從婦癌婦女性健康照護看我們的性別敏感度

Bringing Gender Sensitivity into Sexual Health Care for Women with Gynecological Cancer

性生活品質是癌症存活者及其伴侶健康福祉重要的一環，也是影響癌症預後的因素。由於癌症本身及其治療嚴重影響婦癌婦女性健康及其伴侶關係，迫切需要醫護人員提供他們在性生理、性心理與社會文化等層面調適的指導與協助。然而，當前醫療院缺乏合適性衛教介入之方法或管道，醫護人員常因自覺性知識或專業素養不足或認為性生活衛教不在醫護專業範圍內，而未能提供合適指導。而以生物醫學為主流的臨床醫療文化，更窄化了癌症治療後婦女性健康的建構，其所形塑的性功能障礙或性問題的本質與範圍，壓制了婦女及其伴侶於治療後性生活恢復過程應包含的心理及人際關係層面內涵，進而形成性別盲的性健康照護環境，提供了不適合婦女的性功能或性問題的評估標準與指導內容。因此，本文以不同性學論述模式及性別敏感度來檢視當前婦癌性健康照護情形與婦女性健康需求，提出臨床常見性別盲與改善建議，以供臨床實務與學者專家於研擬婦癌婦女性健康照護之參考。

Quality of sexual life is a vital component of wellbeing for cancer survivors and their partners that may affect the disease prognosis. However, the experience of cancer and its treatments significantly challenge sexual expression and partner relationships and often require health professionals to help partners adapt the many physical, psychological, social / relational, and cultural factors that impact psychosexual functioning. However, an appropriate approach to providing sexual health education for gynecological cancer women and their partners has yet to be established. Additionally, nurses and health professionals have limited relevant professional knowledge and lack the communication skills to respond effectively to the sexual concerns of patients. Further, these professionals frequently hold the incorrect perspective that sexual matters are not relevant to the treatment process. Furthermore, the dominant biomedical culture of the clinic holds that health professionals determine the construction of female sexuality after cancer treatment. This precept turns the nature and scope of the discussion toward dysfunction and/or morbidity, while inherently constraining the integration of psychological and relational elements of sexual recovery for women and their partners. The dominant model constructs gender-blind circumstances and inappropriate standards for the clinical assessment and treatment of women's sexual health. Therefore, this article examines the current clinical practice for the sexual health care of gynecological cancer patients under the dominant biomedical model through the lens of gender-sensitivity and proposes gender-sensitive sexual guidelines as a reference for health professionals.