Category Archives: Cancer

Sexual Healing for Cancer Survivors

By KATIE KOSKO

sexual-healing

Sexual health can be an uncomfortable or embarrassing topic to discuss for many people, and for patients with cancer, survivors and their partners, it can feel even more awkward. In fact, sex ranks among the top five unmet needs of survivors, and a new digital health startup, Will2Love, has been launched to help fill this void.

Sixty percent of cancer survivors — 9.3 million individuals in the United States alone — end up with long-term sexual problems, but fewer than 20 percent get professional help, according to Leslie R. Schover, PhD, Will2Love’s founder. Among the barriers she cites are overburdened oncology clinics, poor insurance coverage for services related to sexual health and an overall lack of expertise on the part of providers, many of whom don’t know how to talk to patients and survivors about these issues.

Sexual issues can affect every stage of the cancer journey. Schover, who hosted a recent webinar for health care practitioners on the topic, has been a pioneer in developing treatment for cancer-related problems with sexuality or fertility. After decades of research and clinical practice, she has witnessed firsthand how little training is available in the area of sexual health.

“Sex remains a low priority, with very little time devoted to managing sexual problems even in specialty residencies,” she adds.

The problem is twofold: how to encourage oncology teams to do a better job of assessing and managing sexual problems and how to help those impacted by cancer to discuss their sexual concerns.

Schover says that simple, open-ended questions such as: “This treatment will affect your sex life. Tell me a little about your sex life now,” can help to get the conversation started.

Sexual side effects after cancer treatment vary from person to person, and also from treatment to treatment. Common side effects for men and women include difficulty reaching climax, pain during sexual intercourse, lower sexual desire and feelings of being less attractive. Men specifically can experience erectile dysfunction and dry orgasm, while women may have vaginal dryness and/or tightness, as well as loss of erotic sensation such as on their breasts following breast cancer treatment.

Sexual dysfunction after cancer can often lead to depression and poor quality of life for survivors and their partners.

Cancer treatment can impact hormonal cycles, nerves directing blood flow to the genitals, and the pelvic circulatory system itself, explains Schover. In addition, side effects like prolonged nausea, fatigue, and chronic pain also can disrupt a patient’s sex life.

“Simply to give medical solutions rarely resolves the problems because a person or couple needs to make changes in the sexual relationship to accommodate changes in physical function,” Schover stresses. “That kind of treatment is usually best coming from a trained mental health professional, especially if the couple has issues with communication or conflict.”

Schover hopes that Will2Love will bring much-needed attention to the topic by providing easily accessible resources for patients, survivors, their partners and health care providers. (Box)

Currently visitors to the website can subscribe to its e-newsletter and receive a free introductory five-part email course covering topics related to what your doctor may not be telling you about sex, fertility and cancer. After the fifth lesson, users will receive a link to the Will2Love “Sex and the Survivor” video series. “Sexual health is a right,” Schover stresses, and oncology professionals, patients and survivors need to be assertive to get the conversation started.

Complete Article HERE!

Sexual pain after cancer treatment an unspoken affliction for many women, UC Davis oncologist says

Sexual pain is a common, but unspoken, aftermath of women’s cancer treatment. Doctors can be reluctant and patients too embarrassed to discuss it.

But it’s an all-too-real aspect of cancer treatment for women, according to Dr. Vanessa Kennedy, a gynecological oncologist for the UC Davis Health System.

Dr. Vanessa Kennedy, assistant professor in gynecological oncology, UC Davis Health System, Sacramento.

Dr. Vanessa Kennedy, assistant professor in gynecological oncology, UC Davis Health System, Sacramento.

“Some patients are two to three years out of treatment and they’re dealing with sexual pain and no one’s talked about it. Patients hesitate to bring it up because it’s a sensitive issue,” said Kennedy, who recently discussed the problem in the journal Obstetrics & Gynecology. Her co-author, Dr. Deborah Coady of New York University Langone Medical Center in New York, is author of the book, “Healing Painful Sex: A Woman’s Guide to Confronting, Diagnosing and Treating Sexual Pain.”

Kennedy estimates that about 50 percent of female patients with cancer – of any type – experience some form of sexual pain, due to physical changes caused by surgery, chemotherapy and radiation. It can range from vaginal dryness caused by early menopause to anatomical changes that can make sex uncomfortable.

Some women feel guilty they’re even concerned about their sex lives, given what they’ve been through battling cancer. “There’s some guilt that they should just feel lucky to be alive and shouldn’t ask about these other things,” she said. But when sexual health is addressed, “They’re actually relieved to know they’re not alone.”

Twice a month on Fridays, Kennedy holds a regular clinic, seeing UC Davis patients who’ve been referred for post-cancer problems with sex. She works with patients on a number of interventions, including physical therapy, lubricants (even coconut or olive oil), vaginal dilators and couples counseling to re-establish intimacy.

Kennedy said doctors and medical students need to learn to be comfortable broaching the topic. “A lot of students and providers are still a little bit nervous asking about sex,” she said. “How do you get comfortable talking about these things? You just do it. It’s just like asking a patient about changes in appetite or changes in sleep. Sex is another thing (on the list). Get over it and ask about it.”

There’s a difference in how men and women cancer patients deal with sexual health, Kennedy contends. For men who’ve undergone prostate cancer treatment, there’s an emphasis on restoring their sexual function. For women, there’s often physical pain and a loss of intimacy, along with the added fear by some that their partners view them as less desirable. In some cases, where sex has become nonexistent, patients confide that their partners have threatened to leave or cheat on them.

Kennedy, who did fellowship training at the University of Chicago, which has a sexual health program for women cancer patients, says research on women’s sexual health issues is lagging, compared with that for men with prostate cancer. Next April, she’s hosting a national gathering of the Scientific Network on Female Sexual Health and Cancer, which promotes research and information for women patients and their providers.

“Sex is a quality-of-life issue and a core of our well-being,” Kennedy concludes. “We have to bring back the intimacy and make this a part of the body that’s associated with pleasure, rather than an uncomfortable, negative place.”

Complete Article HERE!

Does Anal Sex Lead To Anal Cancer?

3 Facts And Myths For Sexual Partners

 

Anal sex is no longer quite the salacious taboo it once was.

Not only has society steadily become more accepting of sexual relationships between men, but more heterosexual people are trying it and trying it more often than ever before. Recent surveys  estimate that 40 percent of women between the ages of 20 to 24 have tried anal sex, and 20 percent of all women have tried it in the last year.

Our greater societal acceptance aside, you may have heard that anal sex can have some dangerous effects on our health, particularly as a leading cause of anal cancer. So let’s take a brief look at some basic facts and myths about anal sex and its connection to cancer.

The myths and facts behind the connection between anal sex and anal cancer.

The myths and facts behind the connection between anal sex and anal cancer.

1. It Can Cause Anal Cancer

The long and short of it is that yes, anal sex is a risk factor for anal cancer.

Anal sex can transmit the human papillomavirus (HPV), and HPV in turn leaves the cells around our rectum more vulnerable to mutating and becoming cancerous. A similar risk exists wherever HPV rears its ugly microscopic head, including the mouth, throat, and cervix. And because anal sex is generally more damaging to the inner lining of the rectrum than the stereotypical notion of heterosexual sex is to the vagina, HPV and other sexually transmitted infections are more easily spread between people who engage in anal sex. Similarly, the greater number of sexual partners, the greater the risk of cancer.

2. But It’s Rare

Close to 90 percent of anal cancer cases can be traced back to HPV. But the cancer itself is relatively rare.

According to The American Society of Colon and Rectal Surgeons, only 8,000 people will be newly diagnosed with anal cancer this year. And though cases have been slowly increasing in recent decades, only one of every 500 people will develop anal cancer in their lifetime, generally between the ages of 55 to 64 — a stark contrast to the one in every 22 people who will develop colorectal cancer.

3. And Preventable

Like other forms of cancer fueled by HPV, the available HPV vaccine can likely cut down the risk of developing anal cancer in both men and women.

While HPV vaccination rates still aren’t anywhere near as high as we’d like them to be, there is already evidence that the vaccine has lowered the risk of later cervical cancer in teen girls. And though we don’t have any concrete evidence that the same decline has occurred for anal cancer just yet, there is some showing the vaccine reduced the risk of cells in the anus becoming precancerous in young men who have sex with men.

Both teen boys and girls are now regularly encouraged to get the HPV vaccine, but when it comes to anal cancer, it may benefit women more — two-thirds of new cases are diagnosed in women.

Complete Article HERE!

Cancer patients and survivors can have trouble with intimacy

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People who survive cancer treatment — a growing group now topping 5 million — often have trouble with intimacy afterward, both from the actual treatment and physical recovery and from the psychological damage of feeling so vulnerable.

People who survive cancer treatment — a growing group now topping 5 million — often have trouble with intimacy afterward, both from the actual treatment and physical recovery and from the psychological damage of feeling so vulnerable.(Photo: Getty Images/Comstock Images)

In the mirror, Kelly Shanahan looks normal, even to herself.

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Kelly Shanahan of South Lake Tahoe, Calif., has been battling breast cancer for eight years. She’s a big believer in doctors and their patients discussing sexual health.

But she does not feel like herself.

The breasts she had reconstructed eight years ago look real, the nipples convincing. But her breasts have no sensation. The only time she feels them at all is during the frigid winters of her South Lake Tahoe, Calif., home, when they get so cold, she has to put on an extra layer of clothing.

“For a lot of women, breast sensation is a huge part of sexual pleasure and foreplay. That is totally gone,” says Shanahan, 55, who has lived with advanced breast cancer for three years. “It can be a big blow to self-image, even though you may look normal.”
Kelly Shanahan of South Lake Tahoe, Calif., has been battling breast cancer for eight years. She’s a big believer in doctors and their patients discussing sexual health. (Photo: Kelly Shanahan)

Shanahan is part of a growing group of patients, advocates and doctors raising concerns about sexual health during and after cancer treatment.

“None of us would be here if it weren’t for sex. I don’t understand why we have such a difficult time talking about it,” she says.

Though virtually all cancer diagnoses and treatments affect how patients feel and what they think about their bodies, sex remains an uncomfortable medical topic.

Shanahan, an obstetrician herself, says that until her current doctor, none of the specialists who treated her cancer discussed her sex life.

“My former oncologist would rather fall through the floor than talk about sex,” she says.

Major cancer centers now include centers addressing sexuality, but most community hospitals still do not. The topic rarely is discussed unless the patient is particularly bold or the doctor has made a special commitment.

There’s no question that cancer can dampen people’s sex lives.

Hormone deprivation, a common therapy for breast and prostate cancer, can destroy libido, interfere with erections, and make sex extremely painful. Weight gain or loss can affect how sexy people feel. Fatigue is unending during treatment. Body image can be transformed by surgeries and the idea that your own cells are trying to kill you. The constant specter of death is a sexual downer, as are the decidedly unsexy aspects of cancer care, like carrying around a colostomy bag. Then, there are the healthy partners, feeling guilty and terrified of causing pain.

And once people start to associate sex with pain, that can add apprehension and muscle tightness, which makes intercourse harder to achieve, says Andrea Milbourne, a gynecologist at the University of Texas MD Anderson Cancer Center in Houston.

There’s almost never a medical reason cancer patients or survivors shouldn’t be having sex, says Karen Syrjala, a clinical psychologist and co-director of the survivorship program at the Fred Hutchinson Cancer Research Center in Seattle. Even if there is reason to avoid intercourse, physical closeness and intimacy are possible, she says, noting that the sooner people address sexual issues the less serious those issues will be.

“Bodies need to be used and touched,” she says said. “Tissues need to be kept active.” Syrjala recommends hugging, romantic dinners, simple touching, “maybe just holding each other naked at night.”

There are ways to improve sexual problems, starting with doctors talking to their patients about sex. Milbourne and others say it’s their responsibility, not the patients’, to bring up the topic.

Hormone deprivation, a common therapy for breast and prostate cancer, can destroy libido, interfere with erections, and make sex extremely painful. Lubricants can help smooth the way.

Hormone deprivation, a common therapy for breast and prostate cancer, can destroy libido, interfere with erections, and make sex extremely painful. Lubricants can help smooth the way.

Communication between partners also is essential. “A lot of times, it’s unclear, at least in the mind of the other partner who doesn’t have a cancer, what has happened. ‘Why does this hurt? Why don’t you want to do anything?’ ” Milbourne says.

For women who have pain during sex, Milbourne says one study found benefit to using lidocaine gel to numb vaginal tissue.

Jeanne Carter, head of the female sexual medicine and women’s health program at Memorial Sloan Kettering Cancer Center in New York City, recommends women do three minutes of Kegel exercises daily to strengthen their pelvic floor muscles and improve vaginal tone, and to help reconnect to their bodies.

For women sent abruptly into menopause, moisturizing creams can help soften tissue that has become brittle and taut. Carter says she’s conducted research showing that women with breast or endometrial cancers who use moisturizers three to five times a week in the vagina and on the vulva have fewer symptoms and less pain than those who don’t. Lubricants can help smooth the way, too.

“We’ve got to make sure we get the tissue quality and pain under control or that will just undermine the whole process,” Carter says.

Sex toys also take on a different meaning after cancer treatment. Specialized stores often can offer useful advice and the ability to examine a product before buying. Rings and other equipment, in addition to medications such as Viagra, can help men regain erections.

Doctors and well-meaning friends also need to stop telling cancer patients that they should simply be glad to be alive, Shanahan says. Of course she is, but eight years after her initial diagnosis and three years after her disease advanced, Shanahan wants to make good use of the time she has left.

And that, she says, includes having a warm, intimate relationship with her husband of 21 years.

Complete Article HERE!

Expert Shares Tips for Talking Sexual Health With Cancer Survivors

by KATIE KOSKO

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Sexual health can be an uncomfortable or embarrassing topic to discuss for many people, and for patients with cancer and survivors it can feel even more awkward. Nevertheless, sex ranks among the top 5 unmet needs of survivors, and the good news is, proactive oncology practitioners can help fill that void.

Sixty percent of cancer survivors—9.3 million individuals in the United States alone—end up with long-term sexual problems, but fewer than 20% get professional help, according to Leslie R. Schover, PhD, founder of the digital health startup, Will2Love. Among the barriers she cited are overburdened oncology clinics, poor insurance coverage for services related to sexual health, and an overall lack of expertise on the part of providers, many of whom don’t know how to talk to patients about these issues.

And, oncologists and oncology nurses are well-positioned to open up that line of communication.

“At least take one sentence to bring up the topic of sexuality with a new patient to find out if it is a concern for that person,” Schover explained in a recent interview with Oncology Nursing News. “Then have someone ready to do the follow-up that is needed,” and have other patient resources, such as handouts and useful websites, on hand.

Sexual issues can affect every stage of the cancer journey. Schover, who hosted a recent webinar for practitioners on the topic, has been a pioneer in developing treatment for cancer-related problems with sexuality or fertility. After decades of research and clinical practice, she has witnessed firsthand how little training is available in the area of sexual health for healthcare professionals.

“Sex remains a low priority, with very little time devoted to managing sexual problems even in specialty residencies,” said Schover. “I submitted a grant four times before I retired, to provide an online interprofessional training program to encourage oncology teams to do a far better job of assessing and managing sexual problems. I could not get it funded.”

In her webinar, she offered tips for healthcare practitioners who want to learn more about how to address sexual health concerns with their patients, like using simple words that patients will understand and asking open-ended questions in order to engage patients and give them room to expand on their sex life.

Schover suggests posing a question such as: “This treatment will affect your sex life. Tell me a little about your sex life now.”

Sexual side effects after cancer treatment vary from person to person, and also from treatment to treatment. Common side effects for men and women include difficulty reaching climax, pain during sexual intercourse, lower sexual desire and feelings of being less attractive. Men specifically can experience erectile dysfunction and dry orgasm, while women may have vaginal dryness and/or tightness, as well as loss of erotic sensation such as on their breasts following breast cancer treatment.

Sexual dysfunction after cancer can often lead to depression and poor quality of life for both patients and their partners.

According to Schover, oncologists and oncology nurses should provide realistic expectations to patients when they are in the treatment decision-making process.

“Men with prostate cancer are told they are likely to have an 80% chance of having erections good enough for sex after cancer treatment,” Schover says. “But the truth is it’s more like 20 to 25% of men who will have erections like they had at baseline.”

To get more comfortable talking about sex with patients, Schover advises role-playing exercises with colleagues, friends, and family—acting as the healthcare professional and then the patient. When the process is finished, ask for feedback.

Brochures, books, websites and handouts are also good to have on hand for immediate guidance when patient questions do arise. But Schover is hoping for a bigger change rooted in multidisciplinary care and better patient–provider communication to find personalized treatments tailored to each individual’s concerns and needs.

Cancer treatment can impact hormonal cycles, nerves directing blood flow to the genitals, and the pelvic circulatory system itself, she explained. In addition, side effects like prolonged nausea, fatigue, and chronic pain also can disrupt a patient’s sex life.

“Simply to give medical solutions rarely resolves the problems because a person or couple needs to make changes in the sexual relationship to accommodate changes in physical function,” Schover stressed. “That kind of treatment is usually best coming from a trained mental health professional, especially if the couple has issues with communication or conflict.”

Schover wants to make sure that those resources are easily accessible to patients and survivors. Thus, she has created the startup, Will2Love, which offers information on the latest research and treatment, hosts webinars, and provides access to personalized services.

“Sexual health is a right,” concluded Schover, and both oncology professionals and patients need to be assertive in getting the conversation started.

Complete Article HERE!