In a heterosexual female, it is very important to discuss preventing pregnancy while receiving treatment. Referral to gynecology prior to starting chemotherapy should be considered in order to discuss/start some form of birth control. It is also important to emphasize the need for double contraception, both to prevent pregnancy and to decrease risk of STIs. Barrier protection is needed while receiving chemotherapy to prevent exposing one’s partner to chemotherapy. It is also important to discuss side effects from treatment, which can include vaginal dryness/decreased libido/altered physical perception, and to be able to provide resources/referrals for symptom management.
Further precautions regarding sex are also necessary to educate and reinforce (not only during, but) after receiving treatment with chemotherapy due to lower platelet and neutrophil counts (untl count recovery or at acceptable levels of safety) that increase the risk for bleeding and infection respectively (besides contraception mentioned in an earlier post).
I agree with the direct communication approach of being open, clear, and factual to help them understand their unique circumstances. I also agree that we as HCPs need to initiate the conversations to not only give permission to discuss these private and very personal things, but to bring them up as a point understanding that we know sex, body image, etc are parts of entire personhood and important enough for us to spend some time on, showing that we are available and acknowledge that these questions are just as important as treatment decisions and follow-up care for example.
Our valuable time is worth spending on this topic to emphasize its importance and to ensure patient understanding, promoting safety, and addressing their holistic care needs. EZ