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Assessment and recording tools

The assessment of sexual problems by nurses is thought to be essential for timely advice and support (Dean [68]). The absence of this discussion or information may potentially lead to the patient misconception that sexual difficulties are unique following cancer and may result in feelings of isolation (Perz and Ussher [224]). Reported barriers to effective communication regarding cancer‐related sexual difficulties by healthcare professionals include a lack of time and formal training, and poor grounding to assess sexuality and treat sexual functioning (Zhou et al. [294]). Communication and sexuality discussions can be facilitated with sexuality intervention models (Quinn and Hapell [233]). However, these specialist assessments may be more frequently used in services seeing a large volume of people or where specialist management is undertaken (LCA [148]).

The PLISSIT model

This model provides a framework for healthcare professionals that can allow for engagement of discussion of sexual changes, provide sexual information, and offer support at various levels of increasing concern with corresponding levels of intervention. The intervention levels within the PLISSIT model include: Permission, Limited Information, Specific Suggestions or Intensive Therapy (Perz and Ussher [224]).

The BETTER model

This model is a structured approach that can be useful in supporting nurses in discussions about sexuality. This sexuality intervention model has six individual stages (Quinn and Happell [233]):

B = Bring Up. The nurse simply raises the subject of sexuality, showing that there is a willingness to address this now or in the future.
E = Explain. The nurse normalizes the discussion, explaining that sexuality is an important quality of life issue for many people.
T = Tell. The nurse tells the patient that if there are concerns and they are unable to be immediately addressed a referral for specialist review can be made.
T = Time. The nurse offers the possibility of a future time for further discussion.
E = Educate. The nurse educates regarding the sexual side‐effects of treatment.
R = Record. The assessment, treatment and outcome are recorded by the nurse.

Sexual functioning assessment scales

There are multiple validated sexual functioning assessment scales available. These include:

Body Image Scale (BIS)

This scale comprises of 10 items for which a total score is calculated, ranging from 0 to 30; a higher score indicates a higher frequency of body image problem (Bredart et al. [26]).

Sexual Activity Questionnaire (SAQ)

This comprises of questions on sexual status and reasons for a possible absence of sexual activity. It includes an evaluation of sexual pleasure and discomfort during sexual intercourse (e.g. vaginal dryness, pain during sexual intercourse) (Bredart et al. [26]).

Tools specifically for use with women

The Female Sexual Functioning Index (FSFI)

The FSFI organizes sexual function data across six scales: desire, arousal, lubrication, orgasm, satisfaction, and pain (Raggio et al. [235]).

The Female Sexual Distress Scale – Revised

This is a 5‐point rating scale (0 = never, 4 = always) with higher scores indicating sexual distress. It evaluates the frequency of negative emotions related to sexual problems over the previous month (Raggio et al. [235]).

Assessment tool for use with men

The International Index of Erectile Function (IIEF)

The IIEF addresses the relevant domains of male sexual function: erectile function, orgasmic function, sexual desire, intercourse satisfaction and overall satisfaction. The abridged Sexual Health Inventory for Men (SHIM) or five‐item version of the IIEF (Table 27.6) can be used as a screening tool to identify the presence or absence of erectile dysfunction (Rhoden et al. [236]).

Table 27.6 SHIM/IIEF‐5 screening tool

	Score
Over the past 6 months:	1	2	3	4	5
How do you rate your confidence that you could get and keep an erection?	Very low	Low	Moderate	High	Very high
When you had erections with sexual stimulation, how often were your erections hard enough for penetration?	Almost never or never	A few times	Sometimes	Most times	Almost always or always
During sexual intercourse, how often were you able to maintain your erection after you had penetrated (entered) your partner?	Almost never or never	A few times	Sometimes	Most times	Almost always
During sexual intercourse how difficult was it to maintain your erection to the completion of intercourse?	Extremely difficult	Very difficult	Difficult	Slightly difficult	Not difficult
When you attempted sexual intercourse, how often was it satisfactory for you?	Almost never or never	A few times	Sometimes	Most times	Almost always or always
Total score questions 1–5 =
1–7, severe erectile dysfunction; 8–11, moderate erectile dysfunction; 12–16, mild–moderate erectile dysfunction; 17–21, mild erectile dysfunction; 22–25, no erectile dysfunction.

Source: Adapted from Rosen et al. ([242]). Reproduced with permission from Elsevier.