Sexuality for Women With Cancer - A Necessary Discussion

What Is Sexuality?

Sexuality refers to the way people express themselves sexually. This can include their thoughts and feelings about their sexuality and behavioral patterns in relationships. Another term used to refer to sexuality is sexual health.

Why Is Sexuality for Women With Cancer an Important Discussion?

Being diagnosed with cancer and cancer treatment can cause a lack of interest or energy towards sex in the early stages. As time passes, patients may adjust to the new normal and, in some cases, regain interest in sexual activity. At least half of the women undergoing cancer treatment have experienced some form of difficulties in sexuality.

• While most cancer-treatment-related concerns disappear or improve in due course, sexual health concerns remain persistent in women with cancer. This can cause undue distress and sexual difficulties. It can also contribute to issues within their personal and sexual relationships.

• Many women who carry breast or ovarian cancer genes are advised surgeries to reduce their risk. When the question of how it affects their sexuality arises, they may ignore medical advice.

• Often, the discomfort of the sudden reduction in sexual desire may cause women to discontinue the medication that reduces estrogen or are responsible for ovarian suppression.

Sexual health is thus a discussion that must be facilitated to achieve better health for women with cancer.

What Types of Cancer Come With the Greatest Sexual Side Effects?

The cancers that typically display sexual side effects for women include:

• Breast.

• Cervical.

• Bladder.

• Ovarian.

• Uterine.

• Vaginal.

• Endometrial.

• Vulvar.

• Colon.

• Rectal.

Sexual side effects are not limited to these types of cancers and may occur with almost any kind of cancer.

How Does Cancer Affect Sexuality in Women?

Women with cancer usually report side effects such as:

• Diminished or non-existent sexual desire.

• Reduced energy and interest in sexual activity.

• Difficulty with achieving orgasm.

• Dyspareunia or painful intercourse, particularly during penetration.

• Vaginal dryness.

• Vaginal itching.

• Reduction in vaginal size.

• Changes to sex hormones.

Apart from the specific side effects related to sexuality, other issues that come with cancer and cancer treatment can also contribute to reduced sexual interest and desire.

These include:

• A general feeling of sickness.

• Body pain.

• Weakness and lethargy.

• Sadness and grief.

• Anxiety and depression.

• Irritability.

• Bowel problems (like diarrhea).

• Bladder problems.

• Breathing difficulty.

• Problems with oral health and hygiene.

• Changes in the body, such as scarring.

While most people report a lack of interest and energy to engage in sexual activity, there have been rare reports of people wanting to have sex more often than normal. The issues that arise and the factors that contribute to them may differ for different people.

How Does Cancer Surgery Affect Sexuality in Women?

Surgery performed for gynecologic cancers can harm sexual life. Breast removal (mastectomy) and ostomies that create openings from inside the body to outside for digestive or urinary problems can result in difficulties with having sex or body image issues leading to impaired sexuality.

How Does Cancer Radiotherapy Affect Sexuality in Women?

It is pelvic radiotherapy causes the most problems in terms of sexual function in women. Pelvic radiotherapy could imply radiation to any of the following organs:

• Cervix.

• Vagina.

• Bladder.

• Ovaries.

• Uterus.

• Colon.

• Rectum.

This can cause a range of problems in specific areas:

1. Vagina:

• Vaginal dryness.

• Inflammation and tenderness of the vaginal lining.

• Burning sensation.

• Thickening and scarring of the vaginal lining.

• Stenosis - Elasticity of the vagina decreases, and it becomes narrower due to vaginal scarring after radiotherapy.

• Atrophy - Weakened vaginal muscles.

• Vaginal ulcers and sores may develop rarely.

2. Ovaries:

• Menopause - Ovaries stop producing estrogen, which can cause menopause in women who are still menstruating. Younger women may start to menstruate again once radiation therapy is complete, but there may be no reversal in symptoms if the dose is large.

3. Bladder and Bowel: The bladder and bowel may also experience some damage following radiation, negatively impacting sexual health.

4. Infertility: Radiation to the pelvis can lead to infertility and affect sexual health in women wanting to get pregnant.

As far as sexual intercourse itself goes, sex during radiation therapy is not contraindicated unless there is heavy bleeding from the tumor. The patient will usually be able to achieve orgasm. For some types of cancer, a radiation implant may be inserted into the vagina, uterus, or bladder for a while. In this case, sex is forbidden until the implant is removed.

How Does Hormone Therapy Affect Sexuality in Women?

Hormone therapy is used for cancers of the breast and uterine lining. Sexual arousal, desire, and function are hormone-dependent, so hormonal therapy can reduce women's quality of sexual life.

How Does Chemotherapy Affect Sexuality in Women?

1. Chemotherapy can affect the ovaries by lowering the levels of estrogen produced, leading to menopausal symptoms like hot flashes and termination of periods or irregular periods.

2. It also causes significant irritation to the vagina, including vaginal dryness and sores.

3. Some types of chemotherapeutic drugs may be delivered to the tumor through a catheter and can cause sexual repercussions:

• Painful sexual intercourse due to irritation of the bladder or urethra.

• Pelvic infusion chemotherapy through a catheter for pelvic cancers can have long-lasting effects on sexual health.

How Are Sexual Health Issues in Cancer Managed?

1. Managing Sexual Side Effects- The doctor may recommend a combination of medication and exercises for the symptoms of cancer and cancer therapy that cause sexuality issues:

• Vaginal moisturizers and lubricants for dryness.

• Vaginal gels and creams for burning and itching sensations.

• A vaginal dilator device to help with scarring and tightening of the vagina.

• Vaginal estrogen cream.

• Exercises: Pelvic muscle exercises may be taught to the patient - these will improve bladder and bowel function, reduce pain and improve blood flow to the vaginal area, thereby improving sexual activity and function.

2. Managing Other Side Effects:

• Contraceptives - Chemotherapy can sometimes leave drug remnants in the vagina, which can be passed on during sexual intercourse, so proper care must be taken, such as to use condoms and other contraceptives. Additionally, although fertility is impacted by cancer treatment, there is a chance of getting pregnant in some cases. Contraceptives are recommended to avoid this possibility.

• Supportive Therapy - Counseling and support may be helpful, whether from within the patient’s family or a professionally trained counselor.

• Lack of energy, negative body image after hair loss, extreme weight loss, surgical removal of organs, and psychological difficulties can sometimes be overwhelming. In this case, talking to a doctor or nurse and receiving adequate treatment and advice can help improve personal and interpersonal relationships and sexuality.

How Can Healthcare Providers Be Trained in Approaching the Issue of Sexual Health in Women With Cancer?

Educating and training healthcare providers is necessary to communicate sexuality in cancer effectively.

This can include:

• Training in mental and sexual health.

• Training in obtaining the sexual history.

• Education about sexuality at different ages and across different cultures.

• Sexual Health Classes - Including a discussion on the causes of sexual health issues in women with cancer.

• Patient-Centered Education - Raising awareness amongst patients and encouraging them to discuss their sexual health issues with their healthcare providers.

What Questions About Sexuality Should Women With Cancer Ensure They Ask Their Healthcare Providers?

While healthcare providers must take responsibility for asking about the patient’s sexual health problems, patients are also encouraged to speak up or ask relevant questions if their physician has not brought up the subject or if they want clarification.

Some of the questions women with cancer can ask concerning their sexuality include:

• What sexual problems will I likely face if I undergo this treatment, and when will they begin?

• How long will symptoms last? Will they be life-long?

• Can I undergo treatment for issues of sexuality, or can I prevent them from occurring?

• How can I manage the symptoms I may face?

• Is there a specialist physician or therapist I can take my concerns to?

• How do I broach the subject with my partner?

• Is there anything I need to remember when engaging in sexual intercourse for myself or my partner?

• Do I need to use birth control, and what is the acceptable form of birth control?

• If I require emotional support, are there groups or counselors who can provide this?

How Can a Single Woman Approach Cancer and Sex?

In some cases, single women are often caught on the precipice of not having a partner while also being interested in a relationship. With the added complication of cancer, this becomes a slightly tricky task.

For women who are interested in relationships and sexual activity, some of the struggles they may face include:

• How to approach the subject with a potential partner? How in-depth does it need to be conveyed?

• How to deal with body image issues? And their resultant perception of their sexuality.

• Physical issues like fatigue and pain can spoil the sexual experience.

• The possibility of infertility and how this may affect any long-term relationships they may get into.

• The best way to deal with the doubts is to first take time out for oneself and learn to get used to the physical and other changes one may experience.

• Obtaining support from therapists and support groups could give relief and provide perspective on the issues faced.

• Broaching the subject with a potential partner may be fraught with awkwardness and complicated emotions. Still, it is okay to take some time and talk only about what feels comfortable in the initial stages.

How Can a Woman With Cancer Cope With Sexual Health Issues?

Sexual issues due to cancer do not imply that one must stop all sexual activity.

Women can find ways to prepare for and enjoy sexual and non-sexual intimacy:

1. Painkillers - Taking painkillers before engaging in sexual activity can help reduce the pain felt during intercourse.

2. Alternatives - If both partners are willing to forgo sexual activity temporarily in favor of less strenuous non-sexual intimacy, then they can try the following actions:

• Kissing.

• Touching.

• Massaging.

• Stroking.

• Holding hands.

• Simple conversations.

3. Partners must try to have open, honest conversations about what can be done and what cannot be attempted and all the negative emotions and fears they are feeling.

Conclusion:

Sexuality can be a complex topic to discuss, particularly with cancer. However, it is normal to worry, and patients are encouraged to seek support from their healthcare providers or support groups. If this is difficult, anonymous online support groups may be of help. Regaining pre-cancer levels of sexuality might take time and patience. Still, it is possible to attain happiness in intimate relationships when partners work together to identify what suits them best.