Getting a cancer diagnosis is usually stressful not only for the patient, but also for their friends and family.“I think when you have it, your whole life stops. Everything runs around the cancer and the treatment,” said Hayley Bennett, a reflexologist with special training in cancer therapies.While doctors recognise the impact of the disease on the physical body and on a person’s emotional state they tend to overlook how cancer can change sex and sexuality, according to Anne Katz.Dr Katz, a nurse with a doctoral degree and training in sex therapy, spoke with local doctors on this much-ignored area earlier this month as part of the Bermuda Hospitals Board’s continuing education for health care practitioners.Based in Canada, she first visited Bermuda last year to speak with a group of breast cancer survivors. Women at that meeting agreed that the subject had not come up in consultations with their physicians.That doctors had not raised the issue with their patients is not unique to Bermuda, Dr Katz told Body & Soul.“Excuses I get from health care providers very often are that they don’t think that the patient thinks it’s important. It’s a quality of life issue. Sometimes health care providers are very much focused on cure and not particularly in quality of life. I think that is changing but it still exists.”Lack of time and lack of privacy are other common excuses she hears from physicians.Privacy becomes an issue because in some settings the patient is not alone when they are receiving treatment.For example, she said chemotherapy is typically done with several patients in the same room. But she said whatever the doctors’ excuses, “I have answers for all of them”.“Privacy cannot be an excuse because if we need to talk to a patient about end-of-life issues or financial issues, we find a private place to talk.“Lack of knowledge is something I hear a lot of because unfortunately healthy human sexuality is not a topic that is not well covered in nursing schools and medical schools anymore. It’s been pushed aside with all this other stuff that people have to know, “ she said.Sex is different from sexuality, she added.“It is about how we see ourselves as men and women as sexual beings.“The cancer itself and the many different treatments we use most profoundly affect sexuality. So my message for health care providers is that this is an important topic for patients.“Patients want to talk about it but they wait for us to ask and if we don’t ask there’s this silence and we are not attending to a very important part of the patient’s life.”Sexual difficulties arise in 80 percent of cancer patients, Dr Katz said. People who have lymphoma and have a bone marrow transplant “can experience profound changes”, she said.And the side effects of cancer treatments often impact sexuality.“For example if someone has radiation to the head or neck it can actually impact the brain itself and parts of the brain that are conductors of our hormonal and endocrine systems, so that can profoundly affect sexuality.”Sexuality is also often impacted when cancer causes a person’s body image to change.“For a woman who’s had breast cancer and for a man who’s had colorectal cancer and now has an ostomy bag, loss of interest is very, very common,” she said.And she said it’s the most frequent complaint of those who come to see her.Talking about it is the most important first step she said. And this is what she stresses with physicians.“Sometimes the health care providers are just embarrassed to talk about it,” she said.In her physician presentations she said she gives a few examples of easy ways to start the conversation.“There are two well known models that we use when we are asking patients about other stuff as well. I enlighten a little bit and role model for them by using stories to show them that this is not the Pandora’s box that they think it is.”