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Sexual Dysfunction after Breast Cancer

Posted 1/29/2014

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  It is not a surprise to any of this that most women experience some changes/difficulties in their intimate relationships during and after breast cancer. There are the physical changes directly caused by cancer treatment (breast surgery, hair loss from chemotherapy) as well as the more subtle assaults on one's sense of womanliness and desirability. Virtually everyone exeriences a diminished libido during treatment, but most women regain a comfortable level of sexuality and intimacy. To be fair, it is also true that women are very adaptable, and it may be that some (? many?) women and their partners gradually readjust their expectations and become satisfied with a relationship that would have previously been seen as unacceptable. One obvious comment is that breast cancer treatment throws many women int an abrupt early menopause, so the normal sexual changes of that time of life come fast and furious and early.

  It is also not a surprise that most oncologists don't do a very good job of discussing this issue with their patients. That is due to a number of things, including all the others topics that must be addressed and may seem more urgent and the relative discomfort of some physicians in discussing sex. Sexual health absolutely should be part of the conversation, especially after treatment has been completed, and one hopes that more doctors will recognize the importance of the topic.

  This is a review article from The Journal of Clinical Oncology. I am unable to post a working link, but, if you want to read the whole thing, just email me (hhill@bidmc.harvard.edu), and I will send it right along. Here is the abstract:

Sexual Dysfunction in Female Cancer Survivors
Michael DeSimone, BS,* Elizabeth Spriggs, BA,w Jennifer S. Gass, MD,*z Sandra A. Carson, MD,*z
Michael L. Krychman, MD,y and Don S. Dizon, MD, FACP*

Abstract: Cancer survivors face a myriad of long-term effects of their
disease, diagnosis, and treatment, and chief among many are problems
associated with sexual dysfunction. Yet despite their frequency and the
degree of distress they cause patients, sexual dysfunction is not effectively
screened for or treated, and this is particularly true in female
survivors. Inconsistently performed general sexual health screening at
all facets of cancer care and survivorship ultimately translates into
missed attempts to identify and treat dysfunction when it does arise. In
this paper, we will review the current research and clinical practices
addressing sexual dysfunction in female cancer survivors and propose
questions in need of future research attention. This article will review
the phases of sexual response and how each may be affected by the
physical and emotional stress of cancer diagnosis and treatment. We
will then discuss existing tools for assessment of sexual function and
approaches to their treatment. Finally, we will conclude with advice
to health care professionals based on current research and suggest
questions for future study.

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