A Cry for Help

A Cry for Help

Anne Katz, PhD, RN, FAAN

@DrAnneKatz
Mar 12, 2015

I received an email this week and this is all it said:  “I’m 51 years old and I was diagnosed with breast cancer 8 years ago, I love my husband very much I have no sex drive I do not want to be touched by him I hate sex it hurts is not comfortable it's not enjoyable, I have talked to my spouse about my sex drive and he just thinks it's a phase that I'm going through but it's not, we still have sex once a week I don't call it lovemaking sex I call it being [******], it makes me feel terrible I just feel bad I could just cry, maybe I really just have not accepted that I have breast cancer.”

There was a name at the end, just a first name, and no information about where she lives. No information about her treatment either—just a long and lonely cry for help.

The distress in this short email says so much. And if I put aside my emotional response to her words, what I see is a total lack of communication. It’s been eight years since her diagnosis and treatment. Where in that time did anyone provide her with anticipatory guidance or even a brief assessment of her emotional response to treatment? Perhaps she’s on endocrine manipulation therapy and the pain she experiences is a side effect of the vaginal atrophy we see in women on aromatase inhibitors (AI).

But if she’s taking this medication, someone must be prescribing it, and why aren’t they asking her how she’s doing? Even if she’s not on an AI and is taking tamoxifen instead, which doesn’t have quite the same effect on the vaginal mucosa, the same cautions apply. Who is NOT talking to this woman about her coping after treatment? And who has screened her for distress in all this time? Eight years later and she is not sure that she has accepted her diagnosis . . .

She’s tried to explain her lack of desire to her husband. What women could possibly feel desire when the end result is pain? He doesn’t understand what she is going through; this is not a phase, and she is somehow hiding her distress from him during intercourse—or else, perhaps, he doesn’t care about her pain. That thought takes away any professional distance I can muster.

Communication lies at the root of all human interaction. I see the failure of communication every day in practice. The patient who doesn’t hear what is said after being told their diagnosis. The nurse who completes his laundry list of patient-education information—and neglects to assess what the patient has heard, or if she understands what she has been told. The couple who are having sexual difficulties and don’t talk about it at all, at least not until they are in my office, and they finally start to communicate with each other. We are human, and we have the gift of words and voice. We need to use both more effectively so that the only thing being said is not a cry for help, eight years later.

 

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Comments

Mary Joanne Deforest

Jun, 25 2015 12:58 AM

How sad!


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