Cancer can put a patient’s life on hold, especially among young adults who are just starting their careers or families.
[A] cancer diagnosis affects a person’s sexual functioning, according to a research.
The study, led by the University of Houston, found that more than half of young cancer patients reported problems with sexual function, with the probability of reporting sexual dysfunction increasing over time.
The study discovered that two years after their initial cancer diagnosis, nearly 53 percent of young adults 18 to 39 years old still reported some degree of affected sexual function.
“We wanted to increase our understanding of what it’s like to adjust to cancer as a young adult but also the complexity of it over time,” said Chiara Acquati, lead author and assistant professor at the UH Graduate College of Social Work.
“Cancer can put a patient’s life on hold, especially among young adults who are just starting their careers or families.”
The study also found that for women, being in a relationship increased the probability of reporting sexual problems over time; for men, the probability of reporting sexual problems increased regardless of their relationship status.
“We concluded that sexual functioning is experienced differently among males and females. For a young woman, especially, a cancer diagnosis can disrupt her body image, the intimacy with the partner and the ability to engage in sex,” Acquati said.
At the beginning of the two-year study, almost 58 percent of the participants were involved in a romantic relationship. Two years after diagnosis, only 43 percent had a partner. In addition, psychological distress increased over time.
She says it’s important to research how psychological and emotional developments are effected so tailored interventions and strategies can be created. Detecting changes in the rate of sexual dysfunction over time may help to identify the appropriate timing to deliver interventions.
Failure to address sexual health, the study concludes, could put young adults at risk for long-term consequences related to sexual functioning and identity development, interpersonal relationships and quality of life.
Acquati said health care providers might find it challenging to discuss intimacy and sex because of embarrassment or lack of training, but she believes addressing sexual functioning is vital soon after diagnosis and throughout the continuum of care.
“Results from this study emphasize the need to monitor sexual functioning over time and to train health care providers serving young adults with cancer in sexual health,” said Acquati.
“Furthermore, patients should be connected to psychosocial interventions to alleviate the multiple life disruptions caused by the illness and its treatment.”
The findings have been published in the American Cancer Society journal Cancer.
[S]o 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.
“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.
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.”
My doctor’s advice on how to not get HPV again threw me for a loop.
By Rachel Bowyer
[B]efore 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.
[N]eurotoxic 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.”
[S]exual 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.
[S]exual 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.
“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.”
[A]nal 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.
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.
[P]eople 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.
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.
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.
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.
And now for something completely different… It’s Product Review Friday all right, but we’ve seen nothing like this before. Today I, Dr Dick, will do the honors and tell you about a unique product for men. It’s a brand new product that will, I believe, change your life for the better. And in the process we welcome another new manufacturer to our review effort, Adult Fitness Concepts.
There are a handful of things that I have been very passionate about throughout my long career as a sexologist. Each of my passions revolve around two simple principles: the importance of knowing and owning who we are as sexual beings and an knowing about how our body works. These are the basic building blocks of sexual health and wellbeing.
Sexual wellbeing means a whole lot more than simply being able to perform. It also means taking responsibility for one’s eroticism as an integral part of one’s personality and involvement with others. But being unfamiliar with the basics of how our body works will surely short-circuit even our ability to perform.
My aim has always been to provide information, guidance, and resources that will help people approach their unique sexuality in a realistic and responsible manner. That’s what Dr Dick’s Sex Advice and Dr Dick’s Sex Toy Reviews are all about. So when a representative of Adult Fitness Concepts contacted me via email to tell me about their new product (actually, it’s more of a program than a product), the first FDA registered Kegel exercise program for men, my interest was piqued. I was told that the Private Gym was created after 3 years in development with several leading urologists, physiotherapists, and sexual health experts.
I have been an avid proponent of pelvic floor musculature toning for both women and men for my entire career in sexology. I write and speak about this topic so often that sometimes I feel like a broken record. Don’t believe me? Look for yourself. Use the search function in the sidebar of either of my sites, Dr Dick’s Sex Advice and Dr Dick’s Sex Toy Reviews, type in pelvic muscles, and BANG!
Women tend to know more about Kegel exercises, the exercises that tone and strengthen one’s pelvic floor musculature because doctors encourage them to do their Kegels during pregnancy. But here’s a tip for all you guys out there who are reading this and rolling your eyes and getting ready to turn the page because you think this is some kinda Oprah — vagina moment. Listen up you monkeys; kegel exercises aren’t just for the ladies. Us men folk have pelvic muscles too. So pay attention, you’re gonna want to know about Kegels too.
What are Kegels, you may be asking. They’re muscle contraction and relaxation exercises designed help restore, tone, and strengthen the muscles that surround the opening of the urethra (see guys, we have one of those), vagina (ok, we don’t have one of those, but we do have a penis and we get erections), and anus (we sure as hell have one of those). Since this includes the muscle that you use to stop and start the flow of urine, you can check if you’ve identified the right muscle by testing your kegel technique while peeing — if you can stop the flow of urine when tightening, then you know that you’re contracting the correct muscle group. BTW, the main muscle is call the pubococcygeus muscle, or PC muscle for short.
There are several “toys” on the market that are designed to help women tighten and tone their pelvic floor muscles, Ben Wa balls, and all their modern incarnations, for example. Now, thanks to the Private Gym us men folk have our own exercise program. A program that promises stronger, more rigid erections, a reduction in premature ejaculation, heightened orgasms, improvement in urinary control all while supporting prostate health.
I know what you’re thinking, if I can do Kegels on my own, why do I need a program? Good question. The best answer I can come up with is it will help you stray on track and achieve your goals. I mean, isn’t that the reason we go to a gym? Surely we can workout on our own, but the support and encouragement we get from being part of and involved in a program makes the effort more rewarding. It’s all about psychology, right?
The Private Gym is the first interactive, follow-along exercise program that helps men strengthen the muscles that support and control our cock. As men approach age 30, the muscles that support erectile function begin to weaken. By age 40, more than 50% of men experience some form of erectile dysfunction and this number increases to more then 66% as men approach 60 years of age. And for all you bottoms out there, you know how important it is to keep anal muscles in tip-top, pardon the pun, shape.
There are two parts to the Private Gym program — 1) the Basic Training Program (available on DVD or through digital download) and 2) the Complete Training Program, which involves resistance training.
As we all know, resistance training is key to building strong muscles. Imagine doing bicep curls or a bench press without weights. The Private GymComplete Training Program resistance equipment is basically a weighted high-quality, latex-free, nonporous, phthalate-free, and hypoallergenic silicone cuff for your dick. How amazing is that? You slip this puppy around your stiffy and do your Kegels. The cuff is also waterproof, so it cleans us easily with mild soap and warm water.
Just like all weight training, muscle contractions increase blood flow and increased blood flow to your johnson will…wait for it…produce harder, larger, and longer-lasting erections. Your pelvic musculature is also responsible for the strength of your ejaculation. Do you dribble instead of shoot? Well, my friend, you have some important exercisin’ to do.
While the Private Gym is a practical tool for any guy at any age, I have a few extra words for those men—friends, clients, and correspondents—who are living with and through prostate cancer. I get how difficult things can be after an invasive and life altering surgery. I also know that, for the most part, oncologists are not inclined to walk each of their patients through the emotional and physical minefield that is life after these often devastating medical interventions. But that doesn’t mean you have to sink to the lowest common denominator and shut down as a sexual being.
I believe that the Private Gym Basic Training Program can be helpful in regaining a sense of your sexual self after surgery and radiation. I’m currently working with two clients and we are using the Basic Training Program to rehabilitate their traumatized pelvic musculature. While it is too early to tell what kind of success rate we will have, I can say for certain that the effort involved in this program, as well as both of them knowing that someone really cares about their sexual performance issues, is making a huge psychological difference in terms of outlook and confidence. And that is huge!
My own experience with the program has been very positive. I’m 65 years old and I’ve been dealing with prostate issues, bladder control issues, and erection issues for some time now. I’ve also been doing Kegel exercises for decades, so I conclude that I am as functional as I am because of my efforts to keep my pelvic musculature toned and strong. The Private Gym is helping me be more conscientious about my workouts. And that is a real good thing. Full Review HERE!
We’re back from spring break, so it’s time to turn our attention to the sexually worrisome in our audience. I have another swell Q&A show in store for you today. Each of my correspondents is eager to share his or her sex and relationship concerns with us. And I will do my level best to make my responses informative, enriching and maybe even a little entertaining.
Carmen is loosing her man to religion.
Chad has a big tit fetish.
Jamal has a big dick and doesn’t quite know what to do with it.
Joe asks about Hepatitis-B and oral sex.
Holly returns to tell me about life after her double mastectomy.
After a spate of marvelous interview shows, it’s time to turn our attention to the sexually worrisome in our audience. I have a swell Q&A show in store for you today, which just so happens to be our last podcast before our annual spring break. Each of my correspondents is eager to share his or her sex and relationship concerns with us. And I will do my level best to make my responses informative, enriching and maybe even a little entertaining. And I think there will be enough time for us to do some sex science too. So please stay tuned, you won’t want to miss this.
Kennedy, Jim, and Ronald’s lives are being fucked up by meth.
Sam wants to know about and share some information about penis pumps.
Rebecca has a heartbreaking story to tell of the last days before her husband of 46 years died.
Tracy asks about babies and gender. So you know it’s time for some Sex Science.
I have a special announcement. Today’s program marks a huge milestone. This is my 400th podcast. I know; can you stand it? We’ve come a long way since I timidly began this audio educational and enrichment effort on February 12, 2007.
Today’s special show, which is also my last one of 2013, features some really interesting stuff. There are a few questions from the sexually worrisome, and I also have an interesting profile of a woman who is trying to reclaim her sexual-self after breast cancer. I think you will find her heartfelt story enriching as well as empowering.
We start off with…
Part 2 of my lengthy answer to Candice about porn for women.
Eleanor wants to explore her husband’s hole and prostate. She asks for my guidance.
Holly is dealing with some heavy intimacy issues after breast cancer.