Sexual Health for Women After a Cancer Diagnosis
Sex may be the last thing on your mind after a cancer diagnosis, but experts believe that sexual health is an essential part of women’s overall health. According to a presentation at the European Society for Medical Oncology (ESMO) Congress 2022, women can improve their sexual health during and after cancer treatment, but it may be up to the patient to ask for the help she needs.
We see women talk about low desire,
loss of sexual activity and sexual satisfaction,
body image, loss of sensation,
and body integrity changes,
said Sharon Bober, PhD, Founder and Director of the Sexual Health Program at the Dana-Farber Cancer Institute in Boston.
In the end,
this really has an impact on quality of life.
Let’s Talk About Sex
In her experience, Dr. Bober said that patient-reported outcomes around quality of life often do not include specific questions about sexual health. They may ask about vaginal dryness, but that doesn’t address other critical issues like sexual function, body image, feeling attractive, or feeling whole in one’s body after recovering from invasive treatment. Avoiding the topic or hoping it will improve over time is not an effective strategy. Dr Bober said …
These problems do not self-resolve.
Sexual dysfunction tends to worsen over time.
We know it’s related to quality of life,
depression, anxiety, and relationship stress.
It is also a major reason why
women prematurely discontinue their hormonal treatment
and do not adhere to their treatment over time,
which clearly has a major potential impact on outcomes.
Citing a 2018 study of 84 breast cancer survivors who had been diagnosed between 20-35 years of age, Dr. Bober said 66% remained sexually active through treatment and 60% met the criteria for sexual dysfunction, but only 7% of those who wanted support for cancer-related sexual problems during treatment received it. When asked why they didn’t broach the topic, 66% said they were concerned about embarrassing their healthcare providers, and 71% assumed their providers would dismiss their concerns.
Dr. Bober said healthcare providers also cite embarrassment as a reason to avoid discussing sexual health with patients. Others defer the conversation until later if they deem it less significant than the cancer diagnosis. For some, the issue may be a lack of knowledge, training, or resources. Dr. Bober said …,
If a medical provider is not educated
about the appropriate options,
often we stay away from the question,
Improving Sexual Health During and After Treatment
Dr. Bober outlined a few solutions for addressing sexual health in women with cancer. The first is vaginal estrogen, which was previously associated with an increased risk of recurrence or death in some patients with breast cancer, but has recently been re-examined. Dr. Bober said …
Vaginal estrogen is worth talking about
because we do have some evidence for its use,
although it’s still somewhat controversial.
We have to weigh the decision-making
about using vaginal estrogen.
There are pros and cons,
and more desirable and less desirable candidates.
She explained that local vaginal estrogen increases sensitivity and blood flow. It can also increase lubrication, protect against vaginal thinning, and lower the risk of genitourinary infections.
Some women may choose not to use vaginal estrogen, even if their oncologist gives them the go-ahead. In these cases, non-hormonal moisturizers are an alternative option. Dr. Bober said these have a reputation for being less effective, but that is likely due to improper use.
We have the data to show that
non-hormonal moisturizers are helpful
for vaginal dryness,
if used properly.
The truth is,
if a woman is not given the support and education
on how to use moisturizers
properly or appropriately,
often the experience is that they don’t work.
When we ask more questions about it,
typically the woman is either
not using them enough
or not using them on
both the inside and outside of the vagina.
In some cases, a woman needs to address more than vaginal dryness to improve her sexual health. If she is experiencing pain during sex or difficulty having sex due to pelvic floor dysfunction, she may benefit from pelvic floor physical therapy, vaginal dilation therapy, or pelvic floor relaxation.
Dr. Bober cautioned against focusing solely on menopausal symptoms when addressing sexual health in women with cancer.
When we talk about sexual recovery
and sexual rehabilitation,
it is important
not to become uniformly focused
on only managing menopause,
although that is a critical aspect of this.
We need to remember that
sexual function and sexual health
are at the intersection of an entire person,
including what’s happening in relationships,
their own experiences
in terms of emotional, psychological
and cultural factors.
If you have questions about your sexual or vaginal health, talk to your doctor to get the care that’s right for you.
Tips for Talking to Your Doctor
Dr. Bober and her colleagues employ a sexual symptom checklist as a starting point for discussing sexual health with their patients. If your healthcare provider doesn’t offer something similar, consider reflecting on the questions below before your next appointment. You may find it helpful to jot down notes and bring them with you:
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Has your interest in sex decreased since your cancer diagnosis?
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Has your interest in sex decreased since starting cancer treatment?
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Are you experiencing less sensation during sex?
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Are you experiencing vaginal dryness?
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Are you having difficulty reaching orgasm?
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Do you feel pain during sex?
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Do you have anxiety about having sex?
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Are you experiencing any other changes in sexual function or vaginal health?
When answering these questions, be honest about how and what you are feeling. If you feel embarrassed while discussing these topics, try to push past that so you can get the help you need. If your healthcare provider lacks the knowledge or resources to help with sexual health issues, ask for a referral for someone who can. Also, remember that you are not alone. Others have similar concerns.
Dr. Bober said,
Overwhelmingly, the majority of women
will tell you they have concerns
about vaginal health and sexual health.
We also know that the majority of women
will tell you
they are dissatisfied with the information
because they do not get enough.
The reality is that we are talking more all the time
about reproductive health,
which is fantastic,
but I do not think
that we have the same consistent focus
on sexual health,
which is similarly important to quality of life.
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