Maxfacts

Below we aim to provide some additional information for professionals, researchers in psychosexual therapy and psychosexual therapists with no specific training in maxillofacial pathology or surgery, as well as for patients and carers.

It is not unusual to feel a lack of knowledge in this field. There is very little data available specific to the area of maxillofacial surgery (something that prompted research). In order to support patients and/or partners who highlight an issue through initial conversation or a health needs assessment (something performed by nursing staff in the admission process of patients having treatment in the UK – this will vary country by country) or any sexual problems that are worrying them in relation to that treatment event (as distinct from a visit to a general practitioner where more general intimacy and sex issues would be discussed more appropriately), a medical professional does not need to be an expert to ‘open the door’. However, some of the concepts outlined below, or a head & neck cancer specific questionnaire may be helpful for all involved. The questionnaire has been designed alongside a specialist cancer team and patients undergoing treatment for, or having had, head and neck cancer. The questionnaire has also been developed in light of the assessment that trained psychosexual therapist use, called ‘history taking’.

From the data collated in the research process undertaken to develop and initially validate the questionnaire (the ‘MHK tool’), a number of symptoms that affect the desire for sexual intimacy were identified. In some instances, these are amenable to self-help/management once the issue has been identified. Suggestions and possible remedies to address such issues by means of self-help are available, sometimes a formal referral for professional input and support is more appropriate.

Relevant symptoms commonly mentioned by patients include

• 68 % tiredness/exhaustion;
• 62 % dry mouth;
• 50 % thick saliva;
• 44 % loss of confidence;
• 41 % anxiety;
• 38 % restricted tongue movement;
• 35 % breath smelling bad;
• 35 % pain;
• 30 % loss of feeling in tongue;
• 30 % communication/speech difficulties;
• 30 % restricted head movement;
• 23 % scars from surgery;
• 23 % oral thrush;
• 23 % breathing difficulties;
• 21 % loss of control of lip suction;
• 15 % loss of feeling in lips;
• 15 % reflux;
• 12 % feeding tube (nasogastric tube or gastrostomy, although both have different issues).

Non-maxillofacial specific sexual dysfunction is defined as

• erectile dysfunction (medical and/or psychological);
• rapid ejaculation;
• delayed ejaculation;
• vaginismus and dyspareunia (painful penetration);
• orgasmic disorders.

Lack of, or no, sexual desire or arousal - if this precedes maxillofacial intervention and was not or is not considered to be an issue, it is exactly that – not an issue. If it has become an issue since maxillofacial intervention, then it may (or may not) be something which combined specialist techniques can help with. Referral to the general practitioner or self-referral to organisations such as Relate (in the UK) for support and help with a trained psychosexual therapist may be appropriate. Psychosexual therapy can be for individuals as well as for couples. It is worth noting that very few psychosexual therapists have training in dealing with individuals with concomitant disease or treatment effects, and when they do this is usually in the fields of gynaecology, urology or breast cancer.