Klaske van Sluis

142 8.5. Discussion in daily life again. Nevertheless, participants remain persistently vulnerable after total laryngectomy, because of the effort required by foreseeing and man- aging functional, social, and health-related issues. As a result, participants are required to continuously manage their disabilities as well as other people’s re- sponses to them. The disease and its treatment mean that both body and self are radically and irrevocably altered. This study explored the perceptions of females on their life after total laryn- gectomy and shows the presence of women-specific issues. Interestingly, when asked directly, most participants did not think there were substantial differences between the experiences of men and women after total laryngectomy. Similarly, Graham and Palmer (2002) found that responses of men and women after to- tal laryngectomy were more similar than dissimilar [10]. The study of Lee et al. (2010) showed that females following total laryngectomy had significantly lower global health status than males and lower levels of physical, emotional, cognitive and social functioning [7]. Our findings illustrate that some of the challenges participants experience are due to their inability to adhere with so- cietal expectations regarding feminine roles and activities (e.g. taking care of others and the home, looking attractive, having a high pitched voice). Many re- spondents discussed being self-conscious about their appearance and how they present themselves to others. In addition, they all disliked the sound of their voice, which several described as unfeminine. Our findings herein therefore cor- roborate Cox et al.’s (2015) hypothesis that changes in voice, sound, and speech quality after total laryngectomy lead to a loss of femininity [6]. Our study also demonstrates that the relationship of women with their partner is influenced by the total laryngectomy. Cancer treatment in general impacts the spousal relationship [19, 20]. Offerman et al. (2015), showed that female laryngectomees run a greater risk of a negative impact of total laryn- gectomy on their relationship than their male counterparts [8]. Specifically, our results show that the surgery and its aftermath leads to a noticeable shift in give-and-take balance between partners. This shift is presumably associated with the fact that women in a heterosexual relationship still mainly perform the majority of household chores [21, 22]. In line with this point, this study also revealed women-specific issues in participants’ performance of informal care-work. Some respondents found it hard to depend on others who cared for them or delegate household chores after the surgery. Problems with informal care-work were also a recurring topic in interviews for participants who were (grand)mothers. Earlier studies on the impact of total laryngectomy on affected individuals did not investigate how care-work activities take shape in daily life after the procedure. Again, since the majority of child-care is still performed by women [23], (informal) care- work is a domain in which gender differences are still very much relevant. To further investigate the impact of total laryngectomy on women therefore required addressing both shifts in the spousal relationship and care-work. Issues pertaining to femininity also arose in the areas of intimacy and sexu- ality. Research shows that libido and sexual problems are common after treat-