Background: Treatment for pelvic cancer results in various late adverse effects, many of
which can be detrimental to sexual health. Sexual counseling includes interventions aimed at
ameliorating these. The objective of this study was to explore how cancer survivors
perceived the value of sexual counseling. Methods: Data for this descriptive qualitative
study was collected through 10 semistructured interviews with patients treated for pelvic
cancer. A qualitative thematic analysis was performed to inductively construct descriptive
themes. Results: Twelve descriptive themes under 3 theoretical themes emerged: ‘The
changed life’ encompassed feelings of loss, grief and abandonment related to sexuality. ‘The
systemic possibilities and barriers’ examined the relevance, characteristics, process, and
accessibility of sexual counseling. ‘The informants' possibilities and barriers’ explored
acceptance, coping, efforts to practice, and sexual renegotiations in relation to the
individual’s ability to profit from counseling. Conclusion: Clinicians are obliged to inquire
about sexual late adverse effects, and referral to sexual counseling should be offered as a
standard following treatment for pelvic cancer. Most informants in this study sought to
maintain their ability to engage in penetrative sex. Not being able to do so, affected self
esteem and relationship dynamics negatively. Accepting and coping with the permanency of
sexual late adverse effects is a complex and continuous process. The process is affected by
interlinked factors, both within the cancer survivor and their intimate relationship, and within
the system offering sexual counseling. Ideally, sexual counseling should facilitate this
process and support survivors in expanding their sexual repertoire. However, to ensure
therapeutic alliance, counselors must first elucidate what the survivor hopes to gain from
treatment and start from there. This requires an open minded and empathic
bio-psycho-social approach, as well as professional skills within the realm of sexual
rehabilitation and sexual aids. Regular and prescheduled follow-up visits are vital to ensure
progress and treatment satisfaction.