Sexual Problems Common in Women After Cancer Therapy

NEW YORK—Sexual problems are common after cancer treatment, Sarah Auchincloss, MD, said at a Cancer Care Inc. teleconference on “Intimacy, Sexuality, and Love.”

Dr. Auchincloss, a consultant in psychiatry at Memorial Sloan-Kettering Cancer Center, pointed out that cancer and cancer treatment affect the same areas that determine sexual response—the body, the mind, and the relationship—and “the goal is to get things better in all three areas,” she said. “Sex gets better when the whole person gets better.”

Shutting Down Emotionally

The factors that affect sexual desire develop over the course of cancer treatment, she said. Sexual desire may diminish or disappear during diagnosis and treatment as the woman becomes preoccupied with meeting the challenges of treatment and handling her emotions. Shutting down emotionally is a common response and an adaptive one, Dr. Auchincloss said. Even so, during treatment, many women will still maintain the ideal of themselves as sexual beings.

Recovering emotionally and sexually after cancer treatment can take a year or two, first to become familiar with the issues, and then to work on them. “In the months after treatment, a woman begins the work of coming to terms with what she has been through,” Dr. Auchincloss said. She must first work to restore her strength and well being.

“The woman watches for her hair to grow back and her energy to return,” she said. “She touches her skin over a breast reconstruction to see if sensation is returning. She may feel hot flashes or vaginal dryness and wonder what a future with a different hormonal infrastructure will feel like. She’s trying to rebuild a sense of her body as okay, not good yet or sexy, just okay.”

Painful Intercourse

Intercourse may be painful, and if it is, the first rule, Dr. Auchincloss said, “is to stop and do something else. There are almost always things you can do to continue a sexual situation while avoiding activities that cause discomfort.”

If the women keeps having painful sex, she may soon lose her sexual desire completely, a problem that is harder to treat than dyspareunia, she said. Common causes of dyspareunia after cancer include atrophy of the vaginal mucosa due to chemotherapy or radiation, scarring after radiation to the pelvis, or narrowing or shortening of the vagina after surgery.

“Give yourself lots of time for foreplay,” Dr. Auchincloss advised. “This is really helpful for women learning how to fully develop a sexual response.”

A medical examination to determine any physical causes, which includes a check of the vulva and vagina, is the first step in treating sexual problems.

An oncologist may agree to local applications of estrogen if the patient has been cancer free and the cancer was not hormone-receptor positive. Otherwise, a vaginal moisturizer used three times weekly regardless of sexual activity, together with a vaginal lubricant before sex, will be very helpful, Dr. Auchincloss said. Vaginal dilators are useful for women who have received pelvic radiation or surgery to maintain vaginal openness.

“Working on psychological and relationship issues are just as likely to improve sexual desire and response,” Dr. Auchincloss said. “Feeling that your body and your partner are okay goes a long way. The goal is to move toward feeling reunited with one’s body, to see oneself as less perfect, perhaps, but more vital.”

Exercise, nutrition, yoga, and massage can reduce tension and enable the individual to regain a sense of appreciation for the whole self. “Playing with one’s appearance after treatment,” she suggested, such as getting a new hair-do, make-up, and clothes, “can help reflect a woman’s inner changes, changes that can dovetail with the desire to reimagine oneself as desirable once again.”

Counseling and attendance at functions sponsored by cancer support organizations can also help reduce the feeling of being different or damaged.

Previous levels of sexual functioning are the best predictors of post-treatment functioning, Dr. Auchincloss said. The 1 to 2 years following cancer treatment can be the most difficult for couples, particularly those with relationships of relatively short duration, and here, too, counseling or support may be useful.

Anger and tension often develop in relationships during this period, she said. Learning ways to weather these difficulties and ease tension will not only improve the relationship but also improve sexual relations.

Other measures to enhance sexual activity, Dr. Auchincloss said, include avoiding stressful topics during intimate moments; taking an unhurried pace; doing things that promote relaxation such as bathing, showering, or massaging; exploring through touch; and emphasizing comfort and not performance.

Single, divorced, and widowed women will have special issues regarding their future relationships, Dr. Auchincloss said. A cultural background that places a special value on fertility may present particular difficulties to some women who may require additional support.

The good news, she said, “is that alone or with a partner, the woman treated for cancer may find her way to a life better lived, lived more fully in deeper appreciation and with stronger connections in every way.”