Pelvic Exenteration and Nursing

Pelvic Exenteration and Nursing


PelvicExenteration and Nursing

PelvicExenteration and Nursing

Pelvicexenteration is mainly conducted to help in the treatment of cancer. There being no signs in the body, the operation is done whereby thebody parts such as rectum, bladder and the internal reproductiveorgans are removed(Bhangu et al., 2014).Women who have already been treated for cervical cancer undergo thisform of operation as the condition comes back in the pelvis. It is aspecialized operation that requires expert surgeons to perform.According to Annon (2013) it is recommended that the patients undergocounseling and emotional support before undergoing the operation(Annon, 2013).Women who undergo the operation experience massive body changes,which affect their sexual functioning. It affects the sexual desire,orgasm and pleasure in most women before the full recovery takesplace (Carter,2013).On most, cases the outer reproductive organs such as outer genitalsand clitoris are not removed hence a woman can still experiencesexual desire. Nonetheless, it does not mean that woman can no longerenjoy a productive and quality life after the operation. It is thusappropriate that the healthcare teams in gynecologic oncology areeducated about the approaches to take to enhance positive outcomesfor patients with pelvic extenteration. As Annon (2013) puts it, thePLISSIT model is proposed as the best approach to provide theframework for improving the sexual outcomes for the patients.

Overthe years, nursing professionals and medical practitioners have triedto generate innovative approaches to help in enhancing the oncologicoutcomes for the patients(Patel, 2015).The paper seeks to examine the nursing care and support for femalepatients who have undergone pelvic exenteration. In particular, itwill explore the various nursing interventions that can help thepatients to enhance their sexuality. Information will be gatheredthrough the review of journal articles and books that have researchedon the matter. The aim is to gain better understanding on theintervention measures that can help the female patients lead aquality sex life even after undergoing pelvic exenteration. Withproper counseling and support, women can adjust faster to theclinical treatment. PLISSITmodelhascome out as an appropriate method to offer guidelines and frameworkthat will enable the patient lead a quality life.

ThesisStatement: Elaboratecommunication, support, and clinical guidance to patients with pelvicextenteration enhance the realization of positive outcomes andquality sexual functioning of the patient.


Thepurpose of the paper is to educate the inter-displinary team ofgynecologic oncology about using the PLISSIT model in embeddingsexual health discussion with patients and partners who haveundergone pelvic extenteration. Further, the paper seeks to provideuseful information to the caregivers of the patients on the need tosupport the patients emotionally and psychologically to enable themrecover from the cancer treatment as well as improve their sexualoutcomes. The joint efforts are imperative in the collaborativepatient care. The participation of clinical staff boosts thecollaboration by attracting a cordial relationship and improvedawareness of patient care and service delivery. The development ofsuch a program not only results in positive effects for patients butalso the discipline in the practice of nursing. The provision of theright supportive setting is a shared responsibility and concern forstakeholders including family members, patient and hospital staff.


Accordingto the AmericanCancer Society,gynecologic cancers accounts for about 90,000 cases of cancerdiagnosis in the US and about 1 million in the world every year(Stabile et al., 2015).Pelvic exenteration leads to the removal of the reproductive organsin a female patient. The removal of the internal reproductive organsaffects the sexual life of an individual. It is important to notethat the operation does not necessarily affect the external organs.Pelvic exenteration generates both short-term and long-term effectson a patient(Stabile et al., 2015). In particular, the operation affects sexuality, emotional welfare,quality of life and reproductive function. Even after the treatment,side effects are likely to emerge that affects the sexual functioningof an individual and the quality of life. The sexual and emotionalconsequences after the operation generate concerns among thepatients. Already, the patient is struggling to recover from cancerhence the need to offer continuous support to supplement the clinicaltreatment. Depending on the intervention, the patient can recoverfaster or slower.

Stabileet al (2015) agree that physicaland emotional effects emerge irrespective of the nature ofgynecologic cancers. The recommended clinical treatment bringschallenges to the quality of life of the patient. The commonchallenges include sexual dysfunction, pain, and emotional problems,among others. Clinical treatment procedure involves the removal ofreproductive organs such as cervix, fallopian tubes, and lymph nodes,among others. Research studies indicate that over 90 percent of thefemale patients with cancer experience sexual dysfunction. Thereported causes of sexual dysfunction include dyspareunia, lack ofpleasure, vaginal dryness, and loss of desire, among others. Thepatients also report incidences of depression and anxiety disorderthat affect their recovery process. According to Stabileet al., (2015), depression and anxiety disorder affect the quality oflife, length of hospitalization, and compliance to the clinicaltreament. The emotiional strain is also reported to affect thepatient’s capacity to attend to personal care. Emotional andphysical facets have negative effects on the patients response tosexual functioning. It is thus necessary and appropriate to addressthese concerns as part of clinical treatment (Stabile et al., 2015).The emotional and sexual concerns have great influence of the qualityof life and the ultimate cancer survivorship of the patient. As such,clinical interventions and support can help identfying theappropriate measures to address the concerns raised in the essay(Benrubi, 2010). Counselingand emotional support have been identified as some of theintervention that can be used to address the concerns. In clinicalpractice, it is expected that the clinical care setting provides theappropriate support before and after the operation. Apatient-centered approach is more appropriate as it identifies theindividual needs of a patient to enhance her oncologic outcomes.Unfortunately, the clinicians have not elaborately utilized methodssuch as PLISSIT model to improve the clinical outcomes. In addressingthe matter, the paper will provide elaborate information on how tointegrate the model in the intervention program (Farnamet al., 2011).


Definitionsof Sexuality and Sexual Health

Accordingto Gott (2005), human sexuality isthe capability of individuals to have certain experiences that areinfluenced by their sexual characteristics. Sexuality can beexpressed in various formations such as attitudes, behaviors, deeds,and thoughts, among others. Sexual health is described as the social,mental and physical well-being of an individual pertaining sexuality.In sexual health, every individual is expected to safe and enjoyablesexual experiences hence the need to promote good values on sexuality(Gott,2005).

Sexualityin the Pelvic Extenteration Patients

Pelvicexenteration is an operation conducted to help in the treatment ofcancer. The operation leads to the removal of the internalreproductive organs in the body. As such, the operation affects thesexual functioning of the body for a given period. Accordingto Lindau, Abramsohn and Matthews (2015), tumors that develop inwomen having cancer affect the sexual organs such as ovaries andbreasts. Cancer that affect the sexual organs is more prevalent inwomen compared to male. Majority of the females are sexually activebefore undergoing the clinical treatment for cancer. Cancer treatmentfor sexual organs leads to damage or removal of the organs henceaffect the sexual activity on an individual. Pelvicexenteration takes long time before one recovers with researchreporting that an individual can up to two years before one adjuststo the body changes (Farnamet al. 2015). Manyresearch studies have shown great relationship between sexuality andcancer. Ordinarily, cancer appears to lower the sexual functioning onfemale patients. The situation gets worse for the pelvicextenteration patientssince the disease has recurred in the body. After undergoing aclinical treatment, the quality of sexual activity in women isaffected. In their study, Grimm,Hasenburg, Eulenburg, Steinsiek, Mayer, Eltrop, (2015)note that majoirty of women remain dormant in sexual activity. Thisis an indication that women experience functional challenges thattake time to heal. Some take longer time due to inappropriate orinsuffficient intervention measures from the care givers. In othercases, female victims appear disinterested in their sexualfunctioning while others lack the internal motivation (Grimmet al. 2015).Patients who have undergone pelvicexenteration are exposed to high risks especially on theirreproductive organs. The health risks associated with cancer makewomen to refrain from active sexual activities. As such, suchpatients have lower interest on sexual activities (Djaladatet al., 2012).

Irrespectiveof the nature of the disease, physical problems arising from aclinical treatment generate instances of emotional difficulties.Studies indicate that about 25 percent of cancer patients are treatedwith depression and anxiety disorders. The patients experienceinstances of distress and negative feelings that arise from physicalcomplications and lack of support. Female patients with pelvicexenteration are unable to experience sexual pleasure. Normally, thepatients are largely concerned about their recovery after theclinical treatment. Surgical scars, for instance, reminds thepatients about the cancer experience hence affect theirself-perception (Carterea al., 2004). A patient’s perspective about their sexual selfaffects their sexual functioning. The patients view the changes witha sense of unattractiveness. The feeling of vulnerability followingthese body changes affects their welfare and sexuality. Studiesindicate that positive outlook by the patients can help in reducingthe effects of depressive signs (Carteret al. 2004).

Pelvicexenteration is said to disrupt the normalsexual cycles such as menopause and hormonal balance. The operationgenerates both short-term and long-term effects that hamper thenormal sexual function. The effects range from social, physical andpsychological functiong of the body. Sleep disruption, depressionand pain are some of the direct effects that hinder the normal sexualfunctioning of the body (Farnamet al. 2015).Unfortunately, most of the patients do not receive sufficientcounselling and social support. As such, they are unable to regaintheir sexual function after undergoing the treatment (Lindau et al.,2015). Allthese consequences have negative effects n sexual health andsexuality. Studies indicate that women who undergo pelvicexenteration have lower sexual desires. The situation gets worse whentheir partners or the nursing staff do not give the patients enoughsupport. Sexuality is a sensitive matter that needs appropriatecommunication between the clinicians and the patients. The patientsshould be provided with the appropriate and timely information thataddresses their specific needs (Lachman, 2012).

Assumptionsof Shared Definitions

Manypeople tend to assume that pelvic exenterationpatients cannot enjoy a quality sex life. Others assume that theintimate relationship with the partner will change owing to the poorsexual functioning of the body (Ayaz&amp Kubilay, 2009).Due to poor understanding about the nature of the clinical treatment,many people tend to imagine that the operation affects both theexternal and internal reproductive organs. Such assumptions affectthe recovery process of an individual since the patient do not getthe right support and counseling from their partners and caregivers(Annon, 2013). The operation on pelvic exenteration does not affectthe external reproductive organs meaning that the patients canexperience sexual pleasure if touched by the partner. Assumptions mayalso arise due to poor awareness for either the clinicians or thepatient.

Accommodatingfor Changes

Oneimportant step in enhancing the quality of sexual functioning for thepatient is through accommodating the changes in our normal life. Thepartner is required to understand that the operation has effects onthe normal functioning of the body hence affect sexuality (Lachman,2012).One cannot imagine that the patient will experience similar sexualdesires, as was the case before. On most cases, the patient becomesdisinterested in sexual activities. The main concern by the patientis to recover from cancer and enjoy a quality life (Djaladatetal., 2012).Nonetheless, some partners have not been accommodative with somelooking other sexual partners to meet their desires. Such actions cangenerate negative effects on the patient such as depression. On theirpart, some patients fail to communicate the body changes to theirpartners and caregivers hence increasing their worries(Nadelson &amp Marcotte, 1983).Patients with pelvic extenteration experience changes both physicallyand emotionally. It is thus appropriate to use intervention methodsthat will accommodate such changes.

Lackof Awareness

Accordingto Lambert(2015) thereis a general lack of awareness by the caregivers and partners inaddressing the challenges faced by the pelvicexenteration patients. Awareness is important to help the patientsrecover from the cancer treatment and enjoy a quality life. Awarenessis realized through giving the caregivers the appropriate guidelinesto support the patients (Lambert,2015). Nonetheless,the many clinicians lack the appropriate strategy to create awarenessthat is instrumental towards the realization of positive outcomes.Some of the approaches are either bypassed or ignored by theclinicians for lack of appropriate information. Patient fears mirrormisunderstandings which can be resourcefully corrected.

Also,as Roach(2013) puts it patients’anxiety arises from the shortage of information or appreciation aboutthe surgical procedures and becoming dependent on others. Lack ofunderstanding and the patient’s realization of the complexitiesinvolved in the procedure add to the tension hence bringpsychological difficulties(Roach, 2013). Thereis a general laxity in sharing health information between theprofessionals and patients. PLISSIT model helps in preparing thepatients psychologically about the challenges they are likely toexperience in the recovery process. It is thus imperative for thenurses and other medical practitioners to create a form of awarenesson the patient.



Variousmodels are used to enhance the communication between the patients andthe health workers. One such approach is using the PLISSITModel.According to Irwin (2002), the PLISSITmodel is used to examine the various forms of interventions for thepatients with sexual problems. Generated in 1976, the system is usedfor sex therapy using four levels namely permission,limited information, specific suggestions, andintensive therapy. Insexual health, the aim of the model is to generate the framework forinterventions that help the patients in enhancing their sexuality.Developed by Jack Annon, the model is seeks to address the specificneeds of a client. A client should feel comfortable to discuss ordisclose information regarding sexual health and sexuality. Under thepermissionlevel,the sexologist offers the client an opportunity to raise theirconcerns and sexuality. The sexologist allows the client to raise theissues without interrupting or appearing judgmental. Another level islimitedinformationwhere the client is given specific and direct information regardingthe issues raised (Staintonet al., 2011).It is through the information generated that the client is offeredsupport depending on the need. Under the specificsuggestions level,the therapist gives suggestions to the client on the nature ofinterventions that would help address mental or health difficulties.The therapist can recommend change on sexual behavior, participationin physical activities, and clinical treatment, among others(Stainton et al. 2011). The last level on intensivetherapyis designed for specialized treatment. The sexologist often refersthe patient to other medical practitioners to examine the healthproblem deeply and provide the appropriate interventions (Yarbroet al., 2011).

Limitationof the PLISSIT Model

Unfortunately,the PLISSIT model has limitations in that it does not offermedication or any form of diagnosis to the patients. According toAnnon(2013)patients require specialised treatment that cannot be undertakenusing the model. The model only proposes suggestions to the patientthat may not be necessarily applicable or effective in the treatmentprocedure. Further, the effectiveness of the guidelines given usingthe model is dependent on the relationship between the patient andsexologist (Annon2013).Some patients are sceptical about giving certain informationregarding their sexual functioning. Further, the model does not offerspecific medication suggestions that can be relied upon by themedical practitioners. With diverse needs, the patients requirepersonalised approach with distinct recommendations. It is notablethat the model is too general to support the needs of the patient(Annon, 2013).

IntegratingPLISSIT model

Theeffectiveness of the PLISSIT model in sex therapy for the patientscannot be underestimated. In their study for its effectiveness forpatients with stomas, Ayaz &amp Kubilay (2009) observe that thesexual problems reduced among the patients after the sex therapy. Inparticular, the patients recorded improvements regarding theiremotional and physiological worries. (Ayaz &amp Kubilay, 2009). ThePLISSIT model is integrated in the counseling procedures offered tothe patient before and after the treatment. The sexologist seeks touse multi-dimensional approaches that will effectively addressing theemotional and psychological challenges facing the patient. Using theapproach, the sexologist counsels the patient depending on theindividual needs. The best way to integrate the model is by usingright from before the treatment for pelvic extenteration (Walter,2013). As such, the therapist can easily understand the patient’s worrieshence offer the appropriate counsel.

Tipsfor the Clinicians

Theclinicians should seek to offer range of counseling care andsuggestions that will effectively address the patient’s challenges.It is also appropriate that they assure the patients that the helpfor their health problems is available. The clinicians need to assessthe nature of the symptoms to instigate deeper discussion as well asoffer treatment interventions (Walter,2013).Provision of educational materials about sexuality to the patients isalso essential. Often, the clinicians need to follow-up the patient’sresponse to the counseling procedure. Comfortable setting is alsoappropriate to enhance the confidence among the patients.Additionally,the clinicians need to acknowledgethe likely side effects that arise from the cancer treatment (Walter,2013).Byusing the tips highlighted, the clinicians will effectivelyfacilitate a discussion that will give the clients confidence todiscuss sensitive matters about their sexual health.

PatientCare Pathway

Theclinical pathway defines the approaches to realise quality care for apatient through the standardisation of the clinical processes. Theapproach helps in the realisation of positive outcomes. Patients withpelvic extenteration require close examination by the sexologist toenhance their recovery from cancer as well as maintain quality sexuallife. According to Wakleyet al., (2003).Thepatients require a patient-centered approach that addresses thespecific needs of the patient. To enhance the success of the carepathway, the clinicians need to target specific areas such ascounselling on how to reduce sexual problems. Further, the cliniciansshould seek to counsel the partners on the expectations from thepatient following the clinical operation (Wakleyet al., 2003).

Theinter-disciplinary team to involve in the exercise includessexologist and gynaecologist. It is expected that barriers due tosensitivity of the information are likely to emerge. Some patientsmay find it hard to disclose some of the information. Moreover,either the patient or the clinician may not be supportive hencejeopardising the realisation of positive outcomes. To enhancesustainability, the clinicians need to devise specific guidelines andapproaches that are workable until the patient recovers(Wakley et al., 2003).

Discussionand Implication to Practice

ThePLISSIT model has significant input towards addressing the sexualproblems affecting the pelvic extenteration patients. It is expectedthat the model will create awareness and capacity to the cliniciansin attending to their duties. The approach will enhance partnershipbetween the patient and the clinical staffs hence improve theclinical outcomes. According to Annon(2013) pelvicexenteration patients experience sexual problems that affect thequality of life. Intervention model developed within the framework ofthe PLISSIT model is instrumental in addressing the sexual problemsfacing the pelvic extenteration patients(Annon, 2013).This form of integrated approach enables the patients to expresstheir difficulties to a sexologist with ease. Sexual health requiressupport and continuum care from the clinicians.

Variousinterventions have been proposed to address the challenges facing thepatients with pelvic extenteration. Most of the guidelines developedin the nursing care are meant to improve the quality of life andsexual functioning. Awareness is considered as an important tool forunderstanding and functioning resourcefully in relation to healthcare (Lambert,2015).It is a pre-requisite necessity for understanding and workingeffectively with other stakeholders to promote sexual health due tothe sensitivity of the matter. The main objective is to promotepsychological, expressive and behavioral change as acknowledged inthe intervention plan using the PLISSIT model. It is expected thatthe clinicians can help promote awareness through individualassessment of the patient. According to Radford,et al. (2004), the patient are expected to show their willingess toundergo the proposed interventions. This helps improve their recoveryprocess as well as enhance their sexual functioning (Radford et al.,2004), As part of the awareness, the clinical settings need touphold goodvalues (Radfordet al., 2004). Suchvalues are necessary to enhance the determination of right actionsand decisions by the clinicians. Communication is a crucial part ofthe nursing profession. Therole participating in the care of a patient in several occasionsmakes the management of information difficult(O’Lynn, 2013).The PLISSIT model provides the necessaryinformation to the cliniciansin their quest to address the patients’ needs. It is appropriate toidentify the problems facing the communication between thepatients and patients.The model will help the patients recognize and handle theirpsychological problems through proper counseling. Further, it seeksto develop an improved interpersonal rapport and encourage thepatients by providing emotional support. A socially supportiveatmosphere prompts the adoptionof a patient-centeredness approachand healthy behaviors(O’Lynn, 2013).Pre-operational and post-operational counseling are linked to reducedincidences of complications and anxiety (Zhang,et al, 2012). The studyserves a platform to understand why a supportive environment isthought to serve as the best approach to handle the nursingchallenges. It also generates a better understanding of the impactof disconnection endured by the patients while trying to face up withadjustments after an operation. Besides analyzing the importance of asupportive environment, the study is significant in demonstrating thefundamental basis for handling and managing the sexual problemsaffecting patients with pelvic extenteration(O’Lynn, 2013).

Interventionprograms have demonstrated immense progress in the recovery of apatient after a clinical treatment. According to Ping(2012), joint effortsare imperative in the collaborative patient care. The participationof clinical staff boosts the collaboration by attracting a cordialrelationship and improved awareness of patient care and servicedelivery (Ping,2012)The development of such a program not only results in positiveeffects for patients but also the discipline in the practice ofnursing. The provision of the right supportive setting is a sharedresponsibility and concern for stakeholders including family members,patient and hospital staff. The contribution of the nurse in thereduction of patient’s anxiety is essential(Fincher et al., 2012).Social support is essential for the patient to improve theiroutcomes. It is expected that the study will inform the nursingpractice on the appropriate steps and interventions that will enhancepositive clinical outcomes for patients with extenteration. It willalso be instrumental in improving sexuality among the patients.Healthcare providers and policy makers need to generate guidelinesthat will address the psycho-social needs of the patients withgynecologic cancer.


Asseen in the discussion above, the PLISSIT model offers the clinicianswith appropriate guidelines to help in addressing the sexual problemsaffecting the patients with pelvic extenteration. It is notable thatthe patients face emotional and psychological difficulties owing tothe poor sexual functioning of the body. The findings from the studyindicate that the nature of clinical treatment and support has greatinfluence on sexual functioning, recovery, and quality of life of thepatient. It is evident that the quality of life and sexual outcomesadvance when the right intervention measures are used. Theresearchers assert that it is imperative to consider sexuality andquality of life when making decisions about the treatment criteria.Psycho-educational interventions, social, and emotional support arenecessary to tackle the sexual and health concerns among the patientswith pelvic exenteration. Awareness initiatives boost an individual’sself-esteem and comfort. Emotional support and guidance to thepatients using the PLISSIT model is recommended for the patients withpelvic extenteration. The clinicians need to have a clearunderstanding about the common sexual problems affecting the patientsas it helps in the development of appropriate intervention measures.Greater physician-patient communication is required before and afterthe clinical treatment to enhance the realization of positiveoncologic outcomes. Most of the researchers propose future studies onsexual morbidity to enhance the creation of appropriate interventionsto the patients at higher risk. Under the PLISSIT model, theclinicians can ably help the patients realize positive clinicaloutcomes as well as maintain their sexual functioning. Theinformation contained in the paper communicates to the patients,their partners and inter-displinary team of gynecologic oncology.


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