by Amy K. Siston, PhD
Have you experienced low libido, vaginal dryness, or painful intercourse since your cancer diagnosis and treatment? Have you been told you have vaginal stenosis or vaginismus? Do you feel like your body doesn’t look or feel the same as it did before cancer? Or, perhaps, have you avoided being physically intimate with your partner or seeking an intimate relationship altogether? If you responded yes to any of these questions, you are not alone.
Sexual issues are a common – and often ongoing – side effect of cancer treatment. Decades of research examining sexual function after cancer suggest that up to 94 percent of women with a history of cancer will experience difficulty with sexuality and intimacy at some point during their cancer journey.
How Cancer Treatment Affects Sexual Health
All cancers and cancer treatments, including surgery, chemotherapy, radiotherapy, hormonal therapy, immunotherapy, and stem cell transplant, can directly or indirectly affect sexual health. Most of the research to date examining sexual issues after cancer focuses on breast and gynecological cancers. However, though not as prolific, there is research that does focus on sexual issues for survivors of cancers that do not directly involve sexual organs but that still indirectly affect sexual response.
Unlike other side effects of cancer treatment, sexual health issues usually do not resolve on their own and may not get better simply with the passage of time.
Loss of libido, or decreased desire to engage in sexual activity, is one of the most difficult sexual side effects for cancer survivors to cope with. Other sexual health problems women with cancer commonly experience include low or absent arousal, or the inability to become physically aroused; difficulty achieving orgasm or changes to orgasm intensity; and pain with penetrative sexual activity. Body image issues and emotional distress can also interfere with sex and intimacy. Moreover, many medications prescribed to manage emotional distress can have a negative impact on sexual function.
The Importance of Addressing Sexual Health Problems in Women with Cancer
Despite the high prevalence of sexual health issues in women cancer survivors, these problems often go unaddressed and untreated. In a review of 29 different studies across 10 countries, only 28 percent of women said they were told of the potential for sexual health problems following cancer treatment. Even fewer (only 17 percent) said that treatment for their sexual dysfunction had been offered. Unlike other side effects of cancer treatment, sexual health issues usually do not resolve on their own and may not get better simply with the passage of time.
Most women with cancer do care a great deal about their sexual function. However, misconceptions that older, single, or widowed women; LGBTQ+ cancer survivors; and women from certain cultural backgrounds don’t view sexual health as a priority are prevalent. These misconceptions prevent countless women from getting the sexual health education and treatment they need after cancer diagnosis. To counteract this, the American Society of Clinical Oncology’s 2018 Clinical Practice Guidelines recommend that sexual health be discussed with all cancer survivors and that these discussions be routine and occur early and often.
Getting Help for Sexual Health Problems
If you’re experiencing sexual health issues after cancer, don’t despair. Help is available. Sexual function and satisfaction in women cancer survivors often can be improved through psychological interventions like patient education, psychosexual therapy, cognitive behavioral therapy, and mindfulness strategies. These interventions are generally used in combination, and often are accompanied by medical therapies.
A sex therapist can teach you techniques to restore sexual intimacy so that it brings you comfort and pleasure rather than anxiety and pain.
Patient Education Most cancer survivors will benefit from learning more about the sexual difficulties often faced by women with cancer, as well as the causes behind them and the factors that influence them. Additionally, psychosexual education about the female sexual response cycle, body image, common relationship issues experienced by people with a history of cancer, and cancer’s overall impact on sexual function and satisfaction may prove helpful. You may also benefit from learning about how certain psychological factors – like fear of pain, body image concerns, or worry about your sexual health – can affect your sexual function and satisfaction, as these concerns frequently distract from your ability to be in the moment and can interfere with sexual response. If you feel comfortable, you may want to include your partner in these educational sessions so they may also be informed and can share in the responsibility of restoring or improving your sexual relationship.
Psychosexual Therapy, or Sex Therapy If you’re struggling in the bedroom, you may want to consider seeing a sex therapist. A sex therapist uses traditional psychotherapy and specialized treatment to help cancer survivors improve their body image, sexual relationships, and overall sexual functioning and satisfaction. A sex therapist can teach you techniques to restore sexual intimacy so that it brings you comfort and pleasure rather than anxiety and pain. One such technique is called sensate focus therapy. Sensate focus therapy is a series of at-home exercises in which a couple engages in gradual, mindful touching focusing on heightened sensory awareness. This method promotes exploration of the body, rather than intercourse or orgasm, as the goal of the encounter. A sex therapist can also help you and your partner improve sexual communication; they can incorporate cognitive behavioral therapy techniques to help you understand the link between your thoughts, feelings, and behaviors and your sexual symptoms, as well as address anxiety and sexual avoidance, which are often associated with sexual pain; and they can teach you mindfulness and relaxation strategies to help enhance your sexual function.
Mindfulness Mindfulness-based therapies have been shown to increase libido, ease sexual distress, and improve overall sexual function. According to Professor Jon Kabat-Zinn, creator of the mindfulness-based stress reduction program, mindfulness is “awareness that arises through paying attention, on purpose, in the present moment, non-judgmentally.” Mindfulness-based sexual health interventions include psychoeducation on sexual difficulties and how mindfulness can connect you with your sexuality; the act of challenging negative thoughts related to sexual beliefs; and mindfulness exercises of breath, body, and thought.
Mindfulness-based therapies have been shown to increase libido, ease sexual distress, and improve overall sexual function.
Medication Medical therapies may include the use of vaginal lubricants, non-hormonal vaginal moisturizers, or topical anesthetics (like lidocaine) to ameliorate vaginal dryness and reduce pain associated with sexual intercourse. Some women cancer survivors may benefit from seeing a pelvic floor physical therapist for exercises, diaphragmatic breathing, massage, biofeedback, or dilation therapy to improve pelvic muscle strength, reduce muscle tension, and restore sexual function. More recently, medications have been developed to treat low sexual desire in women; however, their effectiveness and use in people with a history of cancer is still under investigation.
If you’re a woman living with a history of cancer and you’re having trouble with sexual function, satisfaction, or intimacy, reach out for help. Don’t wait until your sexual health problems worsen. Talk with your healthcare providers so they can connect you with the right treatments and services. Communicate with your partner so you don’t have to face this alone. It may take some work, but you can have a fulfilling sex life – even after cancer.
Dr. Amy Siston is an assistant professor in the Department of Psychiatry and Behavioral Neuroscience at UChicago Medicine in Chicago, IL, where she serves as the director of the Psycho-Oncology Program. Dr. Siston is a licensed clinical psychologist and an American Association of Sexuality Educators, Counselors, and Therapists (AASECT) certified sex therapist who provides clinical psychology services focusing on sexual health and cancer survivorship.
To find a certified sex therapist or counselor in your area who can help you address your sexual health concerns, visit the website of the American Association of Sexuality Educators, Counselors and Therapists: aasect.org.
This article was published in Coping® with Cancer magazine, Fall 2023.