Category Archives: Cancer

How To Talk To Your Doctor About Sex When You Have Cancer

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More people are surviving cancer than ever before, but at least 60 percent of them experience long-term sexual problems post-treatment.

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So you’ve survived cancer. You’ve endured brutal treatments that caused hair loss, weight gain, nausea, or so much pain you could barely move. Perhaps your body looks different, too—maybe you had a double mastectomy with reconstruction, or an orchiectomy to remove one of your testicles. Now you’re turning your attention back to everyday life, whether that’s work, family, dating, school, or some combination of all of those. But you probably aren’t prepared for the horrifying side-effects those life-saving measures will likely have on sex and intimacy, from infertility and impotence, to penile and vaginal shrinkage, to body shame and silent suffering.

More than 15.5 million Americans are alive today with a history of cancer, and at least 60 percent of them experience long-term sexual problems post-treatment. What’s worse, only one-fifth of cancer survivors end up seeing a health care professional to get help with sex and intimacy issues stemming from their ordeal.

Part of the challenge is that the vast majority of cancer patients don’t talk to their oncologists about these problems, simply because they’re embarrassed or they think their low sex drive or severe vaginal dryness will eventually go away on their own. Others try to talk, but end up with versions of the same story: When I went back to my doctor and told him I was having problems with sex, he replied, ‘Well, I saved your life, didn’t I?’ And many oncologists aren’t prepared to answer questions about sex.

“Sex is the hot potato of patient professional communications. Everyone knows it’s important but no one wants to handle it,” says Leslie Schover, a clinical psychologist who’s one of the pioneers in helping cancer survivors navigate sexual health and fertility. “ When you ask psychologists, oncologists and nurses, ‘Do you think it’s important to talk to patients about sex?’ they say yes. And then you say, ‘Do you do it routinely?’ They say no. When you ask why, they say it’s someone else’s job.”

Schover spent 13 years as a staff psychologist at the Cleveland Clinic Foundation and nearly two decades at the University of Texas MD Anderson Cancer Center. After retiring last year, she founded Will2Love, a digital health company that offers evidence-based online help for cancer-related sex and fertility problems. Will2Love recently launched a national campaign called Bring It Up! that offers three-step plans for patients and health care providers, so they can talk more openly about how cancer treatments affect sex and intimacy. This fall, the company is collaborating with the American Cancer Society on a free clinical trial—participants will receive up to six months of free self-help programming in return for answering brief questionnaires—to track the success of the programs.

Schover spoke to Newsweek about the challenges cancer patients face when it comes to sex and intimacy, how they can better communicate with their doctors, and what resources can help them regain a satisfying sex life, even if it looks different than it did before.

NEWSWEEK: How do cancer treatments affect sex and intimacy?
LESLIE SCHOVER: A lot of cancer treatments damage some of the systems you need to have a healthy sex life. Some damage hormone levels, and surgery in the pelvic area removes parts of the reproductive system or damages nerves and blood vessels involved in sexual response. Radiation to the pelvic region reduces blood flow to the genital area for men and women, so it affects erections and women’s ability to get lubrication and have their vagina expand when they’re sexually excited.

What happens, for example, to a 35-year-old woman with breast cancer?
Even if it’s localized, they’ll probably want her to have chemotherapy, which tends to put a woman into permanent menopause. Doctors won’t want her to take any form of estrogen, so she’ll have hot flashes, severe vaginal dryness and loss of vaginal size, so sex becomes really painful. She’ll also face osteoporosis at a younger age. If she’s single and hasn’t had children, she’s facing infertility and a fast decision about freezing her eggs before chemo.

What about a 60-year-old man with prostate cancer?
A lot of men by that age are already starting to experience more difficulty getting or keeping erections, and after a prostatectomy, chances are, he won’t be able to recover full erections. Only a quarter of men recover erections anything like they had before surgery. There are a variety of treatments, like Viagra and other pills, but after prostate cancer surgery, most men don’t get a lot of benefit. They might be faced with choices like injecting a needle in the side of the penis to create a firm erection, or getting a penile prosthesis put in to give a man erections when he wants one. If he has that surgery, no semen will come out. He’ll have a dry orgasm, and although it will be quite pleasurable, a lot of men feel like it’s less intense than it was before. These men can also drip urine when they get sexually excited.

Why are so many people unprepared for these side-effects?
If you ask oncologists, ‘Do you tell patients what will happen?’ a higher percentage—like in some studies up to 80 percent—say they have talked to their patients about the sexual side-effects. When you survey patients, it’s rare that 50 percent remember a talk. But most of these talks are informed consent, like what will happen to you after surgery, radiation or chemotherapy. And during that talk, people are bombarded by so many facts and horrible side-effects that could happen, they just shut down. It’s easy for sex to get lost in the midst of this information. By the time people are really ready to hear more about sex, they’re in their recovery period.

Why is it so hard to talk about sex with your oncology team?
It takes courage to say, ‘Hey, I want to ask you about my sex life.’ When patients get their courage together and ask the question, they often get a dismissive answer like, ‘We’re controlling your cancer here, why are you worrying about your sex life?’ Or, ‘I’m your oncologist, why don’t you ask your gynecologist about that?’ Patients have to be assertive enough to bring up the question, but to deal with it if they don’t get a good answer. Sexual health is an important part of your overall quality of life and there’s nothing wrong with wanting to solve or prevent a problem.

What’s the best way for people to prepare for those conversations?
First, because clinics are so busy, ask for a longer appointment time and explain that you have a special question that needs to be addressed. At the start of the appointment, say, ‘I just want to remind you that I have one special question that I want to address today, so please give me time for that.’ Bring it up before the appointment is over.

Second, writing out a question on a piece of paper is a great idea. If you feel anxious or you’re stumbling over your words, you can take it out and read it.

Also, some people bring their spouse or partner to an appointment. They can offer moral support and help them remember all the things the doctor or nurse told them in answering the question.

So you’ve asked your question. Now what?
Don’t leave without a plan. It’s easy to ask the question, get dismissed, and say, I tried. Have a follow-up question prepared. For example, ‘If you aren’t sure how to help me, who can you send me to that might have some expertise?’ Or, ‘Does this particular hospital have a clinic that treats sexual problems?’ Or, ‘Do you know a gynecologist or urologist who’s good with these kinds of problems?’ If you want counseling, ask for that.

What happens if you still get no answers?
I created Will2Love for that problem! It came out of my long career working in cancer centers and seeing the suffering of patients who didn’t get accurate, timely information. When the internet became a place to get health info, it struck me as the perfect place for cancer, sexuality and fertility. Sex is the top search term on the Internet, so people are comfortable looking for information about sex online, including older people or those with lower incomes.

Also, experts tend to cluster in New York and California or major cancer centers. I only know of six or seven major cancer centers with a sex clinic in the U.S. and there are something like 43 comprehensive cancer centers!

We offer free content for the cancer community, including blogs and forums and resource links to finding a sex therapist of gynecologist. We also charge for specialized services with modest fees. Six months is still less than one session with a psychologist in a big city! We’re adding telehealth services that will be more expensive, but you’re talking to someone with expert training.

What can doctors do better in this area?
For health care professionals, their biggest concern is, ‘I have 40 patients to see in my clinic today and if I take 15 extra minutes with four of them, how will I take good care of everybody?’ They can ask to train someone in their clinic, like a nurse or physician’s assistant, who can take more time with each patient, so the oncologist isn’t the one providing sexual counseling, and also have a referral network set up with gynecologists, urologists and mental health professionals.

 

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How Lube, Dildos And Dilators Are Helping Cancer Survivors Enjoy Sex After Treatment

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Tamika Felder, a cervical cancer survivor, founded the nonprofit Cervivor to help fellow survivors navigate the jagged path back to sexual health.

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“I don’t know if readers are ready for what I’ve got to say!” Tamika Felder chuckles over the phone. “I just don’t think they’re ready.”

If you’re a cancer survivor, you should be, because Felder, 42, is an intimacy advocate who dedicates her life to helping cancer survivors navigate the oftentimes brutal path back to sex and pleasure. She was diagnosed with cervical cancer at 25, and spent the next year getting chemotherapy, radiation and a radical hysterectomy. She wound up with “bad radiation burns from front to back” as well as vagina atrophy, shrinkage and dryness, all of which led to painful sex.

“I knew at 25 this just couldn’t be it for me. I knew I wanted to have sex again, and I wanted to have good sex again,” she says. “It takes time, but it’s absolutely possible.”

Felder founded Cervivor, a nonprofit that educates patients and survivors of cervical cancer. She also works with both women and men struggling to regain their sexuality and intimacy post-treatment. Many survivors aren’t aware that there are items, exercises and treatments that can help them. Felder spoke with Newsweek about what people can do to experience pleasure again, even if it’s different than it used to be.

What exactly do you do?
I am not a doctor, I’m patient-turned-advocate who is passionate about the total life beyond cancer—and that includes the sensual side. Cancer treatments are saving our lives, but they’re also damaging our lives. I knew one guy who had to have his penis removed. That’s a life-saving surgery but how do you help that patient navigate life after? I’ve counseled women who survived gynecological cancer, whose vaginal canals meshed so close together that their doctor can’t even fit a speculum inside. What does that do for the quality of life for a woman like that? You have to offer alternatives! Maybe she can’t have penetration through the vaginal canal, but I expect the medical community—her hospital or cancer center—to help her navigate to a good quality of life. Because part of a good quality of life beyond cancer is your sexual self. Doctors have to talk more freely about that.

What if they don’t?
If your clinical team doesn’t raise the concern with you, you need to speak up. Email them or call them on the phone if it’s too hard to do it face-to-face. Find your voice. If something is not functioning the same way or how you think it should be functioning, speak up.

Now that you’ve identified a problem, what are some of the ways to deal with it?
Dilators: Whether you have a partner or it’s all about self love, dilators are important because they stretch out your vagina. Start with a small size dilator and move up. If you need something more, take a field trip to a toy store and get different sized dildos and vibrators. With some cancers, if you don’t use your dilators, your vaginal canal—or whatever is left of it—can close back up, so it’s important to follow those suggestions. Other people think, If I’m not dating now it’s not an issue. No! You need to deal with it now so when you’re intimate with another person you can be ready. Practice makes perfect.

Lubrication: If you’ve had any type of gynecological cancer, lube is going to be your best friend. After chemotherapy and especially radiation, your vagina can be very dry. Women deal with it as we age, but radiation causes you to go into menopause early. For cervical cancer, not only do you have external radiation but also internal radiation. Lube is important when you become sexually active again, because your body isn’t producing moisture on its own. Otherwise you’ll have abrasive sex—it will hurt to enter the vaginal walls.

You have to find out what works for you. Coconut oil is perfect for putting in your vagina and using as lube. A little goes a long way. I also like Zestra, an arousal oil. It’s a natural lubricant. For women who may have slow libidos, you put it on your clitoris and labia and experience what some people call a tingling experience. They call it the “Zestra Rush.” It’s a slow progression of warming up and you’re like, Oh! It still works!

Pocket Rockets or Lipstick Vibrators: These bring blood flow back to the vulva. I don’t care if you’re a southern Baptist from the Bible Belt, I want you to get a pocket rocket and take it with you when you travel and use that sucker so it can help the blood flow. There are lots of fun toys out there that can help. My favorite one is the Ultimate Beaver. Order discreetly online or take a fun field trip to an adult toy store.

Mona Lisa Touch: There are new therapeutic procedures, like the Mona Lisa touch laser treatment, that helps with vaginal rejuvenation. If you’re a reality TV fan like myself, you might think, it sounds like what the Real Housewives do! It’s not just something that rich people do. In many cases, insurance won’t cover it, but we’ve seen with the right doctor and the right type of letter, they’ve gotten insurance to cover it. Or, you may find a doctor willing to donate or discount services. Take a chance and write them, saying, “This is what happened to my vagina after cancer, and this is how you can help.”

Pay Attention to Pain: Make sure you heal properly. You may have healed on the outside but it doesn’t mean you’re healed internally. If you’re properly healed but still experience pain, have a conversation with your doctor.

What pitfalls should people be aware of?
A lot of people focus on what their body was like before cancer. I hate to say, “You have to give that up,” but you do in order to move forward. Your body has changed. Your objective shouldn’t be an orgasm, because maybe your body won’t do that again. It pains me to know that women have vaginal canals that have closed and they’re just living a life where they think they can’t have pleasure stimulated vaginally anymore. It’s not fair. They weren’t given the resources to help them along the way.

How did you redefine sex and intimacy for yourself?
In my own eyes and my husband’s eyes, I’m a perfect 10, but if I’m walking down the street, I don’t look like the magazine covers. I’m a plus size woman but I do love myself. It starts with that. Part of the homework I give men and women— When you look at yourself, tell me what you see. They always start out with the negative. I’ve never had anyone, no matter the age group, in all my cancer talk about sex and intimacy, who’s started with anything good. So I flipped it: Tell me what you love about yourself? You can go get these toys and procedures, but at the end of the day, the true pleasure comes from how you feel about yourself. That’s going to make your sexual self stronger. I’m not saying, don’t go for pleasure, but it really is how you feel about yourself.

Where can people go for more help?
Sites like Memorial Sloan Kettering and Dana Farber have amazing resources. Find out if your cancer center has a program to help cancer patients reclaim their sensual side, like this one at Dana Farber. Or find someone in your local area through the American Society of Sex Educators, Counselors and Therapists.

Complete Article HERE!

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Oncologists need to discuss sexual issues with patients, says doctor

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Dr. Anne Katz was in Windsor on May 11, 2017, to address Windsor Regional Hospital staff about cancer, intimacy and sexuality.

By Chris Thompson

A Winnipeg doctor who specializes in treating sexual issues with cancer patients is hoping to spread the word about doctors being up front with their patients.

Dr. Anne Katz held an online forum for Windsor Regional Hospital workers about cancer, intimacy and sexuality.

Katz is the author of several books dealing with the issue.

“Really the message is that sexually it is really important for people, for all of us, and I really want to encourage oncology care providers to raise the topic of it with their patients, because when we don’t talk about it, the patients thinks it’s a taboo,” said Katz.

“And 80 per cent of cancer survivors experience sexual difficulty after cancer treatment.”

Katz said doctors should be more willing to bring up sex issues with their cancer patients.

“So it really is something where we have to expose people to having that conversation,” said Katz.

“All cancers, all people, men, women, gay, straight, people recognize things aren’t going right during treatment, but all more commonly sexual problems aren’t recognized until after treatment.”

Katz said many people undergoing cancer treatment don’t realize there is an issue until later.

“Usually people during treatment are really not feeling that well, so it’s kind of on the back burner but it really is a sentinel of survivorship,” Katz said.

“People come to see me and we know certainly that most men who experience prostate cancer are going to experience erectile difficulties, most women with breast cancer often experience body issues, early menopause, or exaggerated menopausal symptoms, people with colorectal cancer have problems.”

Katz said everyone who is experiencing cancer needs to address the issue.

“It really is all cancers,” Katz said. “We’re all sexual beings, literally, from cradle to grave, whether you act on it or not.

“Even if you’re not partnered. It’s so much a part of quality of life for cancer survivors. So it goes away, there are some couples that lose that connectedness, there are some couples that use sex to make up after fights. They are fighting a lot because there is no way to resolve the fights.

“Unless oncology workers can address it and talk about it, patients are very reluctant to bring up the topic.”

Complete Article HERE!

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How a Cervical Cancer Scare Made Me Take My Sexual Health More Seriously Than Ever

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My doctor’s advice on how to not get HPV again threw me for a loop.

By Rachel Bowyer

Before I had an abnormal Pap smear five years ago, I didn’t even really know what that meant. I’d been going to the gyno since I was a teenager, but I never once really thought about what a Pap smear was actually testing for. I just knew I’d have a “twinge” of discomfort, as my doc always says, and then it would be over. But when my doctor called me to tell me I needed to come back in for more testing, I was pretty concerned. (Here, find more on how to decipher your abnormal Pap smear results.)

She assured me that abnormal Paps are actually quite normal, especially for women in their 20s. Why? Well, the more sexual partners you have, the more likely you are to get human papillomavirus (HPV), which is what generally causes the abnormal results. I quickly found out that it was the cause of mine, too. Most of the time, HPV resolves on its own, but in some cases, it can escalate into cervical cancer. What I didn’t know at the time is that there are several steps between testing positive for HPV and actually having cervical cancer. After having a couple of colposcopies, procedures where a tiny bit of tissue is removed from your cervix for closer examination (yes, it’s as uncomfortable as it sounds), we discovered that I had what’s known as high-grade squamous intraepithelial lesions. That’s just a technical way of saying that the HPV I had was more advanced and more likely to turn into cancer than other kinds. I was scared, and I got even more scared when I found out I had to have a procedure to remove the tissue on my cervix that was affected, and that it needed to be done ASAP—before it got worse. (According to new research, cervical cancer is deadlier than previously thought.)

Within two weeks of finding out about my abnormal Pap, I had something called a loop extrosurgical excision procedure, or LEEP for short. It involves using a very thin wire with an electrical current to cut away precancerous tissue from the cervix. Normally, this can be done with local anesthesia, but after an attempt that went awry (apparently, local anesthetic isn’t as effective for everyone as it’s supposed to be, and I found that out the hard way…), I had to make a second trip to the hospital to have it done. This time, I was sedated. After six weeks, I was declared healthy and ready to go, and told I needed to have a Pap smear every three months for the next year. Then, I’d go back to having them once yearly. Let’s just say I’m not a great patient, so after all was said and done I knew I never wanted to have to go through this process again. Since there are over 100 strains of HPV, I knew it was a real possibility that I could contract it again. Only a small number of the strains cause cancer, but at that point, I really didn’t want to take any chances.

When I asked my doctor how to prevent this situation from happening again, her advice really surprised me. “Become monogamous,” she said. “That’s my only option?” I thought. I was dealing with the perils of the New York City dating scene at the time, and at that point couldn’t even imagine meeting someone I’d want to go on more than five dates with, let alone finding my mate for life. I had always been under the impression that as long as I was *safe* about sex, opting not to settle down wouldn’t be detrimental to my health. I almost always used condoms and got tested for STIs regularly.

Turns out, even if you use a condom every single time you have sex, you can still get HPV because condoms don’t offer complete protection against it. Even when used correctly, you can still have skin-to-skin contact when using a condom, which is how HPV is passed from one person to another. Pretty crazy, right? I didn’t think there was anything wrong with not wanting to be monogamous (and still don’t), so it was hard to grasp the fact that my ideological stance on sex was directly opposed to what was best for my sexual health. Was my only option truly to settle down at 23 and decide to only have sex with one person for the rest of my life? I wasn’t ready for that.

But according to my doctor, the answer was essentially, yes. To me, this seemed extreme. She repeated to me that the fewer partners you have, the lower your risk of contracting HPV. Of course, she was right. Though you can still get HPV from a long-term partner that could take years to show up, once your body clears whatever strains they have, you won’t be able to get it from them again. As long as you and your partner are only having sex with each other, you’re good to go in terms of re-infection. At the time, I was pretty taken aback by the fact that the best thing I could do to protect my sexual health was basically to not have sex until I found “the one.” What if I never found that person? Should I just be celibate forever!? For the next couple of years every time I even thought about having sex with someone, I had to ask myself, “Is this really worth it?” Talk about a mood killer. (FYI, these STIs are much harder to get rid of than they used to be.)

Truthfully, it didn’t turn out to be such a bad thing. Whenever I decided to have sex with someone in the years after that, not only did I follow safe-sex practices to the letter, but I also knew that I had strong enough feelings about the other person for it to be worth the risk I was facing. Basically, that meant I was genuinely emotionally invested in every person I slept with. While some would say that’s how it should be all the time, I don’t really subscribe to that school of thought—in principle. In practice, however, I did save myself a ton of heartache. Since I had fewer partners who I got to know better, I dealt with less post-sex ghosting. Some people might not mind that, but even when I wasn’t super-invested in someone, the ghosting part almost always sucked.

Now, five years later, I happen to be in a long-term monogamous relationship. While I can’t say that it happened directly because of my experience or my doctor’s advice, it’s certainly a relief when what your heart wants and what’s best for your health happen to match up. And not having to constantly worry about HPV the way I once did? Love.

Complete Article HERE!

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Childhood cancer treatment may hinder later-life sexual relationships

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Neurotoxic treatment for cancer during childhood may influence sexual activity and relationships in adulthood, according to new research.

Study co-author Vicky Lehmann, Ph.D., of Nationwide Children’s Hospital and Ohio State University – both in Columbus, OH – and colleagues found that adults who received high-intensity neurotoxic treatment for cancer as a child were less likely to meet certain sexual and romantic milestones.

However, the team found that childhood cancer treatment did not affect overall satisfaction for sexual and romantic relationships in adulthood.

Lehmann and team recently reported their findings in the journal Cancer.

According to the American Cancer Society, it is estimated that around 10,380 children aged 15 and under were diagnosed with cancer in the United States last year.

Leukemia is the most common form of childhood cancer, accounting for around 30 percent of all cases, followed by brain and spinal cord tumors, which make up around 26 percent of all childhood cancer cases.

Childhood cancer treatment and psychosexual development

While cancer was responsible for more than 1,200 childhood deaths last year, over 80 percent of children diagnosed with the disease will survive for at least 5 years. This is due to significant advances in cancer treatment, which include surgery, chemotherapy, and radiation therapy.

However, such treatment is certainly not without risk. For example, studies have shown that cranial radiation – often used to treat brain tumors – may cause harm to the developing brain, leading to long-term neurocognitive impairment.

Previous research has shown that neurocognitive impairment as a result of childhood cancer treatment may impact social interaction in adulthood, but studies investigating the effects of such treatment on psychosexual development are few and far between.

“Psychosexual development entails reaching certain milestones, such as sexual debut, entering committed relationships, or having children.

It is a normative part of becoming an adolescent or young adult, but only comparing such milestones without taking satisfaction into account falls short. These issues are understudied among survivors of childhood cancer.”

Vicky Lehmann, Ph.D.

To address this gap in research, the team enrolled 144 survivors of childhood cancer aged between 20 and 40. A further 144 participants who were not treated for childhood cancer (the controls) were matched by age and sex.

All participants completed questionnaires on psychosexual development, sexual satisfaction, and relationship satisfaction.

To determine the brain toxicity of cancer treatments in childhood, the researchers used data from the participants’ medical charts.

Neurotoxic cancer treatment might predict later-life psychosexual issues

Overall, the team found that adults who were treated for cancer in childhood did not differ significantly from the controls in terms of psychosexual development, sexual satisfaction, and relationship satisfaction.

However, on analyzing subgroups of childhood cancer survivors, the researchers found that those who previously received treatments high in neurotoxicity were less likely to have had sexual intercourse, be in a relationship, or have had children, compared with controls.

The type of cancer treatment in childhood did not appear to affect sexual satisfaction, the team reports. “This highlights the subjective nature of psychosexual issues, and the importance of addressing any concerns in survivorship care,” notes Lehmann.

The researchers say that their findings indicate that the neurotoxicity of cancer treatment in childhood may predict the likelihood of psychosexual problems in adulthood. They add:

“Additional research is needed to delineate how neurocognitive impairment undermines social outcomes for survivors, as well as other related factors.

Given the findings of the current study, healthcare providers should assess romantic/sexual problems among survivors, especially those who received high-dose neurotoxic treatments. Referrals to psychosocial care could prevent or reduce potential difficulties.”

 
Complete Article HERE!

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