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Sexual function after cancer

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You’ve been through the long and difficult road of cancer treatment. You have finally reached the point where the cancer is gone, and you’re ready to get back to your normal life. Your partner is ready for that as well, but trying to get back to your previously typical sexual routine has been frustrating for both of you.

Sexual dysfunction is one of the most common and distressing consequences of cancer treatments. Surgery, laser treatments, immunotherapy, radiation and chemotherapy all manipulate tissues while ridding the body of cancer — often with unintentional damage that affects how tissues respond. In addition, the emotional and personal toll of cancer can affect your desire or motivation to have sex.

You’re not alone. Nearly all (90%) of the millions of gynecological cancer survivors (an estimated 19 million by 2024) will experience sexual dysfunction. However, only an estimated 50% of female cancer survivors will report cancer-related sexual concerns.

The cost of silence

The American Society of Clinical Oncology guideline recommends that oncology providers talk about sexual health and dysfunction with all people with cancer. This topic should be discussed at the time of diagnosis and throughout care. This is especially important because:

  • Women may delay care if they are afraid of sexual side effects. Unrecognized treatment-related sexual dysfunction and concerns about potential sexual problems can lead to cancer treatment delay. This can potentially compromise health-related outcomes. For example, concerns about sexual side effects have caused women who carry a hereditary, high-risk gene alteration for breast and ovarian cancer to either delay or refuse risk-reducing surgeries.
  • Women may stop treatments because of sexual side effects. Side effects of long-term cancer treatments, such as difficulties with sexual arousal and desire, may contribute to early discontinuation of or not taking estrogen-reducing treatments or ovarian suppression in breast cancer treatment.

If your doctor hasn’t talked to you about your sexual health, the following steps may help you evaluate and address any sexual problems with your primary care doctor, gynecologist or cancer treatment specialist.

Step one: Recognize the impact

Negative effects related to cancer treatment can be:

  • Physical — This includes vaginal dryness and uncomfortable or painful intercourse.
  • Psychological and emotional — This includes decreased sexual interest, body image distress, low self-esteem or confidence, and loss of femininity, for example, changes in self-esteem after a mastectomy.
  • Interpersonal — If your sex life was on pause, you and your partner may have lost the steps to approaching and discussing intimacy. You might need to go back to what it was like when you were dating by scheduling time to be together and using ambience, music and other triggers to set the mood.

Some of these effects are short-term and with practice and reengagement will return to what was typical prior to cancer treatment. Long-term effects also are possible. These might include treatment-induced menopause with vaginal dryness and decreased tissue elasticity or literal surgical scars and changes.

Step two: Bring it up!

There are a range of intervention strategies available to help people cope with treatment-related sexual problems. But many cancer survivors do not feel prepared for potential sexual changes and often do not receive adequate support to manage sexual dysfunction. If you are undergoing cancer treatment or are a cancer survivor with sexual health concerns and a health care professional has not addressed them, it’s worth bringing these up.

Many people who have survived cancer and its treatment find themselves facing challenges in sexual health. Remember, you are not alone: Cancer-related changes in sexual interest, activity and satisfaction are considered “normal.” There is help available — if it’s not offered by your provider, do not hesitate to ask for a referral to a provider who can address your sexual health concerns. Initiate the conversation. Be your own advocate.

Shilpa Gajarawala, DMSc, MPAS, BS, PA-C

Shilpa Gajarawala is a practicing surgical physician assistant in the Department of Medical and Surgical Gynecology. She has a strong interest in women’s health, specifically gynecologic oncology and urogynecology. In her spare time, Shilpa enjoys spending time in her art studio. Free time away from the easel is spent traveling with her husband and their two sons.

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