Interventions for Sexual Issues after Cancer

What is your experience with sex after cancer?

Just last week,I wrote a blog post about sexual issues for men after cancer. Let us return to this ever-popular topic with the reminder that there is no magic fix and that virtually everyone experiences some troubles with intimacy and sexuality during and after cancer. I am reminded of this as I have just started working with two couples who came to me with this problem. One woman is only 35 and is two years past her diagnosis of breast cancer; she still has little libido and worries about discomfort with intercourse. The other couple brings a different set of problems; the man continues on hormonal treatments for prostate cancer and has found that erectile dysfunction (ED) and diminished libido are likely permanent issues.

The first suggestion is the traditional one. As is true for all issues, the most important strategy is open and loving communication between partners. It can be painful or embarrassing to discuss, but words must come first. Hopefully, accompanying those words, are touch and love. Sex is usually not the most important part of a relationship, but it is always important to feel close and lovable and loving, and physical intimacy helps couples feel that way.

In a perfect world, psychosocial and psychosexual counseling should be offered to all patients with cancer. In a really perfect world, this would begin very quickly after diagnosis. For younger patients, it is vital to address fertility issues before treatment begins, and everyone would benefit from some basic information and encouragement. Instead, the reality is that sperm banking or egg retrieval may be discussed when appropriate, but it is rare for cancer doctors to early on bring up other issues related to sexuality. It would be nice if medical and treatable concerns could be addressed at that time.

For example, many women experience discomfort or pain with intercourse and may be diagnosed with vaginal or vulvar atrophy. These changes are related to treatment and treatment-induced menopause. A reasonable conversation would include information about this condition and suggestions of lubricants that are often helpful (think Albolene and canola oil). Sometimes low dose vaginal estrogen may be considered, but that is a second choice with careful consideration given to possible risks. For men, there are medications (think Viagra) that often help with ED, and there are penile pumps or even surgery to help. It is usually helpful to talk about behavioral options and the value of speaking with a therapist about these concerns.

All cancer patients and their partners should be offered the opportunity to speak with someone about their sexual concerns. This conversation probably needs to be initiated by the oncologist or NP, but certainly a patient can ask. It is unfortunate that, in the midst of so many other things that must be addressed, this important one is too often overlooked. Most cancer centers, including the BIDMC Cancer Center, have oncology social workers on staff. These clinicians are well-informed about these issues.

What seems important and too often missing from cancer counseling is the recognition of the universality of sexual issues, the normalization of them, and the chance for patients to discuss their concerns and hear about possible ways to help themselves to regain a satisfying intimate life.