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From the OHSU Knight Cancer Institute
Lisa Egan, M.M.S., P.A.-C.
Working in the Gynecologic Oncology Division, Egan’s focus is caring for patients through diagnosis to survivorship. She has a special interest in helping women manage the impact of cancer on sexual health.
Female cancer survivors would like to discuss sexual health with their providers, according to extensive literature, research and patient feedback. However, these women may not want to initiate the conversation because they are embarrassed or feel that their sex lives are the least of their worries post-cancer. They may also assume there aren’t solutions for their issues.
As providers caring for cancer survivors, we have many complex topics to cover and it can be easy to put a low priority on sexual health, especially if we’re not sure what we can offer if patients do identify a problem. Also, there can be some barriers to talking about sexual health for both patients and providers. But by asking about sexual health, we take the whole patient into consideration. We need to reassure patients that sexual health is a legitimate medical issue, especially after the trauma of cancer, because we know that sexual dysfunction is a huge quality-of-life issue for survivors.
Barriers to sexual health following cancer
There are myriad variables that can lead to sexual dysfunction post-cancer, including the patient’s age, what part of the body was affected, the mode and duration of treatment, and ongoing medications. Also, cancer has a traumatizing effect on the emotional, mental and psychological health of the individual that often impacts sexual function.
At the OHSU Sexual Health for Women Affected by Cancer Program, our patients’ issues commonly fall into these categories:
Physical factors: Surgeries and radiation therapy can alter anatomy, with attendant changes such as sensitivity, scarring and more. Other treatments can induce menopause, which also creates several physical changes. Some patients will normalize the pain they now associate with sex, assuming that’s just how it is. It’s important to convey that women don’t have to accept painful intercourse. Depending on the cause, we can recommend hormone therapy, topical lidocaine therapy, pelvic floor physical therapy, vaginal dilators and more.
Body image and sense of self: Again, there can be anatomical changes that affect the individual’s self-image, including hair loss and regrowth. Women may no longer feel safe within their bodies and fear how their partners or potential partners will view them. Good talk therapy for the individual or partners can provide an opportunity to work through grief, loss and self-identity. Low libido: A major health crisis sparks anxiety, fear, mood changes and even depression. All of these can contribute to low libido, as can the medications used to treat them. Short-term mental health or couples therapy can help identify the barriers and encourage connection. Another option at OHSU is a mindfulness-based therapy for women with low libido.
Fertility: Some cancer treatments, such as hysterectomy or pelvic radiation, eliminate a woman’s childbearing potential. For other women, their cancer treatment may leave their fertility status uncertain. In both cases, these patients may need assistance understanding what their family-building options are and validation about the emotional impact loss of fertility can have.
Asking, listening and additional resources
When patients receive a cancer diagnosis, they are concentrating on surviving, not thinking about future sexual side effects. For those of us who work in disciplines that treat women with cancer in organs associated with sex, it’s a more natural progression to talk about sexual health. But we can normalize these conversations for women with any type of cancer diagnosis. Just asking opens a door for discussion and validation. There are so many treatments and interventions that can improve sexual dysfunction.
When to refer
- Women who have been or are currently being treated for cancer and are experiencing challenges related to their sexual health.
- Women who have had risk-reducing surgeries that have an impact on their sexual health; i.e., a woman with a BRCA mutation who has risk-reducing BSO.
- Women recently diagnosed with cancer who want to know what to expect regarding their future sexual health.
OHSU Knight Cancer Institute specialists are always available to consult with you. If you have questions about sexual health after cancer, you may email Lisa Egan at firstname.lastname@example.org.
If you have questions or would like to refer a patient for evaluation, please call the OHSU Physician Advice and Referral Service at 503-494-4567.