When faced with a cancer diagnosis your first thought likely isn’t “how will my sexual health and intimacy be affected?”. Although this thought and consideration may not be a huge factor in your immediate steps through cancer treatment, it will almost certainly become a common focus later in treatment and even once your treatment is done. Sex and sexual health has somehow weaselled its way into becoming a topic we “can’t” talk about, yet it is one of the most primitive and important aspects of human relationships. This fundamental aspect of human nature is something that deserves to be talked about and normalized to improve quality of life for those who may be struggling. Unfortunately, one of the many outcomes of cancer and many cancer treatments can be a reduction in sexual health.
When we talk about sexual health we think about the interest for sexual relationships, the potential dysfunction someone may be experiencing with their sexual health, as well as the overall satisfaction with their sexual health. Although sexual health issues are well documented and understood, whether they be as a result of treatment induced hormonal changes, body image concerns, or surgical side effects we still see women experiencing large levels of sexual distress following cancer.
When looking at breast cancer patients and survivors we see a large incidence of sexual problems and distress, so why do we see this, and what can we do about it?
The most commonly reported concerns by women with cancer are low desire/arousal, vaginal dryness, and pain (Bober, S. L., & Varela, V. S., 2012). These concerns can be largely attributed to hormonal therapies that are prescribed for cancer treatment. These treatments are prescribed to reduce the amount of progesterone and estrogen in the body because many breast cancers are fed by these hormones. Treatments to reduce these hormones includes pharmaceutical treatments as well as surgical procedures (oophorectomy and total hysterectomy surgery). This forcefully places women into menopause (potentially prematurely) or increases already existing menopause symptoms. By reducing the levels of those hormones in hormone sensitive cancers we see better cancer outcomes, but unfortunately, we also need those hormones to help with sexual function.
Other common concerns that impact sexual health are the results of surgeries. This may be from the hormone reducing surgeries mentioned above or direct tumour removal surgeries. Surgery can impact body image, confidence, function of the body part, and nerve sensation/arousal.
Cancer and cancer treatment is an overwhelming and full body experience, which is why we see everything including sexual function affected. The really positive news about all of this is that despite the challenges that are presented there are many treatment options that yield great results.
Although when reviewing the literature there are many treatment options explored the large overarching theme is that no matter the concern it is essential that we take a biopsychosocial approach to sexual health care (Sadovsky, R., Basson, R., Krychman, M., Morales, A.M., Schover, L., Wang, R., Incrocci, L., 2010). So what exactly does this mean?
A biopsychosocial approach ensures that we consider many factors that affect health and happiness. Within this framework it is recommended that for the best treatment outcomes of sexual distress patients receive psychological support, social understanding, physical/anatomical support, and if needed pharmaceutical support.
It is recommended that if patients are experiencing sexual health disparities they consult with their medical team, seek psychological support (psychiatry, counselling, group support, etc.), encourage their partner or social circle to support them, and consult medical professionals for physical interventions (pelvic floor physiotherapy, gynecology, etc.). By engaging several disciplines, it helps patients relieve not only their physical symptoms but also their mental health distress.
Sexual health after a cancer diagnosis is a large and complex topic that could be (and is) written about at length. This is just a grazing of the surface to let you know you are not alone in your struggles and you are not at a loss. Sexual health is an incredibly important part of your physical and emotional wellbeing, and there is support available.
References:
Bober, S. L., & Varela, V. S. (2012). Sexuality in adult cancer survivors: challenges and intervention. Journal of Clinical Oncology, 30(30), 3712-3719.
Sadovsky, R., Basson, R., Krychman, M., Morales, A.M., Schover, L., Wang, R., Incrocci, L. (2010) Cancer and sexual problems, The Journal of Sexual Medicine, Volume 7, Issue 1_part_2, January 2010, Pages 349–373, https://doi.org/10.1111/j.1743-6109.2009.01620.x