Sexual Health After Cancer
Talking to your doctor about intercourse isn’t comfortable, but it can help.
The world’s top researchers are working to find better treatments and ultimately a cure for cancer. But there’s one topic of concern that still seems taboo — the impact that cancer and its treatments can have on patients’ sex lives. When someone battling cancer is fighting for survival, it may seem inappropriate or unnecessary to worry about their sexual and intimacy issues. Yet, this part of their physical, emotional, and social lives can greatly affect their overall quality of life.
Cancer survivors are leading long and healthy lives, yet cancer treatments leave physical and emotional scars.
“Sexual side effects are very common among cancer patients, regardless of their age and gender,” says Cristina Pozo-Kaderman, Ph.D., a clinical psychologist and Sylvester Comprehensive Cancer Center’s director of clinical operations for cancer support services. Researchers say 41% of cancer survivors report a decrease in sexual function. Fifty-two percent experience negative changes in their body image. And countless others suffer from physical and mental stress and fatigue throughout their treatment, which leaves patients (and their partners) feeling more exhausted than sexy.
“I would like to see sexual side effects listed among the other common side effects of cancer treatment. It should be explained to patients and their partners and normalized, along with all other aspects of a cancer diagnosis and treatment.”
Today’s health care providers are better prepared to discuss sexual health concerns with cancer patients and other medical professionals. “We address all aspects of the disease, not just the cancer,” says Alejandra Perez, M.D., a breast oncologist at Sylvester.
“Patients experiencing issues pertaining to their sexual health are often hesitant to address these concerns with their doctors,” says Sonjia Kenya, Ed.D., a clinical sexologist at the University of Miami Health System.
While oncologists are focused on patients’ health on a cellular level, it doesn’t mean that their sexual health isn’t important or that treatment isn’t available.Dr. Kenya
“Cancer can change your life, and it may never return to the way it was,” says Dr. Pozo-Kaderman. “But, with the right therapies, patients can make real progress toward experiencing a satisfying sexual life once again.”
Effects among female cancer survivors
Among women surviving breast, ovarian, cervical, or bladder cancer, “we see physical changes caused by surgery, radiation, hair loss from chemotherapy, and others,” says Dr. Perez. “Long-term endocrine therapy and, in some cases, early menopause impairs sexual function due to decreased libido, vaginal dryness, hot flashes, and weight gain.” Some patients experience numbness or a change in sensation in parts of the body.
In response to these changes, female cancer survivors may face a loss of self-confidence or a shift in how they perceive their bodies and experience sexual arousal.
Treatment options for women
“Our patients have multiple options available to them, from vaginal lubricants and moisturizers to physical therapy, counseling, and educational interventions,” says Dr. Perez.
Cancer patients and survivors can also consult with sexual health specialists who can help them and their partners address issues including pain during intercourse, difficulty achieving orgasm, and loss of sexual desire or self-image. Pelvic floor exercises, mindfulness activities, and the reintroduction of self-touch can help female cancer survivors reconnect with their bodies and with their partners.
Effects among male cancer survivors
Men who are fighting prostate or testicular cancer are often concerned about erectile dysfunction (ED). It can be triggered by the disease itself, the treatment, and the emotional impact of a cancer diagnosis. Those in treatment for other cancers (such as head, neck, colon, bladder, or rectal cancer) may face different challenges with their sex lives, such as decreased saliva production or a colostomy/ostomy bag.
Treatment options for men
The right treatment is based on a patient’s specific issues and their causes, his age, the stage of his cancer recovery, and the nature of his sex life and expectations.
Sexual aids, including prescription medication (like Viagra), testosterone replacement therapy, vacuum erection pumps, and injections at the base of the penis can address the physical causes of ED.
Though men may be hesitant to speak with a sexual health specialist or therapist, it can be helpful when dealing with these quality-of-life changes, says Dr. Pozo-Kaderman. This type of expert can encourage men to connect their erotic minds to their anatomy (beyond their penis). A specialist can recommend ways to maintain sexual intimacy with a partner and achieve orgasm while managing the physical and emotional aspects of ED and other sexual health concerns.
And what about couples?
Committed couples dealing with a cancer diagnosis and its aftermath should consider couples’ sex therapy with a cancer treatment specialist. Including a caring professional in the conversation can help couples discuss their shared sadness and frustration more openly, as they learn how to move forward together with patience and communication.
Patients’ partners often don’t want to bring up the sexual changes that they’re noticing. They’re worried about hurting their loved one’s feelings and being insensitive.Dr. Pozo-Kaderman
Couples in this situation shouldn’t be left to wonder and worry in silence. “That’s why we include them in the conversation during sex therapy. This treatment focuses on initiating and easing couples’ communication and sexual intimacy.”
Initially, Dr. Pozo-Kaderman meets alone with each cancer patient to learn about what’s happening to them medically and emotionally. Patients discuss how their body image has changed and how that’s affecting sexual intimacy with their partner.
“Patients who have survived certain kinds of cancers live with an ostomy or colostomy bag, which can cause them concerns about how it looks, smells, and functions during sex. Other patients are managing changes to their tongue and saliva. These patients are struggling with their new bodily functions and appearance,” says Dr. Pozo-Kaderman. “I work with them to become more comfortable with their own body before they enter the bedroom with their partner. Often the partners have more fear than the actual cancer patients.
“They may blame themselves for perceived changes in the patient’s sexual interest in them. And, they might be afraid of physically hurting their partner during sexual activity. When a cancer survivor has surgery scars, sexually reconstructed breasts, pain at the site of surgery, or vaginal tissue thinning due to premature menopause caused by their cancer treatment, their partners can become fearful of hurting them with their touch,” she says.
Many cancer survivors are afraid of experiencing pain during sex
In therapy, they can identify what they’re comfortable with and share it with their partners. That way, they can both regain confidence engaging in sexual activity that feels safe and comfortable.
“I educate couples about the real and false concerns regarding physical activity during and after cancer treatments. We discuss everything from practical tips to dealing with changes to their emotional intimacy and sexual capabilities. This leads to the best outcome for their communication and their relationship.”
“Emotional, physical, and spiritual factors are all equally important,” says Dr. Perez. “That’s why we address body image, intimacy, and relationships in general.”
Cancer patients with sexual health concerns can bring them up with their oncologist, nurse, social worker, or therapist. Don’t feel embarrassed. Ask questions about sexual health after cancer — just as you would with any other aspect of your cancer treatment and recovery.
Dana Kantrowitz is a contributing writer for UMiami Health News.