Sex After Cancer
Cancer treatment has the potential to drastically affect sexual function. This can occur in a number of ways depending on the type of cancer and method of treatment undertaken.
In general, cancer treatments can be divided into medical treatments (including chemotherapy and immunotherapy), radiation therapy and surgical or ablative therapies (such as cryotherapy). Treatment options vary depending on the type of cancer, the cancer’s stage and a variety of other factors. Any of these treatment methods can impact sexual function. It is important to have an individualized discussion with your treatment team about how any proposed treatments might affect sexual function, or how you might be able to address the sexual problems you may have developed as a result of prior cancers and their treatments.
The symptoms of sexual dysfunction related to cancer can vary greatly between sexes and between different cancers and treatment types. When it comes to sexual function, there can be both physical and psychological (or emotional) effects that happen as a result of cancer and its treatment.
Physical effects of cancer and its treatment on sexual function in women can include painful intercourse, urinary incontinence or incontinence during sexual activity, hormone-related vaginal dryness and tissue changes, bleeding, changes in libido (interest in sexual activity) or arousal, decreased genital sensation or hypersensitivity, infertility and/or damage to the internal or external genitalia, among many others.
Physical effects of cancer and its treatment on sexual function in men can include erectile dysfunction, decreased penile length, Peyronie’s disease (penile deformity), urinary incontinence (leakage) or incontinence during sexual activity/arousal, decreased libido, premature ejaculation, retrograde or anejaculation, delayed orgasm or anorgasmia (inability to orgasm), lack of semen expulsion with ejaculation, difficulty with ejaculation, painful orgasm, infertility and damage to the genitalia, among others.
Cancer can take a large emotional toll on an individual and their support system. Psychological (emotional) effects in both women and men can include depression, anxiety, distress, body image concerns, decreased self-confidence, financial stress and suicidal thoughts. Partners, family members and caretakers of cancer patients are also at risk for these same psychological effects as this experience can cause significant stress to them as well. Thus, treatment discussions for sexual issues after cancer should always include an individual’s partner when possible.
The causes of these various issues vary depending on the cancer and type of treatment undertaken. Many of these cancers and their treatments can damage the genitals and urinary tract directly. Some may also damage other organs which can affect hormone levels. Coping with cancer diagnosis and treatment can be difficult and several resources are available including counseling/therapy, support groups, among others.
If you are preparing to undergo cancer treatment, have a discussion with your doctor about any possible sexual side effects. Ask about any ways to try to prevent or reduce the risk of sexual problems developing. Knowing about rehabilitation therapies ahead of time might mean that, in certain cases, you may be able to implement them right away — rather than suffering the ill effects in silence, and risk compounding the trouble.
The diagnosis of cancer-related sexual dysfunction relies on a thorough history obtained by a provider experienced with sexual problems. Many family medicine physicians, general practitioners and therapists/psychologists have experience with these issues, but some do not. A licensed sex therapist has special training to provide help with sexual issues of many kinds. Obstetricians/gynecologists (for women) and urologists (for both women and men) receive general training to help with sexual issues. However, some of these providers may not see many patients with cancer-related sexual dysfunction, so it is important to seek out an experienced provider. Several providers with subspecialty training and expertise in sexual dysfunction are listed on this website.
Treatment of the various sexual side-effects of cancer and its treatment vary depending on the cancer, its treatment and the resulting problem. After completing cancer treatment, a treatment summary and individualized care plan should be created. This is called a “survivor care plan” and should include plans to address any side effects of the cancer treatment. This can help ensure that sexual side effects of cancer and its treatment do not go unrecognized. By providing a comprehensive assessment, any issues identified can be addressed and quality of life can be maximized.
As mentioned above, sexual issues after cancer treatment can vary. Providers who treat sexual dysfunction include therapists/psychologists (and sex therapists), general practitioners, urologists and obstetrician/gynecologists, among others. However, some of these providers may not see many patients with cancer-related sexual dysfunction, so it is important to seek out an experienced provider. Several providers with subspecialty training and expertise in the treatment of sexual dysfunction are listed on this website.
Cancer treatments may affect fertility – particularly (but not limited to) radiation, chemotherapy and surgery to remove the testicles, ovaries, fallopian tubes or uterus. These individuals may want to think about saving (banking) sperm, eggs, or ovarian tissue. A reproductive specialist (urologist for men or obstetrician/gynecologist for women) can help with this. (If you are interested in learning more about maintaining fertility go to http://www.fertilehope.org)
Condition overview written by Petar Bajic, MD