Sex after Cancer
In a way, this is a companion piece to yesterday's blog about post treatment issues. For many women, sexuality/intimacy concerns become important in the weeks and months after treatment. As I have said before, this is generally not the top of the list for newly diagnosed women, but, as life returns to "normal", it often becomes more worrisome. (an aside: the one woman I have ever known who said that her sex life was her biggest worry and refused chemotherapy and hormonal therapy because she was afraid it would be damaged as 73 years old--so much for stereotypes!) The bottom line is that hardly anyone has the same libido and responsiveness during and immediately after treatment that she had before. Some women may never reclaim their pre-cancer passions, although all women can recreate a loving and satisfying sex life.
This is usually not a topic raised or discussed by oncologists although it ought to be. If you are not comfortable talking with your doctor about your concerns or if your doctor does not seem all that comfortable or well informed, ask for a referral to someone who can help. The "someone" is likely to be an oncology social worker or another therapist with experience working with people who have been treated for cancer.
Here is a summary from EurekaAlert about a recently published study. If you want to read the primary source, there is a link at the bottom:
Few women seek help for sexual issues after cancer treatment, but many want it
Many women who survive breast and gynecologic cancers want medical help for their sexual issues, but most do not get it. A survey of hundreds of cancer survivors, published online in the journal Cancer, confirms that more than forty percent want medical attention for their sexual health needs.
"Some women have the courage to raise sexual concerns with their doctor, although repeated studies show they prefer the doctor to initiate the discussion," said Stacy Tessler Lindau, MD, associate professor of obstetrics and gynecology at the University of Chicago Medical Center and senior author of the study. "Physicians will often empathize with a patient's concerns, but struggle with a lack of knowledge about how to help."
Sexual problems in women after treatment for gynecological and breast cancers are well-documented —pain, dryness, loss of desire, difficulty with arousal and orgasm, and changes in body appearance due to treatments. Cancer survivors often struggle with body-image concerns, and don't feel attractive or feminine after treatment.
Doctors rarely talk with women about the impact of cancer on their sexuality. "There are few centers in the United States with the expertise to treat sexual problems in women and girls with cancer," Lindau said. Many women also don't discuss the issues with their spouse or partner.
The researchers surveyed 261 gynecologic and breast cancer patients and collected their medical records data. The mean age of the participants was 55, with a range of 21 to 88 years. Only seven percent of the patients surveyed had asked for advice or medical help for sexuality problems, but 42 percent were interested in receiving such care.
"Anything that affects the female sexual organs will have repercussions on body image and on a woman's sex life," said Emily Hill, MD, a fourth year resident in obstetrics and gynecology at the University of Chicago Medical Center, and lead author of the study.
The results of this study demonstrate a large, unmet need for attention to the sexual concerns of women who survive gynecologic and breast cancers.
"A lot of the treatments have effects on sexual health," Hill said, including hormone therapy and chemotherapy. "We see impact after many kinds of breast cancers or gynecological cancers."
Women who had been out of cancer treatments for more than a year were significantly more likely to want medical care for sexual concerns than women who were currently in treatment. Thirty-two percent of the women in treatment wanted to talk about sexual issues, while 47 percent of the women who were more than twelve months out from their last cancer treatment wanted medical care for sexual concerns.
Younger women were more concerned about sexual issues than older women. However, more than 22 percent of women over 65 in the study also said they wanted medical care for their sexual issues.
A woman's sexuality is affected by both physical and psychological issues after cancer treatments, Lindau said. "It is critical that physicians caring for cancer patients know that sexual concerns are often physical. The physical problems associated with cancer treatment can strain relationships, cause worry and stress, and can be very isolating—many women come to us feeling ashamed, guilty, or alone. They feel like the problem is primarily in their head."
In the treatment of prostate cancer, by contrast, many physicians routinely address concerns about sexual function. Preservation of sexual function is a topic that is proactively addressed with menbefore a treatment decision is made and continues openly throughout prostate cancer care in many centers, Lindau said.
Lindau is director of the Program in Integrative Sexual Medicine for Women and Girls with Cancer— the PRISM clinic at the University of Chicago. It was started in 2008 to address and study women's sexual problems. With specialists in gynecology, psychology, physical therapy oncology, and nursing, it is one of few clinics nationwide that comprehensively addresses female sexual concerns caused by cancer. Lindau and her colleagues are establishing a field of research with other cancer centers across the country to generate evidence about how best to treat the sexual problems that women experience after cancer.
Thirty-five percent of the women surveyed were willing to be contacted if a formal program to address sexual issues after cancer were offered to them. The PRISM Clinic is the only place in Illinois that offers such a program. Lindau is working with other physicians in Illinois and around the country to help build similar programs and develop best practices.
The study, "Assessing Gynecologic and Breast Cancer Survivor' Sexual Health Care Needs" was published online December 23, 2010, in the journal Cancer and is freely available. In addition to Drs. Lindau and Hill, authors include Diane Yamada, Stacey Sandbo, Emily Abramsohn, Jennifer Makelarski, Emily Wenrich and Stacy McCoy at the University of Chicago Department of Obstetrics and Gynecology; Kristen Wroblewski at the University of Chicago Department of Health Studies; and Sarah Temkin at the University of Maryland in Baltimore, Maryland.
The research was funded by a grant from the National Institute on Aging at the U.S. National Institutes of Health, and by the University of Chicago Comprehensive Cancer Center.