Sexuality after Cancer

 Sexuality and Fertility after Cancer

As more people achieve long-term survival after cancer, sexual dysfunction and infertility have increasingly been recognized as negative consequences that impact quality of life Cancer treatments cannot be exclusively targeted to tumor cells, damage to the reproductive system will remain an important aspect of cancer morbidity. Problems with sexual function and fertility after cancer are not only ubiquitous, they are less likely to resolve with time than most other treatment side effects. Although not every cancer survivor cares about remaining sexually active, long term sexual dysfunction has been documented in at least 50% of those treated for breast or gynecological cancer.

What is the most common Sexual dysunction from

Cancer Treatment

The most common sexual problems after cancer treatment include loss of desire for  sex, and pain with sexual activity in women.

Why does it occur

Cancer treatments may damage one or more of the physiological systems needed for a healthy sexual response, including hormonal, vascular, neurologic, and psychological elements of sexual function. Treatment also may entail removal or direct damage to parts of the reproductive organs.

Which type of cancers/cancer treatments are involved mainly in sexual dysfunction

In women malignancies involving pelvic organs(ovaries, uterus, cervix, vulva& vagina, intestines,rectum etc) & breasts affect the final sexuality. The autonomic nerves that direct blood flow into the genital area with sexual arousal may also be affected by pelvic surgery.

How significantly the sexual dysfunction is truly affected

Well-controlled studies of large populations of women have shown that benign hysterectomy, including removal of the cervix, does not impair women’s sexual pleasure or capacity to reach orgasm.  But after radical hysterectomy most sexual problems may take a year to resolve after surgery.

Which cancer/cancer treatment  affect ovarian function

Cancer involving ovaries/testes & chemotherapy affecting the gonads. Radiation causes dysfunction if the organ or the autonomic nerves supplying the organ fall in the radiation field Treatment with adjuvant chemotherapy accounts for much of the sexual morbidity of breast cancer, especially in women who experience an abrupt transition to menopause as a result of their cancer treatment selective estrogen receptor modifiers such as tamoxifen and raloxifene do not appear to decrease women’s desire for sex, vaginal lubrication, or ability to enjoy intercourse without pain.

What is the final outcome on sexuality post treatment completion

The only enduring difference between female cancer survivors and matched controls is some loss of desire for sex and reduced vaginal lubrication. If pelvic surgery impairs vaginal expansion and lubrication, it seems that women can compensate by using estrogen replacement or water-based lubricants. But after radiation therapy in fields that include the genital area, women fare more poorly than men. Young women treated with radiation therapy for cervical cancer are significantly more likely to have problems with dyspareunia and other aspects of sexual function than matched controls.

Is any Sexual Rehabilitation possible after Cancer Treatment

Despite the fact that sexual problems in cancer survivors typically have organic causes, successful sexual rehabilitation often requires a broader approach that incorporates behavioral changes and involves both partners in a committed relationship. Sexual rehabilitation after cancer in women also cannot be reduced to a simple paradigm of hormonal replacement or a mechanical device Much of the loss of desire for sex in women with ovarian failure is linked to dyspareunia from vaginal atrophy. A safer hormonal treatment may be the use of low-dose estrogens in the form of a vaginal ring or suppository to treat pain that does not respond to appropriate use of water based lubricants or vaginal moisturizers.

Vaginal dilation is widely accepted as a treatment to prevent vaginal stenosis and agglutination in women who have pelvic radiation therapy. Yet dilation has not been validated by empirical research.    

Sexual dysfunction: The Need for Better Communication in the journey of Cancer Treatment

Sexuality issues has been cited as a major source of distress for cancer survivors in several surveys. It is time to shift the focus from the causes and prevalence of sexual dysfunction after cancer to creating, evaluating, and disseminating practical and cost-effective programs of sexual rehabilitation. The current lack of randomized trials of such interventions is a major problem in psychosocial oncology Clearly educational materials are needed to facilitate communication between health care providers and patients on this important topic.

Also specialized therapist should be included to understand & intervene according to the need of the patient

Can fertility be preserved after cancer therapy ?

 Reproductive health after cancer is only increasing in importance as the number of cancer survivors multiplies and the length of their survival also improves. Sexual function and fertility can no longer be regarded by oncologists as  irrelevant because our current cancer therapies damage reproductive health in ways that are profound and often permanent.

Interventions that prevent or reverse these problems will greatly improve the quality of life of our patients. Women with very early stage or low-grade gynecologic cancer may be able to preserve fertility by having limited surgery. Lateral transposition of the ovaries to remove them from the field of pelvic irradiation is an option that preserves ovarian function Better communication about fertility preservation strongly needed between patient and oncologists, but organizations need to develop practice guidelines on when it is appropriate to bring up infertility, how to discuss new modalities that remain experimental and often involve large out-of-pocket costs to the patient, and what options should be offered by cancer centers.

 “ALWAYS DISCUSS THE SEXUALITY ISSUES WITH YOUR TREATING ONCOLOGIST AS HE /SHE IS SIMILARLY INHIBITED IN DISCUSSING YOUR CONCERNS IF NOT SPOKEN”

 ALSO

avail the help of psychologist, need of psychotherapist & ,behavioral specialist during the cancer treatment should be reinforced to the patient