Reprinted from Australian Family Physician Vol. 32, No. 1/2, January/February 2003  19 T here is evidence that health practitioners are not comfortable discussing the issues of sexual- ity and sexual functioning in cancer survivor patients, are not fully knowledgeable regarding loss or change in sexual function secondary to cancer treatment, or do not feel they have the skills to appropriately raise these issues with their patients. 1 Psychosexual impact of cancer The psychosexual impact of cancer and its treat- ments is influenced not only by the physical changes that affect body image and sexual func- tion, but by other factors such as whether the person is in a current sexual relationship, the quality of the sexual relationship, and to a certain extent the person’s age. Cancers that potentially have the greatest impact on sexuality body image and sexual func- tioning are:  breast  prostate  colorectal  gynaecological  testicular, and  head and neck cancers. Treatments for cancer including surgery, chemotherapy, radiation and hormonal therapy, can all negatively impact on sexual functioning and fertility (Table 1). It has been estimated that approximately half the women who survive breast cancer report severe sexual problems. 2 After a mastectomy women are particularly vulnerable, with younger women being twice as likely to experience sexual problems than older women. 3 Women who are given hormonal treatment for breast cancer have decreased circulating oestrogens which can cause loss of sexual desire, vaginal dryness and painful sexual intercourse. Even with nerve sparing surgery for prostate cancer, impaired sexual function may still be a sig- nificant problem, particularly over time. There is also a risk of urinary incontinence, though this improves over time for the majority of patients. It has been estimated that between 62–88% of men and women experience sexual dysfunction after surgery for colorectal cancer when pelvic auto- nomic nerves are damaged. 4 Psychosexual dysfunction is higher in patients with a stoma, com- pared to those with intact sphincters. 5,6 BACKGROUND Cancer and its treatments can profoundly affect a person’s sexuality including their body image, sexual functioning, relationships, identity and self esteem. One of the more common long lasting effects of cancer treatment is sexual dysfunction, yet for a number of reasons, health practitioners may not adequately address these topics. OBJECTIVE This article describes the range of factors contributing to psychosexual problems for people with cancer and provides a useful framework for addressing problems and taking a sexual history. DISCUSSION More than half of all people diagnosed and treated for cancer in Australia now survive their disease. Many of these survivors suffer from significant physical and emotional changes during and after their cancer treatments that affect their sexuality and sexual functioning. Such patients need an opportunity to discuss these changes with their health practitioners, but all too often are not given the opportunity to do so. Kendra Sundquist, Lesley Yee Kendra Sundquist, EdD, MHlth, Sc(Ed), RN, MCN(NSW), is Program Specialist, Professional Education and Training, The Cancer Council, New South Wales. Lesley Yee, MBBS (Hons), MMed (Psychotherapy), FACSHP, FACPsychMed, is a general practitioner and sexual counsellor in private practice, Sydney, New South Wales. THEME: Cancer survivors Sexuality and body image after cancer