REVIEW ARTICLE Sexual issues in early and late stage cancer: a review Sebastiano Mercadante & Valentina Vitrano & Viviana Catania Received: 10 March 2009 / Accepted: 7 January 2010 / Published online: 18 March 2010 # Springer-Verlag 2010 Abstract Introduction Sexuality is an important aspect of life involving physical, psychological, interpersonal, and be- havioral aspects. The aim of this review was to examine the literature regarding sexuality in advanced cancer patients, after taking into consideration the principal changes produced by the disease and its treatment. Methods This review considered references through a search of PubMed by use of the search terms “advanced cancer,”“palliative care,” in combination with “sexuality” and/or “intimacy.” Results Surgery, chemotherapy, hormonal therapy, radio- therapy, and drugs commonly given for the symptomatic treatment have relevant consequences on sexuality, also in the advanced stage of disease. Sexual dysfunction is a multifaceted issue and different causes may concomitantly have a role, including the psychological and clinical status. The existing clinical studies have shown important cultural barriers on sexuality. Sexuality is not considered a medical concern compared with the priority of treating cancer or symptoms. Although this issue is very private, unaddressed sexuality changes can be among the most negative influences on the social well being of a cancer patient. It is increasingly acknowledged that issues surrounding sexuality are an important factor in quality of life for patients with cancer and that sexuality is a legitimate area of concern in oncology and palliative care. Few studies have assessed sexuality in the advanced stage of disease. Nevertheless, advanced cancer patients are willing to talk about their sex lives and the impact of the disease on their sexual function. Conclusions To provide this component of care, profes- sionals need to have good communication skills, an open and non-judgmental approach, and knowledge of the potential ramifications of disease and treatment of sexu- ality problems. Keywords Sexuality . Cancer . Palliative care According to World Health Organization, sexuality is a central aspect of human being throughout life and encom- passes sex, gender identities and roles, sexual orientation, eroticism, pleasure, intimacy, and reproduction [1]. Sexual- ity is a multidimensional issue, expressed by many socio- cultural aspects, such as thoughts, fantasies, desires, beliefs, attitudes, values, behaviors, practices, roles, and relation- ship [2]. Sexuality has also been defined as the process of giving and receiving sexual pleasure and is associated with a sense of belonging or being accepted by another [3]. Intimacy has been described as the sharing of identity, closeness, and reciprocal rapport, more closely linked to communication issues rather than sexual function [4]. Although sexual intimacy is important, it is not the only form of intimacy. Different psychological and physical problems develop during the disease due to cancer itself or consequences of treatment and inevitably worsen in the advanced stage. The topic is even more rarely addressed in the advanced stage of disease and cancer practitioners falsely assume that those with advanced stage of disease are essentially “asexual.” The aim of this review is to examine the different aspects of sexuality in advanced cancer patients, the possible S. Mercadante (*) : V. Vitrano : V. Catania Pain Relief and Palliative Care Unit, La Maddalena Cancer Center, Via San Lorenzo 312, 90146 Palermo, Italy e-mail: terapiadeldolore@lamaddalenanet.it Support Care Cancer (2010) 18:659–665 DOI 10.1007/s00520-010-0814-0