Surviving Childhood Cancer: Disruptions in the Developmental Building Blocks of Sexuality

Abstract

Clinical work with young adults who were successfully treated for cancer during childhood and adolescence reveals the psychosocial complexities of being a cancer survivor as well as the multifaceted nature of human sexuality and development. Healthy sexual development is based on the delicate interplay of physical, psychological, and interpersonal factors. Young patients with any chronic illness, including cancer, must tackle normative developmental issues as well as disease- and treatment-related challenges. Because development occurs as a succession of inextricably related stages, one building on another, disruption at an earlier stage may have a profound impact on subsequent development. Pediatric cancer and its treatment have the potential to subtly but dramatically disrupt the development of healthy adult sexuality by compromising one or more of these developmental building blocks. A small but convincing literature is developing that, while supporting the overall well-being of cancer survivors (e.g., no evidence of psychiatric symptomatology), suggests that sexual well-being is compromised by a childhood cancer diagnosis and treatment. Most notably, a number of studies have highlighted the devastating effects that treatment for cancer during childhood can have on sexual self-concept and body image in generally well-adjusted survivors. Because human sexuality is so complex, a full range of clinical interventions can be used to address both the current and potential psychosexual disruptions that young adult survivors experience. The developmental context of sexuality must be considered when planning interventions. In addition, the private nature of the topic, as well as the nature of the disease and treatment course, can impede the effective implementation of the interventions. It is crucial for the mental health professional to be aware of these barriers to effective treatment as interventions are planned.