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Sexual Function and Cancer | Image Courtesy of Priscilla Du Preez via Unsplash
Sexual Function and Cancer | Image Courtesy of Priscilla Du Preez via Unsplash

Physical Therapy Can Mitigate the Effects of Cancer on Sexual Function

Sexuality can be a big part of who we are as individuals. Sexual function can be defined as “specific physical, physiological, neurological and emotional behaviors expressed by an individual response”.5 Sexual function and cancer can have an important and detrimental relationship.  There are certain cancers that can unfortunately affect our sexual health, including cervical, ovarian, bladder, kidney, colorectal and breast cancer to name a few.

Some cancer treatments can cause unwanted side effects that affect our sexual health such as decreased sexual arousal or desire, vaginal stenosis (narrowing of the vaginal canal), dyspareunia (painful sexual intercourse), and bladder/bowel dysfunction. This can affect our relationships with ourselves and with our partners, and reduce quality of life.

Hopefully a physical therapist is part of your team to help guide you during this challenging time and minimize these aforementioned side effects. Otherwise, ask for a pelvic floor physical therapist to join your team during your recovery! 

Sexual Function and Types of Cancer

Sixty-seven percent of those diagnosed with gynecological cancer suffer from dyspareunia. In other cancers that are not directly related to genitals can experience sexual dysfunction. In those diagnosed with breast cancer, 50-75% also have pain with sexual intercourse. Common symptoms after bladder or kidney cancer surgeries include decreased sexual desire, decreased ability to achieve orgasm, decreased lubrication, and dyspareunia. Some kidney surgeries bypass the abdominal surgical approach and attempt to remove kidney or tumor intravaginally, which is a less invasive approach. As you can see, the pelvic floor musculature is a very involved player in promoting healthy bladder and bowel function. More importantly, pelvic floor muscles are crucial in sexual function. 

Sexual Function and Cancer Treatments

Radiation, immunotherapies, chemotherapy, antihormonal therapies (usually in breast cancer) and surgery are some of the common cancer treatments. Each type of treatment may increase the likelihood of some type of sexual dysfunction, whether it be pain, decreased sensation, decreased arousal and desire, or vaginal stenosis. Pelvic organ prolapse, a bulging or sensation of something falling in the vaginal canal, can also occur as a result of a shift in organs and or decrease in integrity of the fascia that helps support pelvic organs, and can also lead to pain with sexual activity. There are strategies to help counteract these symptoms, as well as manual therapy to help improve pelvic floor muscle integrity and thus improve symptoms! One systematic review in 2020 found moderate level evidence supporting the rehabilitation of pelvic floor muscles following gynecological cancer treatments.

Physical therapy sessions would incorporate the following to help improve sexual function: 

One study found that an intervention program that consisted of education, manual therapy, specific pelvic floor exercises, development of a home exercise program, and incorporation of a dilator program improved patients’ pain level, pelvic floor symptoms, quality of life, and overall sexual functioning. Remember, you are not alone in experiencing these symptoms and there is help. If you have any questions sexual function and cancer or any other topics, no matter where you are in your journey, it is not too late to seek help from a pelvic floor physical therapist. 

References:

  1. Arthur SS, Dorfman CS, Massa LA & Shelby RA. Managing female sexual dysfunction. Urologic Oncology. 2021; 1-7. https://doi.org/10.1016/j.urolonc.2021.06.006                 
  2. Brennen R, Lin KY, Denehy L & Frawley HC. The Effect of Pelvic Floor Muscle Interventions on Pelvic Floor Dysfunction After Gynecological Cancer Treatment: A Systematic Review. Phys Ther. 2020;100:1357-1371.
  3. Chang YC, Chang SR, Chiu SC. Sexual Problems of Patients With Breast Cancer After Treatment. A Systematic Review. Cancer Nursing 2019; 42(5): 418-425.
  4. Cyr MP, Dumoulin C, Bessette P, Pina A et al. Feasibility, acceptability and effects of multimodal pelvic floor physical therapy for gynecological cancer survivors suffering from painful sexual intercoures: A multicenter prospective interventional study. Gynecologic Oncology 159 (2020) 778-784. 
  5.  Wood F. Human Sexuality in Health and Illness. 3rd ed. St Louis, MO: C.V. Mosby; 1984.

What Our Patients Have to Say

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Testimonial by R.H.

No one could tell me why I was having pain during sex--sharp pain, not just uncomfortable, pain. I was referred to Heather Jeffcoat after researching several different options. I had seen a specialist who told me physical therapy would not help and my only option was surgery. I really didn't want to go that route, so when we got a referral, I decided to try it--it can't hurt, I thought. I am so glad I did. She diagnosed the problem right away, which was a relief in itself.

To know why I was having pain eased my mind immensely. And to hear that she could fix it without surgery was another relief. She said she could fix the problem in 6 weeks. I think it was actually 4 for me. She was very methodical, and treated me as an intelligent human being capable of participating in my own recovery. I would absolutely recommend her to anyone. She did not try to prolong my session numbers, she worked hard to accommodate my schedule (and the fact that I had to bring a baby to sessions), and she was completely honest the entire time. It is so hard to find someone with these characteristics, much less a professional who is so good at what she does. She has my highest respect.

-- R.H.

Testimonial by Amanda W.

Heather's unique physical therapy program literally changed my life! After years of struggling with vaginismus, a condition that made it impossible for me to have intercourse and very difficult to use tampons without pain, a gynecologist referred me to Heather. I was nervous for my first appointment, but Heather's professional and friendly demeanor put me at ease. She did a great job explaining each technique she was using to help my muscles relax. Heather uses a combination of internal and external stretches and exercises to relax the pelvic floor and build muscle strength. Her specially developed home program helped me quickly recover from an issue that seemed insurmountable before meeting Heather. She was optimistic about my progress and incredibly encouraging. Less than 6 months after my first session, I was able to have pain-free sex for the first time in my life! If you are suffering from vaginismus or any other pelvic floor issues, I highly recommend making an appointment with Heather and reading her book!

-- Amanda W., 2/15/16 via Yelp!

Testimonial by Fritzette H.

I went to Heather after the birth of my third child. It was lucky, really, that I was referred to her, because my doctor had referred me to a surgeon for a possible hysterectomy or pelvic wall rebuild. Thankfully, I went to Heather before undergoing either surgery, she was able to fix the problem. She has studied extensively in women's health--even written a book about it--and was able to diagnose my problem, suggest a course of treatment (6 weeks), and then follow through with said treatment. By the end, as she said, I was as good as gold. Boy, was it worth it! Though uncomfortable to talk about, much less write about, it is worth getting the word out there. If you have painful intercourse, especially after birth or other trauma, the treatment may be as simple as Physical Therapy (with Heather, of course). I highly recommend her.

-- Fritzette H., 3/24/16 via Yelp!

Testimonial by S.H., age 24

I just wanted to thank you for everything you've done for me for the past 19 months. I literally could not have reached my goals without you and your practice. You gave me the courage to keep moving forth with my treatment no matter how afraid and anxious I was. You were always there to answer questions and made this whole process so much easier than I expected it to be.

It's because of you that my marriage is on the right track, that I can get pregnant and that this part of my life is finally over. I really feel that Fusion Wellness is a team of people you can call family and are there to root for you and cheer you on until you reach your goals. There is nothing better than knowing I accomplished this with you guys by my side and as calmly and patiently as I needed. Thank you from the bottom of my heart for always being there and helping me reach my goals.

S.H., age 24

Testimonial by R.H.

No one could tell me why I was having pain during sex--sharp pain, not just uncomfortable, pain. I was referred to Heather Jeffcoat after researching several different options. I had seen a specialist who told me physical therapy would not help and my only option was surgery. I really didn't want to go that route, so when we got a referral, I decided to try it--it can't hurt, I thought. I am so glad I did. She diagnosed the problem right away, which was a relief in itself.

To know why I was having pain eased my mind immensely. And to hear that she could fix it without surgery was another relief. She said she could fix the problem in 6 weeks. I think it was actually 4 for me. She was very methodical, and treated me as an intelligent human being capable of participating in my own recovery. I would absolutely recommend her to anyone. She did not try to prolong my session numbers, she worked hard to accommodate my schedule (and the fact that I had to bring a baby to sessions), and she was completely honest the entire time. It is so hard to find someone with these characteristics, much less a professional who is so good at what she does. She has my highest respect.

-- R.H.

Testimonial by P.M.

I was hopeful but frankly skeptical when the doctor treating me for Interstitial Cystitis recommended that I go to Heather for physical therapy. Medication and diet helped control my IC symptoms, but I had never heard of physical therapy being used to treat IC. The education and treatment I received from Heather was a revelation. She explained that the pain I experienced with IC had helped create a cycle of muscle guarding which affected the entire pelvic area. I had no idea of the amount of tension being held there. No wonder my husband and I had not been able to have sexual intercourse for years!

Read more: Testimonial by P.M.

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