Cancer patients might find that their sexual health is often overlooked during treatment and survivorship.
Nicole Dreibelbis, CRNP, WHNP-BC
Gynecologic Oncology Nurse Practitioner, UPMC Magee in Pennsylvania; Member, Association of Cancer Care Centers (ACCC)
Unfortunately, while sexual health concerns are common among oncology patients, these issues are frequently underdiagnosed and undertreated. Sexual dysfunction can significantly impact quality of life, and it’s crucial that patients talk with their cancer care providers about any issues.
Impact of sexual dysfunction
Sexual dysfunction is a common side effect of cancer treatment. Over 50% of women treated for breast cancer, 65-90% of women treated for gynecological cancers, and more than 60% of women treated for colorectal cancer report long-term changes in sexual function. Common issues include painful intercourse (dyspareunia), vaginal dryness, low libido, and difficulty achieving orgasm. These problems can stem from various treatments like surgery, chemotherapy, radiation, and hormone therapy, which affect the body in multiple ways.
Barriers to addressing sexual health
There are several barriers that prevent effective communication and treatment of sexual health issues. Some oncologists might avoid discussing sexual health due to time constraints, biases, or assumptions that patients are not interested in sex. Patients might feel embarrassed or fear judgment, leading to reluctance in bringing up these concerns. Cultural and religious beliefs can also play a role in making these discussions uncomfortable.
How a sexual health clinic can help
Sexual health clinics like the one at UPMC Magee Cancer Center can help patients with:
- Sexual dysfunction
- Decreased libido and desire
- Decreased genital sensation
- Vaginal dryness and decreased lubrication
- Vaginal pain with intercourse
- Difficulty achieving orgasm
A patient’s first visit will be approximately 1 hour and include a review of systems form to address physical symptoms and a sexual health distress screening form completed at the beginning of each visit. These forms help me identify the patient’s needs and develop individualized recommendations. I may also perform a pelvic exam, depending on the patient’s symptoms. Follow-up appointments are approximately 30 minutes and focus on the continued improvement of the patient’s sexual well-being. Treatment may include referrals to other specialists, including pelvic floor physical therapy; sex therapy; and urology, urogynecology, and/or menopause specialists.
Case study: JK’s experience
JK is a 41-year-old female with a history of recurrent stage IIIC cervical cancer. JK had issues with low libido, vaginal dryness, and pain during intercourse. She hadn’t been sexually active since starting oncology therapy 3 years ago. JK expressed that she feels herself pulling away from her partner physically to avoid sending mixed signals or initiating sexual contact. This avoidance has led to a lack of intimacy in their relationship. After JK’s screening revealed significant distress related to her sexual health, including unhappiness with sexual relations, guilt about sexual difficulties, and frustrations with sexual problems, I developed a comprehensive plan to address these concerns. In addition to emphasizing the importance of open communication and encouraging JK to discuss these issues with her partner, the treatment plan included use of vaginal moisturizers and lubricants, consideration of vaginal estrogen, and exploration of pelvic floor physical therapy.
Sexual health is a vital part of patient-centered care. While patients generally prefer that cancer care providers initiate conversations about sexual health to help normalize the topic, I encourage anyone who is bothered by sexual dysfunction to feel empowered to ask their medical provider questions and to never stop advocating for themselves.
