Physical Therapy After Pelvic and Breast Cancer

Specialized Physical Therapy after Pelvic and Breast Cancer Treatment

Physical therapy for pelvic cancer can relieve pain with sex and general pelvic pain that results from gynecological cancer of the female reproductive organs. Physical Therapy after breast cancer can help manage lymphedema (several of our DPTs are also Certified Lymphedema Therapists) and restore upper extremity strength and mobility.

Types of Gynecologic Cancer

• Cervical cancer begins in the cervix, which is the lower, narrow end of the uterus. (The uterus is also called the womb.)
• Ovarian cancer begins in the ovaries, which are located on each side of the uterus.
• Uterine cancer begins in the uterus, the pear-shaped organ in a woman’s pelvis where the baby grows when she is pregnant.
• Vaginal cancer begins in the vagina, which is the hollow, tube-like channel between the bottom of the uterus and the outside of the body.
• Vulvar cancer begins in the vulva, the outer part of the female genital organs.
  CDC, 2020

Each of these types of cancers has different signs and symptoms, varying risk factors, and different prevention strategies. All women are at risk for gynecologic cancers, and risk increases with age. Both men and women are at risk for breast cancer, however it it much more common in women. Physical therapy for pelvic and breast cancer can help reverse the negative symptoms and side effects from the medical treatments performed.

Treatment of Gynecologic and Breast Cancers

According to the CDC, when gynecologic and breast cancers are found early, treatment is more effective.

Types of Treatment

Gynecologic and Breast cancers are treated in different manners, depending on the type of cancer and its spread (stage). Women with a gynecologic cancer often get more than one kind of treatment.

• Surgery: Doctors remove cancer tissue in an operation.
• Chemotherapy: Using special medicines to shrink or kill the cancer. The drugs can be pills you take or medicines given in your veins, or sometimes both.
• Radiation: Using high-energy rays (similar to X-rays) to kill the cancer.

Sexual Problems and Cancer Treatment

Sexual problems are a side effect of both gynecologic and breast cancer treatment that oncologists don’t often talk about, But there are treatments to help, including the type of physical therapy for pelvic and breast cancer that we do at Femina. 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 sexual function.

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 the initial cancer treatment has ended. If you are currently experiencing these effects you are not alone, and we do offer customized treatments to help support your return to exercise, return to sex and return to thriving.

How Pelvic Floor Physical Therapy Can Help

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

• Our comprehensive cancer survivor and thriver rehabilitation program, including Lymphedema therapy with Complete Decongestive Therapy.
• Dilator therapy to help with pain with penetrative intercourse and to prevent or reverse scarring if your vaginal tissues are affected
• Scar tissue remediation over surgical sites.
• Exercises for your whole body, including pelvic muscles, to help improve bladder issues, 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 irritation and dryness—including vaginal lubricants and moisturizer recommendations
• Manual lymphatic drainage for tight, aching, or provoked pain in extremities, vulva, breast, armpits, and chest wall or lymphedema
• Therapeutic yoga and/or pilates 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

Consult 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—and 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 Down Questions and Requests Before Your Appointment

It's easier to remember things you want to bring up with your doctor before your visit. If you are feeling shy, you might even be able to show it to them.

Example: “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.

If you are having sexual pain right now -- What you can do

• 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 physical therapist.
  Get a comprehensive evaluation with one of our pelvic floor physical therapists 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, including physical therapy for breast and pelvic cancer. Your sexual health 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

CDC. What is Gynecologic Cancer.
https://www.cdc.gov/cancer/gynecologic/basic_info/what-is-gynecologic-cancer.htm

CDC. How are Gynecologic Cancers Treated?
https://www.cdc.gov/cancer/gynecologic/basic_info/treatment.htm

CDC. What are the Symptoms of Gynecologic Cancer?
https://www.cdc.gov/cancer/gynecologic/basic_info/symptoms.htm

CDC. What Can I Do to Reduce My Risk?
https://www.cdc.gov/cancer/gynecologic/basic_info/prevention.htm

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