t heir fem ale or m ale r ole and
a b o u t ch a n g es i n t h ei r so ci a l r o l e. Ma l e su b j ect s
r e v e a l e d a l o s s o f s o c i a l l y v a l u e d p e r s o n a l
charact erist ics in m en, such as t he absence of a beard
an d a m u scu l ar b o d y, w h i l e w o m en w er e w o r r i ed
about t heir fem ininit y. One fem ale subj ect m ent ioned
she only had sexual relat ions if she is using a wig or
scarf. Wit h respect t o social roles, t he im possibilit y t o
d o h ou sew or k an d p er f or m t h eir r oles as m ot h er s
w as m en t ion ed as t h e g r eat est sou r ce of con cer n ,
ar gu in g t h at t h e lack of t h ese act iv it ies pr ov ok es a
feeling of incapacit y t o be a wom an. I n NANDA, t hese
dat a ar e cont em plat ed in t he defining char act er ist ic
“ alt er at ion s in ach iev in g per ceiv ed sex r ole” of t h e
Sex ual Dy sfunct ion diagnosis( 8 ).
Pat ient s w it h onco- hem at ological diseases no
longer per for m t heir social r oles because t hey m ov e
aw ay fr om t heir liv ing r out ine and adopt t he r ole of
‘sick person’, charact erized by effort s t o get t reat m ent ,
seek car e, com ply w it h pr escr ipt ion s an d cooper at e wit h doct ors( 1,12).
Th r o u g h t h e i r r e p o r t s , t h e s e p a t i e n t s dem onst rat ed t hat t hey are obliged t o abandon, even
if t em p or ar ily, t h eir r oles as f at h er s, m ot h er s an d pr ofessionals. Dur ing t r eat m ent , t hey liv e in hospit al
and, at hom e, t hey m ent ion t hat t hey cannot perform e v e n t h e i r f a m i l y r o l e s d u e t o t h e e f f e c t s o f
ch em ot h er apy an d r elat ed dr u gs.
Wit h respect t o sexual relat ions, 30% of t he
subj ect s r epor t ed changes in t heir r elat ion w it h t heir
sexual part ner, m ainly due t o a lack of com m unicat ion bet w een bot h par t ner s. This finding can be obser ved
in t h e ch ar act er ist ic “ alt er at ion in r elat ion sh ip w it h significant ot her ”, proposed by NANDA as part of t he
nur sing diagnosis Sex ual Dy sfunct ion( 8 ).
Th e l ack o f co m m u n i cat i o n ab o u t f eel i n g s
b e t w e e n b o t h p a r t n e r s, ch a r a ct e r i ze d a s se x u a l isolat ion , im p air s t h e r elat ion sh ip( 1 ), as m en t ion ed
above. Three pat ient s evidenced t his fact , m ent ioning t h a t t h e su b j ect s o f co n v er sa t i o n s w er e d i sea se,
t r eat m ent and fam ily.
On t he ot her hand, it should be highlight ed t h at sev en p at ien t s in d icat ed t h eir sex u al r elat ion
changed for t he bet t er aft er t he disease, as t hey felt m or e valued by t heir par t ner.
Th e s e r e s u l t s d e m o n s t r a t e t h a t , d u r i n g t r eat m ent , pat ient s w it h onco- hem at ological diseases
pr esent pr oblem s r elat ed t o sexualit y and t he sexual f u n ct ion .
CONCLUSI ON
Th e ch ar act er izat ion of on co- h em at olog ical
p at ien t s’ sex u alit y allow s u s t o con clu d e t h at b ot h d i s e a s e a n d c h e m o t h e r a p y p r o v o k e s i g n s a n d
sy m pt om s t hat collabor at e t o br ing about alt er at ions i n se x u a l f u n ct i o n s a n d i n t h e w a y se x u a l i t y i s
ex p r essed .
Alt erat ions in sexual funct ions w ere cent ered i n d e cr e a se d se x u a l d e si r e , e r e ct i o n a n d v a g i n a l
lu b r icat ion d if f icu lt ies an d alt er at ion s in ach iev in g
sex u al sat isf act ion , pr ov ok ed by t h e clin ical pict u r e of anem ia, by chem ot her apy and by t he influence of
t he sit uat ion in t he em ot ional sphere. These alt erat ions
are cont em plat ed in t he defining charact erist ics of t he Sex u al Dy sf u n ct ion d iag n osis, alt h ou g h t h e sex u al
r e sp o n se p h a se s o f d e si r e a n d e x ci t a t i o n ca n b e
Recebido em : 16.2.2005 Aprovado em : 18.11.2005
As t o a l t e r a t i o n s i n t h e w a y se x u a l i t y i s
ex pr essed, t he fear of acquir ing a disease due t o a
severe w eakening of t he im m une syst em st ands out ,
w h i ch f r e q u e n t l y h a p p e n s i n o n co - h e m a t o l o g i ca l
diseases. How ever, it should be m ent ioned t hat t his
and ot her difficult ies indicat ed by t his sam ple lead t o
alt erat ions in sexual behavior, ranging from decreased
fr equency of sex ual act iv it y t o t he ex t r em e decision
t o i n t er r u p t sex u al l i f e af t er t h e d i ag n o si s o f t h e
d i se a se ; t h e se a sp e ct s a r e co n t e m p l a t e d i n t h e
defining charact erist ic “ report ed difficult ies, lim it at ions,
or ch an g es in sex u al b eh av ior or act iv it ies” of t h e
nur sing diagnosis I neffect iv e Sex ualit y Pat t er ns.
Th ese r esu lt s st r en g t h en t h e n eed t o h elp
t hese client s in aspect s r elat ed t o Hum an Sex ualit y,
m ain ly by aler t in g n u r ses t o pr epar e t h em selv es t o
work in t his area; t o avoid t heir graduat ion wit h m erely
“ fluid and lim it ed not ions of hum an sexualit y, wit hout
a guiding base”( 16), w it hout t he com pet ences needed
t o ident ify t his kind of clinical evidence.
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