Counseling Cancer Survivors With Vaginal Pain
Nurses are encouraged to consider a counseling model when treating female cancer survivors with sexual pain, according to a paper published last year in Nursing2017.
The model is called the Minimizing Pain with Vaginal Penetration Model (MPVP). As the name suggests, it targets pain with penetration. It also addresses other effects of sexual pain, such as low desire.
The medical term for painful intercourse is dyspareunia. In cancer survivors, it is linked to three specific situations:
Typically, when a woman becomes sexually aroused, her vagina lubricates to prepare for penetration and make it more comfortable. But some cancer treatments disrupt this process. For example, surgical removal of the ovaries or chemotherapy might reduce a woman’s levels of estrogen, a hormone that is essential for vaginal health. Other treatments, like radiation and medications, can lead to vaginal dryness, too.
Nurses should counsel women about vaginal lubricants and moisturizers, the authors explained. Both products, which are available over the counter, can help with vaginal dryness, but they are used in different ways. Lubricants are applied as needed just before sex, but moisturizers are used every few days regardless of whether a woman is sexually active.
The vagina is a flexible organ, designed to accommodate a penis. But it can lose some of this flexibility after cancer treatment, especially after pelvic floor radiation. Also, some women avoid sex because of pain, resulting in further lost elasticity.
Women may regain some of the flexibility by using dilators – penis-shaped cylinders of various sizes – that stretch the vagina and help women grow accustomed to penetration again. Vaginal stimulation, administered manually or through a vibrator, may also help.
In addition to vaginal dryness, other changes to the vagina can occur when estrogen levels decrease. Tissues may become thin and brittle, and the labia might become smaller. Moisturizers and lubricants may help in this case, too.
The PLISSIT Model
Healthcare providers and patients don’t always talk about sexual issues. However, nurses can start the conversation using the the PLISSIT model, the authors said.
The acronym PLISSIT is explained as follows:
P – Permission to discuss sexual pain with the patient is requested.
LI – Limited Information is sought.
SS – Specific Suggestions are made.
IT – Intensive Treatment (such as a referral to therapy) is offered.
“Nurses are in an ideal position to address female cancer survivors’ sexual health concerns related to painful vaginal penetration,” the authors wrote. Targeting sexual pain specifically, with an approach like the PLISSIT model, might help nurses “organize their thinking” and offer suitable therapies.
“New counseling model can help minimize vaginal pain in cancer survivors”
(September 11, 2018)
Chism, Lisa Astalos DNP, APRN-BC, NCMP, FAANP and Morris A. Magnan, PhD, MSN, RN
“Talking to cancer survivors about dyspareunia and self-management”
(Full-text. October 2017)