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Women, Cancer, & Sexual Health

by Yung A. Park, MD, and Elena Ratner, MD

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Sexual dysfunction is a common side effect of cancer and its treat­ment, but this doesn’t mean you have to accept it as part of your “new normal.” You can reclaim your sexuality. Many women are even able to get back to the level of sexual functioning and intimacy they enjoyed before cancer.

First, it’s important to understand how cancer affects sexual health. Cancer treatments can temporarily or perma­nently alter the nerves, blood vessels, and sex hormone levels that control nor­mal sexual function. In female cancer survivors, this sex hormone is estrogen. Low estrogen levels can significantly affect a woman’s quality of life in a number of ways.

Hot flashes are a common issue caused by low estrogen levels. They can be severe enough to impair your quality of sleep, which can affect your sexual health. Steps you can take to control hot flashes include eating a healthy diet, losing excess weight, limiting your caffeine intake, and avoiding alcohol, spicy foods, and MSG (monosodium glutamate). Wearing clothing made of natural rather than synthetic fibers, and wearing loose, thin layers rather than thick, tight-fitting clothing, can help as well. If hot flashes are affecting your quality of sleep, try lowering your bed­room temperature at night by keeping a window open or using a fan. Both hormonal and non-hormonal medica­tions are available for relieving hot flashes, but you will need to talk with your doctor to determine which options might work best for you.

By keeping an ongoing open and honest dialogue about your feelings, fears, and concerns with your partner, you can begin to overcome the barriers to sexual intimacy.

About Coping

Dr. Yung Park

Vaginal dryness is another sexual health issue caused by low estrogen levels. Vaginal dryness can result in painful intercourse as well as frequent urinary tract infections. While over-the-counter lubricants can be effective for many women, they may not work as well for some. For the latter group, your doctor may recommend medications to help counteract vaginal dryness.

Low sex drive, or libido, can also be caused by low estrogen levels; however, it can be psychologically based as well, brought on by depression, anxiety, body image issues, or feelings of shame, guilt, or anger. After cancer treatment, fear of recurrence also may be a contributing factor to your low sex drive. A mental health provider who specializes in psycho-oncology can help you get to the bottom of what’s causing your decreased libido and can teach you techniques you can use to improve sexual functioning.

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Dr. Elena Ratner

Intimacy problems may also arise during cancer. You may avoid being intimate with your partner if physical changes have negatively affected your body image. Likewise, your partner may feel wary of initiating sexual activity due to fear of causing you discomfort or pain. If you’re single, you may refrain from dating because of low self-esteem or the fear that you would be rejected because you have cancer. By keeping an ongoing open and honest dialogue about your feelings, fears, and concerns with your partner, or by seeking professional help from a sex therapist or a psychol­ogist who specializes in individual or couples therapy, you can begin to overcome these emotional barriers to sexual intimacy.

A growing number of cancer centers across the nation have opened sexual health centers, as healthcare providers are recognizing that sexual health is a significant area of concern for many cancer survivors. However, if a sex­ual health center is not available in your area, ask your doctor to refer you to a specialist who can help. In the mean­time, you can make some simple lifestyle changes to lessen the emotional impact of sexual issues on your life. Regular exercise can help reduce anxiety and depression and boost self-esteem, and relaxation skills, meditation, and yoga have been shown to help relieve pain and reduce stress.

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Dr. Yung Park is a doctor of internal medi­cine and psychiatry who is currently a fellow of Psychosomatic Medicine at the Yale School of Medicine in New Haven, CT. Her main interest is in hormones, cancer, and women’s health. Dr. Elena Ratner is an assistant professor of Obstetrics, Gynecology, and Reproductive Sciences at the Yale School of Medicine. She works with Dr. Park at the Sexuality, Intimacy, and Menopause Clinic at the Yale Cancer Center.

This article was published in Coping® with Cancer magazine, May/June 2014.