Being diagnosed with cancer and undergoing treatment is a stressful, physically demanding and often traumatic experience. So, it’s not surprising that even after treatment ends, people may find that their sex lives aren’t what they used to be. Though survivors of any cancer can experience sexual dysfunction, it is particularly common in those with gynecological cancers. These cancers may involve the vagina, vulva, uterus, ovaries, fallopian tubes and cervix.
At least 40% of cancer patients experience alterations at the sexual level as a consequence of chemotherapy, radiotherapy, hormone therapy and surgery. These alterations may include reduced sexual desire, difficulties with arousal and orgasm, discomfort during sex due to vaginal dryness, pain during intercourse, and an overall decrease in sexual satisfaction. Such changes may begin at diagnosis and persist, or even intensify, during treatment and beyond, negatively impacting the patient’s perception of well-being and quality of life. These problems may be the consequence of hormonal treatments or surgical interventions in the pelvic area. These treatments may also cause changes in physical appearance such as alopecia, weight change and surgical scars, which lead to issues with body image, self-esteem and have repercussions at the emotional level, making it difficult for the patient to enjoy sexual activity and feel sexually attractive.
Consideration of these effects from the beginning of oncologic management, and throughout the treatment process, is critical to ensure comprehensive care that considers sexual well-being as a key component of overall health. In addition, psychological and emotional disorders that arise after a cancer diagnosis, such as the appearance of fear, anxiety and anguish, can affect sexual health and intimacy.
Most clinicians with oncological patients do not address their sexual health, with the lack of training, lack of time and patient discomfort being the main barriers identified. In addition, some women believe that sexuality is a shameful issue, and they are reluctant to ask questions about it. These women need to be encouraged to talk about these problems, with consideration to their religious and cultural differences.
There is a need for sexual health training, which could contribute to early intervention, strategy establishment and timely referral to specialists in the field. The American Society of Clinical Oncology recommends that counseling to address sexual health difficulties be routinely offered to patients undergoing cancer treatment and to cancer survivors. “Sex therapists are often well versed in helping people navigate sexual side effects and sexual recovery after cancer” says Jennifer Vencill, Ph.D., ABPP, a clinical health psychologist and certified sex therapist at Mayo Clinic in Rochester, Minnesota.
