How cancer affects women’s sexuality and sex life

A woman given a diagnosis of cancer knows bodily changes are likely to occur. These changes might include hair loss, excessive tiredness, digestive issues, skin changes, and changes in appetite. But there’s one other change women may not have thought of – cancer’s influence on her sexuality and sex life both during and sometimes after treatment. 

When going through cancer treatments, interest or having the energy for sex may be the last thing on a woman’s mind.  Depending on how the cancer is being treated, these therapies may affect a woman’s sexual organs or her ability to become aroused. While it may not seem that having sex should be a top priority when fighting cancer, sexuality is about whom a woman is and how she feels as a woman.  It’s the feelings and characteristics that make up a woman’s sexual identity.  Because of this, it is still important for a woman to feel close and intimate with her spouse or partner as she goes through treatments and even after treatments are over with.

Ideally, a woman’s doctor or nurse should bring up the topic of sex, discussing how cancer treatment might affect their sex life.  If they don’t, a woman may need to be proactive by asking questions such as, what sexual changes or problems are common among women receiving this type of treatment or what methods of birth control or protection are recommended during treatment?

Factors that may affect sexual health during cancer treatment

·      The type of cancer

·      The type of treatment(s)

·      The amount or dose of treatment

·      The length or duration of treatment

·      The age of a woman at the time of treatment

·      The amount of time that has passed since treatment

·      Other personal and pertinent health factors of each individual woman

Sexual problems in women that may be caused by cancer treatments

For most women who may experience sexual side effects during cancer treatment, many are often temporary and improve once the treatment is over. But some side effects can be long term or may arise after cancer treatment is done. Any woman, who is noticing sexual side effects either during or after cancer treatment, should discuss this with her doctor as there are various ways to treat them improving the situation.

Here are ways specific cancer treatments may uniquely affect a woman’s sexual health:

·      Chemotherapy – This type of treatment can lower estrogen levels and cause primary ovarian insufficiency. The results of this can mean that the ovaries are not producing hormones and therefore are not releasing eggs. Symptoms a woman may experience include hot flashes, irregular or no periods, and vaginal dryness making sexual intercourse painful. Vaginal tissue is also affected by chemotherapy resulting in sores.

·      Hormone or endocrine therapy – Women receiving this treatment also may notice hot flashes, irregular or no periods, and vaginal dryness, again mainly due to reduced estrogen levels.

·      Radiation therapy – The main area of a woman’s body affecting her sexual health from  radiation therapy is radiation therapy to the pelvis area (such as to the bladder, cervix, colon, ovaries, rectum, uterus, or vagina).  Low estrogen levels, due to the radiation, can lead to vaginal dryness. Other sexual problems from radiation therapy to the pelvis can be vaginal stenosis or loss of elasticity leading to a more narrow and shorter vagina; vaginal atrophy resulting in weal vaginal muscles and thinning of vaginal walls; and vaginal itching, burning, and inflammation causing pain and discomfort during sex.

·      Surgery for gynecologic cancers – For many women who have had to have this type of treatment to fight back their cancer, this may bring about physical changes affecting how they view their body.  A good example is how a woman views herself after a mastectomy or an ostomy for example.

·      Medications – There are many medications that can have sexual side effects but opioids and some drugs used to treat depression may lower a woman’s interest in sex.

How to manage sexual health issues

Any woman who experiences a sexual health problem during or after cancer treatment should seek advice from her health care team.  They can provide valuable suggestions on any concerns or questions a woman may have. One thing all women should ask their doctor is if they recommend for her to be sexually active during treatment. The reason is sometimes during certain cancer treatments, if may put a woman at risk for infection or bleeding and therefore should be advised to abstain from sexual intercourse.

Here are other suggestions a cancer healthcare team can offer women during this time:

·      Suggestions on making sex more comfortable.  This might include learning about vaginal gels or creams to stop a dry, itchy, or burning feeling. Using vaginal lubricants or moisturizes or a vaginal estrogen cream can be of great benefit for sexual issues affecting the vaginal tissues.

·      Advice on exercises for pelvic muscles. This advice can help lower pain, improve bladder retention, improve bowel function, and increase the flow of blood to the pelvic area improving sexual health

·      Learn how to manage side effects. Any woman experiencing fatigue, pain, hair loss, loss of interest in activities, feelings of sadness or trouble sleeping should talk with their doctor or  nurse.  Any of these can directly affect her sex life. 

·      Learn about contraceptives. A frank discussion on contraceptive use is necessary.  For instance, condoms may be advised if a woman is having chemotherapy where residual of it may remain in the vaginal secretions.  The condom would protect a man from exposure to this. Any woman of childbearing age who has cancer will likely be advised to use contraceptive while receiving treatment and for a period of time following treatment in order to prevent pregnancy.

Overall, all women should consider getting support and/or counseling when going through cancer treatment.  There can be significant benefits of participating in a professionally moderated or led support group or in talking about concerns with people on their healthcare team they are close to.

 

Dr. David B. Samadi is a Urologic Oncology Expert and Robotic Surgeon located at 485 Madison Avenue on the 21st floor, New York, NY – 212-365-5000.  Follow Dr. Samadi at www.samadimd.com,  www.prostatecancer911.com, and www.roboticoncology.com.