Sexual Problems and Cancer Treatment

It's Cervical Health Awareness Month!

Sexual problems are a side effect of cancer treatment that oncologists don’t often talk about, but there are treatments to help, including the pelvic floor therapy that we do at Femina PT. Surgery, chemotherapy, radiation, hormonal therapy, stem cell transplantations, and other procedures can negatively affect quality of life, including sexual health and happiness. These side effects are not limited to cancers of the sexual organs either. Cancer treatment anywhere in the body (cervix, breast, throat, GI tract) can lead to changes in sexuality.

Up to 64% of women affected by cancer experience “altered sexuality”—their sex lives just feel different than they did before. There are physical side effects like fatigue, nausea, dry, painful, itchy, and burning vaginal tissues, and hormonal changes which make sex unappealing and painful. Altered self-image, depression, and anxiety can make it hard to connect with others and feel intimacy. These effects can last years after cancer treatment. If you are currently experiencing these effects, you are not alone and there are treatments that can help.

Pelvic floor therapy may help.

The therapists at Femina can help with some of the sexual problems that you may be feeling. Therapy for sexual problems and cancer treatment may include:

Dilator therapy to help with pain with penetration and to prevent or reverse scarring if your vaginal tissues are affected
Exercises for pelvic muscles to lower pain, improve bladder retention, improve bowel function, and increase the flow of blood to the area, which can improve your sexual health
Skincare and hygiene regimens to reduce vulvar tissue thinning, irritation, and dryness—including vaginal lubricants and moisturizers
Manual lymphatic drainage for tight, aching, or provoked pain in extremities, vulva, breast, armpits, and chest wall
Therapeutic yoga to improve lymphatic drainage and reduce chronic pain
Neuromuscular re-education and autogenic relaxation to reduce chronic muscle over-activity, reduce pain, and improve sleep

Bring it up with your doctor.

Unfortunately, not all doctors and nurses are equipped or comfortable with asking about sexual health. Most women can be sexually active during treatment, but you’ll want to confirm this with your doctor. You have every right to bring it up—be empowered to do so.

Sage Bolte, PhD, LCSW, OSW-C, CST, offers the following suggestions in her article, “Your Sexual Health and Cancer: What to Know, What to Do” for the American Society of Clinical Oncology:

Write out questions and requests ahead of time.

One option to do this is using the “Fact, Feeling, Belief, and Question” formula.

Here’s an example:

“I noticed that I have increased discomfort with intercourse (fact), and I’m upset about it (feeling). I believe it’s because of the treatments I was on (belief). Are there any tests that can be done or professionals I can talk to about how to improve this? (action)?”

You can also write out requests for referrals.

“I am experiencing pain with penetration and vaginal dryness. I would like a referral to a pelvic floor therapist to address these issues.”

Write down your questions and requests and hand them to your health care provider or email/fax them before your next appointment. You can also bring someone with you to your appointment to help you address your concerns.

What you can do right now

Schedule an appointment with your doctor.
Ask a health care professional to explore potential causes and treatments for changes in your sexual health and function.
Schedule an appointment with a pelvic floor therapist.
Get a comprehensive evaluation with a pelvic floor therapist to establish a treatment plan and goals for your road to sexual health and recovery.
Explore other avenues for intimacy.
Sex isn’t the only form of intimacy. Skin is the largest sex organ and the brain is the most important sex organ. Don’t be afraid to explore. If you need more support, consider finding a therapist who specializes in sexuality.
Plan for sex and intimacy.
Engage in sex and intimacy during the times of day you have the least fatigue or feel at your best. Time sex and intimacy with your medication schedule so that you don’t feel nauseous or tired. Adjust the temperature of the room so you are comfortable and have any supplies (lubes, condoms) nearby.
Communicate your needs.
Ask for what you want and need from your partner(s) and health care team. You possess the best knowledge of what you are feeling and what you need.
Take it easy.
Rest during sex if you need to; it’s not a marathon.

Whatever your path is, you have many options to explore for sexual problems and cancer treatment. Your sexuality is important and you should feel empowered to bring it up with your team of providers.

Resources:

Coady D, Kennedy V. (2016). Sexual Health in Women Affected by Cancer: Focus on Sexual Pain. Obstet Gynecol. 128(4):775-91
https://www.ncbi.nlm.nih.gov/pubmed/27607852

National Cancer Institute. (ND). Sexual Health Issues in Women.
https://www.cancer.gov/about-cancer/treatment/side-effects/sexuality-women

Bolte, S. (2017). Your Sexual Health and Cancer: What to Know, What to Do.
https://www.cancer.net/blog/2017-03/your-sexual-health-and-cancer-what-know-what-do