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October 03, 2022

Sexual struggles after cancer treatment are common, but help is available

Chemotherapy and radiation can damage reproductive organs. The fatigue they cause also can impact a person's libido

Adult Health Sexual Health
Cancer Sex Life Source/Image licensed from Ingram Image

As many as 85% to 90% of prostate, breast and gynecologic cancer survivors report long-term concerns regarding physical intimacy, according to a LIVESTRONG poll.

Cancer patients and survivors often experience difficulties with intimacy and sex, but many are reluctant to discuss the issue with their doctors, health experts say. But if left unaddressed, these issues can affect their quality of life and intimate relationships. 

More than 60% of women with cancer and 40% of men experience sexual dysfunction, according to Yale Medicine. Though some treatments have a bigger impact on sexual function than others, even the two most common forms of treatment for any type of cancer – chemotherapy and radiation therapy – can damage important reproductive organs and structures. The treatments also can cause fatigue and nausea, which can affect a person's libido. And physical and hormonal changes can add to body image issues, depression and anxiety.  

A LIVESTRONG poll found that as many as 85% to 90% of prostate, breast and gynecologic cancer survivors report long-term concerns regarding physical intimacy.

The most common types of sexual dysfunction that women experience, in general, include low sexual desire, pain with sexual stimulation or penetration, sexual arousal disorder – the struggle to become aroused during sexual activity – and orgasmic disorder – the inability to reach orgasm despite sufficient sexual arousal and stimulation.

Men with cancer can suffer a low libido and difficulties having an orgasm, according to Johns Hopkins Medicine. They also might experience erectile dysfunction, changes in ejaculation and changes in the physical appearance of the penis.

A new study of nearly 700 women, ages 18-39, highlights the need for health care providers to better address the sexual health concerns of cancer patients, particularly women who are diagnosed as young adults. Sexual problems among cancer patients are more prevalent than most people realize, the researchers said. 

More than 500,000 women are diagnosed with cancer in young adulthood each year, according to their data. And about 63% of the women in their study had at least one sexual issue such as vulvar discomfort or vaginal dryness.

The type of cancer and the intensity of treatment affected the quality of cancer patients' sex lives, the study found. The cancer patients reported being as sexually active as other women, but they struggled more with intimacy. 

About 45% of the women reported a lack of interest in sex, with 34% having difficulties reaching orgasm and 22% reporting dissatisfaction with their sex lives. In comparison, 28% of women who never had cancer said they had trouble reaching orgasm and 19% said they were dissatisfied with their sex lives.

The researchers also found that feeling unattractive and body image issues were associated with greater sexual dysfunction. Overall, older women and those with breast or gynecological cancers had a higher risk of sexual problems.

"Our results show 2 out of 3 women experienced sexual dysfunction and the problems are related to their cancer treatment and emotional distress," said researcher Lena Wettergren, a professor in care sciences at Uppsala University in Sweden.

Almost half of the women in the study had breast cancer. Others had survived gynecological cancers, brain tumors or lymphoma. The majority of them reported going through very intense treatment.

Health experts say it is important for both men and women to not ignore problems in the bedroom. There are a variety of treatment options available, depending on the source of the dysfunction. They encourage cancer patients to discuss their concerns with their doctors. 

Sharon Bober, a senior psychologist at the Dana-Farber Cancer Institute, suggests that cancer patients should ask their oncologists how their treatments might affect their sexual function. For instance, will it affect a man's ability to have an erection? Or could it put a women into early menopause?

Dr. Reneita Ross, a urogynecology physician at Jefferson Health, previously told PhillyVoice that health care providers need to ask their patients questions about their sexual health, including questions about past trauma, relationship difficulties and any medications they are taking.

Once the underlying causes are identified, a treatment plan for sexual dysfunction can be developed. Treatment can involve trying different arousal techniques with a partner or going to counseling together. In some cases, medication can also help. 

Flibanserin or bremelanotide are the only two medications approved by the U.S. Food and Drug Administration to treat a low libido in premenopausal women. Hormone therapy can make sex more comfortable for women and, in turn, improve desire. For pain during sex, vaginal lubricants or dilators can help.

Men with sexual dysfunction may take pills such as sildenafil citrate and tadalafil to better maintain an erection. There are also injections, penile implants and other tools that can improve blood flow to the penis. Some men also benefit from testosterone therapy.

Both men and women might also find relief from their distress by talking to a counselor or a sex therapist.

Health experts say that more research is needed to better understand the connection between cancer and sexual dysfunction so that more interventions can be developed. While hormone changes and body image issues are definitely factors, there is still a lot of unknowns when it comes to how cancer and its treatments can affect sexual function.

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