骨盤領域に放射線療法を受けた女性がん患者のセクシュアリティに関わる体験と対処行動

Experience of Sexuality and Coping Behaviors in Female Cancer Patients Receiving Pelvic Radiotherapy

要　旨

　目的：骨盤領域に放射線療法を受けた女性患者のセクシュアリティに関わる体験と対処行動を明らかにすることである．

　方法：子宮頸がん6名，肛門がん3名の9名の女性がん患者に対し，セクシュアリティに関わる生活上での体験と対処行動について，半構造化面接を行い，質的帰納的に分析した．

　結果：骨盤領域に放射線療法を受けた女性がん患者のセクシュアリティに関わる体験は【治療中から数年に渡り，膣，腸，膀胱の粘膜障害による苦痛がある】【下半身が治療によって変わってしまい治療後の裸は見られたくない】【治療後は膣の痛みや出血のため性交渉をしたいという気持ちにならない】【子供が産めない身体になったのだと自覚する】などの6カテゴリーが抽出された．この体験に対し，【治療中から治療後，照射部位のケア方法の指導を受けて放射線の影響を最小限にする】【陰毛の脱毛やお尻やお腹が黒くなるのは仕方がないと思うようにする】【役目を果たすために自分の身体より家族のことを優先する】などの5カテゴリーの対処行動が抽出された．

　考察：照射による有害事象が骨盤領域に放射線療法を受けた女性がん患者のボディイメージや周囲の人々との関係性に影響を与えていた．看護師は，外観からは分かりにくい患者の体験を理解し，有害事象の出現時期に応じた情報提供とセルフケアを支援する重要性が示唆された．

　Aim: To elucidate sexuality-related experiences among women who received radiation therapy to the pelvic area, and their coping behaviors.

　Methods: Among nine women, six with cervical cancer and three with anal canal cancer, who received radiation therapy to the pelvic area, we conducted semi-structured interviews on issues regarding sexuality, including changes in their sex life post treatment and coping behaviors. The data were analyzed using a qualitative and inductive approach.

　Results: Sexuality-related experiences of the female cancer patients were classified into six categories: suffering from mucous membrane disorder of the vagina, intestine and bladder for several years after treatment not wanting to be seen naked due to changes in the lower body caused by the treatment having no desire for sexual activity due to vaginal pain or bleeding, and awareness of inability to get pregnant, and other two categories. Their coping behaviors to deal with these experiences were classified into five categories: seeking guidance on taking care of the treated area even during treatment to minimize damage from radiation, trying to think that pubic hair removal and darkened skin around the buttocks and abdomen should be accepted, and prioritizing one's family over one's physical condition to fulfil one's role, and other two categories.

　Discussion: Pain and suffering caused by adverse events of radiation to the pelvic area influenced the patients' body image and relationships with surrounding people. Our findings suggested that it is important for nurses to understand patients' experiences that may not be apparent and establish supportive relationships that encourage patients to express themselves before providing them with appropriate information and selfcare assistance according to the onset of adverse events.