For over 30 years of my career, I have worked to help people prevent or overcome sexual problems related to their cancer treatment. It has often been an uphill struggle to convince hospital administrators, grant reviewers, and health professionals that these problems are important. In 2014 there are approximately 14 million men and women in the United States who have had cancer. Given the types of cancer that are most common, and that we are successful in treating, about two-thirds had cancer of the breast, prostate, colon or rectum, bladder, or female organs (cervix, uterus, vulva). In that group of cancer survivors at least half are left with long-term difficulties enjoying sex. For other types of cancer, at least 1 in 4 people ends up with a sexual problem. Although cancer becomes more common with aging, many people are upset about having a sexual problem, yet only about 20% ever seek medical help for it. The most common problems include loss of desire of sex, trouble feeling pleasure during sex, erection problems in men, and vaginal dryness and pain with sex in women. Even today I hear stories about men or women approaching an oncologist or nurse with a question about sex only to be told that their concern is not important, and they should be glad to be alive! I also work with fertility issues, and the contrast is glaring. Even though less than 10% of people diagnosed with cancer are of an age where fertility is important, “oncofertility” has received tons of attention in the popular media and has become a focus of research as well. The American Society of Clinical Oncology has now had practice guidelines since 2006 (and updated in 2013) that encourage health professionals to educate patients about cancer treatment and the risk of infertility, and to refer them for sperrm banking or freezing eggs or embryos. My colleague Don Dizon, MD and I went to this society several years ago to ask them to develop a similar guideline about sexual function and cancer and got–nowhere.
It is not easy to get expert help for a cancer-related sexual problem. Most are rooted in physical damage from cancer treatment–damaged nerves or scarring of blood vessels in the pelvic area, changes in hormone levels, graft vs. host disease in the genital area, etc. Yet even if we can mechanically fix the damage, treatment seems to work much better when it includes some counseling about sexual communication, self image as a sexual person, and seeing sexuality as a time for intimacy and pleasure rather than as a physical performance. Unfortunately, most gynecologists have little training in treating problems such as pain during sex or the complexities of prescribing hormones after cancer treatment. Urologists have all kinds of ways to give men rigid erections, but research shows that most men do not use these treatments successfully in the long-term. Mental health professionals rarely are expert both in sex therapy and in the emotional aspects of coping with cancer. Insurance coverage has also been limited, especially for the counseling. Men and women often are uncomfortable with the idea of seeing a mental health professional, thinking it means they are “crazy” or the problem is “all in my head.” Yet we do have medical and psychological strategies to help people get back to a good sex life. I hope to share some of them in this blog.
This educational material is intended for informational purposes only and is not intended to replace, or substitute for, professional advice, counseling, diagnosis, or treatment. Always seek the advice of a qualified health provider with any questions you may have regarding a condition. Never disregard professional advice or delay in seeking treatment because of something you have read in this educational material.