Maxfacts

Many commonly occurring symptoms causing issues with intimacy and sex in relation to the treatment of head & neck cancer may be addressed by some fairly simple interventions, or referrals to members of the treating team may be of some help.

• 68 % tiredness/exhaustion – while this is hardly a symptom specific to maxillofacial interventions, it does have a relatively simple and effective intervention: keep a diary and look at when the affected person has most available energy – that is the most suitable time for active intimacy or sex.
• 62 % dry mouth – this is a quite specific oral and maxillofacial issue, although it is also common outside this area. It is vital to realise that the xerostomia (dry mouth) of patients who have undergone treatment, perhaps radiotherapy for head and neck cancer, is completely different from, for example, the dry mouth of transient anxiety when doing something new or anxiety stimulating. Depending on the cause of xerostomia, different management strategies will be appropriate. General good mouth care is highly recommended, use of natural lubricants such as extra virgin olive oil, other oils or cream not only help with lubricating foods, and (very rarely) salivary stimulants (sugar free) can be helpful.
• 50 % thick saliva – thick, viscous saliva can be very troublesome; apart from general mouth care, the use of fresh pineapple or papaya (which contain mucolytic enzymes) can be helpful.
• 44 % loss of confidence – some basic confidence boosting strategies may be helpful. There is a distinct overlap here with formal psychological input and psychosexual therapy.
• 41 % anxiety - mindfulness techniques short of formal psychological input may help some.
• 38 % restricted tongue and/or lip movement – referral to speech and language therapist (who will already be a member of the head and neck cancer team, but can be referred to outside that specific scenario).
• 35 % breath smelling bad – this may be a real or perceived problem; it is far easier to deal with an objectively verified ‘bad breath’ as a cause can usually be located and dealt with by appropriate oral hygiene measures.
• 35 % pain – this may be as simple as avoiding or developing a workaround for a localised maxillofacial issue, or as complex as conceivable and require a detailed pain assessment (including diary) and intervention.
• 30 % loss of sensation in tongue – this is an issue which runs across multiple oral and maxillofacial surgical interventions.
• 30 % communication/speech difficulties – if this is primarily physical, then referral to speech and language therapy would be appropriate. However, if the issue is more ‘communication’ than ‘speech’, formal psychological or psychosexual therapy referral is required.
• 30 % restricted head movement – physiotherapy referral can be helpful.
• 23 % scars from surgery – once physical management of scars has been exhausted, some techniques used by trained practitioners such as cognitive behavioural therapy or neurolinguistic programming can be helpful for some.
• 23 % oral candidiasis (thrush) – optimal oral hygiene and simple medical intervention with antifungal agents (miconazole or fluconazole).
• 23 % breathing difficulties – hardly specific to maxillofacial interventions, but likely an area which will receive much more attention because of COVID-19; several self-help techniques are being advocated and are available from popular sources such as the BBC homepage. Speech and language therapy as well as physiotherapy may help with breathing techniques that are specific to a maxillofacial issue.
• 21 % loss of control of lip suction – this has a specific impact on swallowing as well – problem specific exercises guided by speech and language therapy can help.
• 15 % loss of sensation in lips –common across the field of maxillofacial interventions; a combination of self-awareness and some speech and language therapy guided exercises may help.
• 15 % reflux – this may or may not precede an intervention. If not specifically related to intervention in the oesophagus or lower pharynx, then measures aimed at laryngopharyngeal or gastro-oesophageal reflux (mainly daily use of antacid agents such as proton pump inhibitors or alginate-based liquid preparations), as well as consumption of small volumes of food and fluid can help.
• 12 % feeding tubes– issues regarding timing of feeds can be altered relatively easily once the problem is recognised. Gastrostomy tubes are less intrusive in everyday life but present a body image issue which may need formal psychosexual therapy input. Nasogastric tubes could be regarded as a driver in that getting them removed as early as is safe and possible, removes the problem.

Non-maxillofacial specific sexual dysfunction is most appropriately managed by referral to a general practitioner, or self-referral to organisations such as Relate in the UK for support and help by a trained psychosexual therapist may be appropriate. Psychosexual therapy can be for individuals as well as 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.