How My Sex Life Changed After My Breast Cancer Diagnosis

By Molly Longman

On Dec. 2, 2015, Erin Burnett was two days out from her wedding and existing in the buzzy state of bliss that’s reserved for people who are very much in love. That morning, as she was happily daydreaming in the shower, she noticed something was different about her left nipple. She took a closer look — it seemed to be inverted. She felt an immediate chill; the sudsy water suddenly felt like ice.

She called her doctor, who said Burnett could come in during her lunch break to get her breast checked out, just as a precaution.

After some testing, the doctor told Burnett to come back after her wedding day. She tried to put the experience out of her mind until after the ceremony. Just 12 days after tying the knot, at 28 years old, Burnett got the call. She had stage II, triple-positive, invasive ductal carcinoma. Her honeymoon would be cut short.

The diagnosis impacted Burnett’s life in myriad ways — but a major factor was the impact on her sex life. “I had a brand-new marriage, with no honeymoon phase,” she remembers. “I used to joke around with my friends and say: ‘You guys are having these crazy sex lives where someone pulls your hair, while my husband’s picking my hair up off the ground.'”

Burnett underwent a double mastectomy and a hysterectomy, which induced what’s known as medical menopause. “I didn’t know until it happened that I was gonna have vaginal atrophy, vaginal dryness, pain with intercourse, lack of lubrication, and lack of libido [following the hysterectomy],” she says. She also faced emotional hurdles, especially as she coped with losing her breasts and went through painful attempts at reconstruction.

Throughout the treatment process, Burnett and her medical team were so focused on saving her life that her quality of life often took a backseat. In particular, the quality of her sex life was not top of mind for her or her providers.

This is a common refrain from cancer survivors, who say that the medical establishment tends to leave out or breeze through conversations about the ways cancer can impact your sexual health, especially because they’re rightfully so laser-focused on keeping you alive. But this can have serious ramifications for people’s sexual health, mental health, and relationships, says Ericka Hart, MEd, a sex educator and breast cancer survivor. “They’re usually not concerned about the ways that you are gonna experience pleasure in the future, they just want to fix you — and in their mind, cancer is the issue they’re fixing,” they say.

This often puts the onus on patients to bring up questions about how their diagnosis and treatment will affect their sexual health.

Anna Crollman, a 37-year-old breast cancer survivor from North Carolina, remembers feeling incredibly nervous about asking her provider about the sexual side effects, such as painful intercourse, she was experiencing during and after her treatment. “I like to call it the ‘doorknob question’ that you squeeze in right when they’re about to leave and their hand’s almost on the door,” she says. “You say: ‘Hey, just one more thing.'”

But if sexual health is brought up earlier and more often by providers, it’s not only easier for patients to discuss their issues when they’re ready to do so, but also for them to find more satisfaction with sex in the long run — and to feel less alone, says Don S. Dizon, MD, a professor of medicine at Brown University and director of the Sexual Health First Responders Clinic at Lifespan Cancer Institute.

It’s common, especially for women and nonbinary people, to blame themselves for sexual health issues and feel they have to suffer alone. “Most of the people I see feel like they’re the only ones going through this,” he says. “When I tell a person, ‘This is really common,’ there’s a weight lifted off their shoulders because [until then,] they think they’ve done something wrong.”

But patients shouldn’t be deterred from seeking information about improving their sexual health, despite cancer, and they shouldn’t have to work up extra courage to get answers. As Dr. Dizon puts it: “everyone deserves a sex life.”

The Physical Impacts Cancer Can Have on Sex

Breast cancer treatments can dampen physical desire in several ways. Breasts are an erogenous organ, Dr. Dizon says, and oftentimes a mastectomy is required as part of treatment. “The loss of breast-specific sensuality is something everyone will go through to some degree,” he says. “The process of naming that is really important, because people don’t consciously think of the breast as a sexual organ, and it is.”

Meanwhile, for those with hormone-positive breast cancer, doctors often prescribe drugs called aromatase inhibitors that lower estrogen levels, causing medically induced menopause. “These notoriously have a negative effect on sexuality, whether it’s vaginal dryness, painful activities, or loss of desire,” Dr. Dizon says. “Chemotherapy can also harm body image, because people gain a lot of weight, and it can cause neuropathy and physical side effects like nausea and diarrhea.”

As patients know, these physical impacts can take a real toll.

Shonté Drakeford, a nurse practitioner and patient advocate in Maryland, was diagnosed with stage four metastatic breast cancer in 2015, after being dismissed by providers for six years when she presented with symptoms. Drakeford says that before her diagnosis, her sex life with her high school sweetheart was “amazing.” For the first two years of treatment, she had no major sexual side effects, though she had to be careful about what positions she took part in, as the cancer had spread to her lungs, lymph nodes, ribs, spine, and left hip. “I asked my doctor what I could do that wouldn’t harm me, physically, because I was fragile,” she remembers. “He got all red and was embarrassed to answer.”

About three years into treatment, Drakeford noticed that her libido had lessened, and she was experiencing vaginal dryness. “Even though, mentally, I wanted to [have sex], my mind and vagina didn’t connect,” she says. “It was like a slow transition into a menopausal state.” This was due to her treatments, which she couldn’t stop. “I’ll be on treatment forever; this is lifelong for me,” she says. “I wish they had Viagra for women.”

Drakeford’s doctors told her that vaginal estrogen therapy — which some menopausal people use to help with some sexual side effects — wasn’t an option for her; her cancer was hormone-positive, so it essentially fed on hormones like estrogen. “It’s all about safety,” Drakeford says. “Am I willing to risk my health for sexual satisfaction?”

Cancer Can Cause Mental Health Barriers to Satisfying Sex, Too

Beyond these physical questions, mental hurdles are also prevalent amid cancer treatments. Many of us have ideas about what sex “should” look like, and those are challenged by a life-changing diagnosis like cancer, says Emily Nagoski, PhD, a sex educator and author of “Come as You Are” and “Come Together.”

Hart says that they felt “disconnected from their body” after their cancer diagnosis, something that they believe to be common for other survivors, but that looks different for everyone. As they were being treated for breast cancer in 2014, they struggled with how their body was constantly being touched, especially by white medical staff. Hart, who is Black, found that this challenged their understanding of bodily autonomy and lead to them distancing themself from their romantic partner, who was white. “I didn’t want a white person to touch me sexually,” they remember.

Hart says that something else shifted following their mastectomy: they felt like people could no longer see them as a whole person — they only saw Hart’s illness. At one point in their healing process, Hart went topless in public, baring their double mastectomy scars to end “the lack of Black, brown, LGBTQIA+ representations and visibility in breast cancer awareness.” As important as this messaging was, Hart felt “de-sexualized” by some of the responses their display elicited. “People would see my topless pictures and respond: ‘Oh my God, you’re so inspiring,'” they say. “But if anybody with nipples went topless on the internet, that would not be the response.”

This is a commonly felt sentiment among breast cancer patients — they feel society begins to see them only as patients, rather than sexual beings. Hart points out that you rarely see sex scenes with cancer patients in the media. FWIW, the only one I could think of was in “Desperate Housewives,” which involved a somewhat superficial plot about Tom feeling uncomfortable having sex with Lynette when she wasn’t wearing her wig, and Lynette fearing it meant he was no longer attracted to her. (This is a real fear among patients, though Dr. Nagoski notes: “In a great relationship, we’re attracted to the human being we chose to be with, not to the body parts of that human. It’s normal to have feelings about changes to our bodies and our partners’ bodies, of course, but a strong relationship adapts to those changes with love and trust.”)

Meanwhile, Crollman, who was diagnosed with cancer at 27, adds that the mental barriers to sex after cancer were “the hardest part.” “The pain, of course, is physically uncomfortable, but even though my partner and I tried so hard to stay in open communication, the reality was, we went through a very, very dry spell,” she says. “I was feeling really lost, mentally. I went through a deep depression, and I was seeing a therapist to cope because I really didn’t feel comfortable in my body.” After having a double mastectomy, Crollman felt “vulnerable” being in front of someone else while she was still “struggling to come to terms with the body that I had.”

Plus, not being intimate for a period due to these understandable challenges led to “more physical triggers and trauma around that experience — around the fear of it, around the pain that was related to it because of the side effects,” Crollman remembers. “So it was kind of this multileveled, emotional, psychological challenge.”

Finding Pleasure Again Post-Diagnosis

The physical and emotional stressors surrounding sex are very real, but reframing can help cancer patients to work through them. “The stakes around treatment certainly may be high, but the stakes around sex are not” — or at least, they don’t have to be, Dr. Nagoski says.

Although our culture tells us we can somehow “fail” sexually, especially “if we don’t perform according to some external, bullshit standard, the reality is there is nothing to lose, there is no way to fail,” Dr. Nagoski says. “We only imagine we’re doing it ‘wrong’ when we compare our experiences to some bogus cultural script of what sex ‘should’ be like — a script that was always irrelevant to our lives, but after a cancer diagnosis is just an absurd, pointless, and even cruel standard against which to assess our sexual connections. There is nothing at stake with sex; you have nothing to lose, only pleasure and connection to gain.”< Pleasure can look different to different people, and sex is just one piece of it. In order to maximize satisfaction for all parties involved, Dr. Nagoski says you first need to get on the same page as your partner — and that means getting curious. "If your partner wants sex, ask each other these important questions: What is it that you want, when you want sex with each other? And what is it that you don't want? When don't you want sex with each other? And, perhaps most importantly, what kind of sex is worth having — as in, what makes sex worth not spending that time watching 'Parks & Recreation'?"

Also, “You could decide to take all sex entirely off the table,” Dr. Nagoski says. “That’s a legitimate choice.” Hart adds that some couples may decide to open up their relationship amid cancer.

However, many people with cancer do want to try to explore sex and pleasure again, whatever that looks like for them. But because there are so few good resources out there and so much stigma around the topic, they may do so with varying levels of success.< Hart, for example, discovered that kink and BDSM was a sexual space of healing for them. "After being poked and prodded and having surgeries and chemotherapy literally once a week with a giant needle, I wanted to go into spaces where I could reclaim that pain," they say. "So doing things like impact play — being consensually spanked and hit — I could reclaim the pain after years of feeling like I didn't have a choice of opting into it." Hart also recommends working with a sex therapist to find pleasure again, which may include finding ways to incorporate chest play after a mastectomy, whether you still have nipples or not. Dr. Nagoski recommends the book “Better Sex Through Mindfulness” by Lori Brotto, who specializes in sexual health interventions for those with cancer and for survivors of sexual trauma.

Dr. Dizon adds that some healthcare providers might be more comfortable pointing their patients to resources rather than giving them actual advice about their sex lives, so asking your doctor if they have recommendations for something to read or a support network you could join might be a smart tactic for finding the support you seek.

Drakeford says she hasn’t been shy about asking for resources but still hasn’t felt satisfied with the level of pleasure she’s experienced since her diagnosis. She’s tried vaginal moisturizers, lube, and sex toys and hasn’t seen much success. “I even tried that slippery elm herb — it did nothing. Not a thing!” Drakeford says. “I’ve been going on nine years without things improving. I hope researchers can get on this and find something that actually works for people like me . . . even if it’s not during my lifetime.”

Burnett, for her part, has tried to be intentional about pleasure from the very beginning — though it hasn’t been easy.

While she was undergoing chemo, Burnett says, she and her partner scheduled sex around treatments. “The first couple of days after chemo, your body’s pretty toxic, so you aren’t going to be intimate,” she says. “Then seven to 10 days after is when you’re at your sickest. So for us, it was usually around that two-week mark that we’d schedule time to be intimate, before the next round.”

Since going into medical menopause, Burnett’s tried multiple tactics to make sex post-breast-cancer more pleasurable with her partner, including lubes, moisturizers, and laser therapy. (Dr. Dizon notes it’s important for those with breast cancer to find options that have specifically been studied in people with breast cancer, not the general population.) She also had to mentally get used to the changes in her breasts — though getting a mastectomy scar tattoo helped her regain some confidence, both in general and in the bedroom.

Although Burnett didn’t get the honeymoon phase she’d always dreamed about, she did learn quickly that she’d found a partner who’d keep every word of his vows. “There is something really intimate about someone who can be there for you and hold your hair back as you’re throwing up, and pick it up as it’s falling out,” she adds, nodding to her old joke about her friends having their hair pulled.

The couple’s 10-year anniversary is coming up next year, and they’re planning to finally take that honeymoon they never got. “It’ll be a different kind of honeymoon, because my body is just different from most other 36-year-olds’ out there. But it will also be a celebration of surviving 10 years.”

Complete Article HERE!

My Cervical Cancer Diagnosis Changed the Way I Think About Sex

— I’ll never approach sexual risk the same way again

By Andrea Karr

I’ve long been a fan of condom use and STI testing. I’m the woman who carries a rubber in her wallet *just in case* and heads to the lab a couple times a year to have my blood and urine screened for gonorrhea, syphilis and other sexually transmitted infections.

Occasionally, I’ve foregone the condom. I’d like a guy and we’d sleep together a few times. One night, he’d suggest that it would feel way better if we skipped protection. He’d keep the conversation light but would make it clear that we’d both have more fun if I’d loosen up. I wouldn’t want to come off as a killjoy or prude, so sometimes I’d give in. Each time it happened and I received a clear STI test afterward, I’d sigh with relief and go on with my life.

But then I was diagnosed with cervical cancer after a routine Pap test when I was 35. The fastest increasing cancer in females in Canada and third most common cancer in Canadian women ages 25 to 44, cervical cancer is almost always caused by human papillomavirus (HPV), an STI with more than 200 strains that can also cause vaginal, vulvar, penile, anal and oropharyngeal (a.k.a. throat, tonsils, soft palate and back of the tongue) cancer. HPV often has no symptoms, and cervical cancer can take one or two decades to develop after infection. Though condoms don’t guarantee protection, they reduce the risk of transmission.

Cervical cancer is no joke for a woman’s wellbeing and fertility. I was very lucky that my cancer was caught at the earliest stage: 1a1. I required two small surgical procedures (called LEEPs) to remove the cancerous cells, and now I get checkups every three months. If it was caught later, I might have needed a hysterectomy, radiation and/or chemotherapy, which could have harmed my eggs or put me into early menopause.

The phrase “it’s cancer” is something we hope to never hear in our lifetime. Those little words changed my life. As a result, I spent a lot of time looking back on my sexual relationships. I regretted ever having sex at all at first. Sex is what gave me cancer! But then I realized that just being alive carries risk, and I don’t want to avoid intimate relationships, which can be so crucial to physical, emotional and mental wellbeing, just because I could get hurt.

Instead of abstaining from sex, I decided I wanted to get educated about my risk, then develop clear boundaries that I can confidently communicate to a partner. I also want to break down the guilt or shame I feel about being a “killjoy” or “prude.” I have a great justification: a history of gynecological cancer. But no one should need a life-altering event to justify having sexual boundaries.

Still, it’s not easy. “As a woman, you’ve been told your whole life that if you stand up for yourself, if you don’t go with the flow, you are difficult, and that it’s not feminine to be difficult,” says Frederique Chabot, sexual health educator and acting executive director at national organization Action Canada for Sexual Health and Rights. She’s referring to the way most girls and women are socialized growing up. “In romantic or sexual scenarios, there are many things that can put you at risk of retaliation, of reputational damage, of harassment. There is the pressure put on women to say ‘yes,’ people asking, asking, asking, asking. That’s not consent. That is getting pressured into doing something you’re not willing to do.”

A woman's legs and a man's legs intertwined in bed

I’m now comfortable with having a detailed chat about sexual history, STI testing, HPV vaccination and condom use before I get into bed with someone. Of course, it’s not only on me. Men are at risk for HPV and other STIs too.

So far, I’ve had this conversation with two guys. One responded badly; now he has no place in my life. The second agreed to have a fresh STI test before we had sex. He also looked into the HPV vaccine, which he ended up getting, and he is okay with consistent condom use. We’ve been dating for almost a year.

I know that every woman in the world won’t share the same boundaries as me. That’s okay. But there are potential risks to sexual contact, even though our hook-up culture likes to pretend otherwise. It’s about deciding how much risk you can live with and then feeling empowered to communicate that. I won’t let my desire for acceptance compromise my sexual health going forward. I hope, after hearing my story, no one else will either.

“Instead of abstaining from sex, I decided I wanted to get educated about my risk, then develop clear boundaries that I can confidently communicate to a partner.”

Ways to be proactive

HPV vaccination

In Canada, Gardasil 9 is the go-to HPV vaccine and it protects against nine high-risk strains of HPV that cause cancer and genital warts. Health Canada currently recommends it for everyone aged 9 to 26, and it’s offered for free in schools sometime between grades 4 and 7, depending on the province or territory. Though it’s most effective when administered before becoming sexually active, it can still have benefits later in life. I wasn’t vaccinated at the time I was diagnosed with cervical cancer, and all my healthcare practitioners told me to get vaccinated immediately. The Canadian Cancer Society recommends the HPV vaccine for all girls and women ages 9 to 45Regular Pap tests

In Canada, most provinces and territories rely on Pap tests to check for cellular changes that, if left untreated, may lead to cervical cancer. Generally, the recommendation is to go to your doctor or a free sexual health clinic every three years (if everything looks normal) starting at age 21 or 25. I had no symptoms for cervical cancer; it was caught early thanks to a routine Pap test. You still need to go for regular Pap tests even if you’ve been vaccinated, you’ve only had sex one time or you’re postmenopausal.

HPV testing

Free STI tests that you can get through your family doctor or a sexual health clinic do not check for HPV. They usually test for chlamydia and gonorrhea (and maybe also syphilis, HIV and hepatitis C). If a sexual partner tells you they’ve had a clear STI panel, they’re probably not talking about HPV since it’s a test that comes with a fee.

P.E.I. and B.C. are transitioning from Pap testing every three years to HPV testing every five years. HPV testing is more accurate than Pap testing. It can detect certain strains of high-risk HPV with about 95 per cent accuracy, while Pap tests are only about 55 per cent accurate at detecting cellular changes on the cervix, which is why they need to be done more frequently.

The shift to provincially covered HPV screening in other provinces is slow. Ontario, for example, may be years away from the transition.

DIY testing

Canadian company Switch Health has launched a self-collection HPV test that can be ordered online for $99. You do your own internal swab, mail your results to the lab and get your results from an online portal—it can take as little as a week. It screens for 14 high-risk strains of HPV, including types 16 and 18, which cause 70 per cent of cervical cancers and precancerous cervical lesions. If you test positive for one of the strains, you should see your family doctor, and if you don’t have one, Switch “will work to set you up with one of our partners for a virtual or in-person appointment,” says co-founder Mary Langley.

The cost may be a barrier, plus privately purchased DIY tests aren’t supported by the infrastructure that there is for Pap testing. “There are quality control checks in place. There’s evidence review on a regular basis. Many people will receive letters from [their provincial health agency] telling them they’re due for their Pap,” says Dr. Aisha Lofters, a scientist and family physician at Women’s College Hospital in Toronto. But if you aren’t getting regular Paps because you don’t have easy access to a doctor or you’re uncomfortable going in for the test, it’s a lot better than nothing.

Complete Article HERE!

Can You Have a Sex Life After Breast Cancer?

— Experts Say Yes.

With patience and treatment, you and your partner can rekindle your sexual spark.

You may find yourself facing physical changes and emotional challenges, but you can overcome them.

By Abby McCoy, RN

If you’ve recently gone through lifesaving breast cancer treatment, you may be looking forward to better days ahead. But as you try to get back to “normal life,” you might notice a change in your libido.

“Cancer treatment across the board can take a significant toll on the body, and breast cancer is no different,” says Gabriel Cartagena, PhD, a clinical psychologist at Smilow Cancer Hospital at Yale New Haven and an assistant professor at Yale School of Medicine in New Haven, Connecticut.

About 60 to 70 percent of breast cancer survivors report sexuality issues after treatment, according to a study published in 2019 in Breast Cancer, so if you’re having that experience, know that many other women are, too. We asked the experts and have some treatments and tips to help you fire up your sex life after breast cancer.

How Breast Cancer Affects Your Libido

So you can understand how to combat a low libido after breast cancer treatment and take back your sexuality, let’s look at the causes.

Premature Menopause

Several cancer therapies can lead to premature menopause, according to a study published in 2022 in the Journal of Clinical Medicine. Chemotherapy and radiation therapy, for example, can decrease hormone levels in your body and make your menstrual cycle slow down or stop altogether, says Mary Jane Minkin, MD, a codirector of the sexuality, intimacy, and menopause program for cancer survivors at Yale Cancer Center and Smilow Cancer Hospital. For women whose breast cancer is fueled by estrogen, treatment may include medication to block the production of estrogen, or surgical removal of the ovaries. These measures, too, can bring on premature menopause. With menopause symptoms like hot flashes, insomnia, and dry mouth, sex may be the last thing on your mind.

Emotional Distress

A breast cancer diagnosis comes with a lot of emotions. Women diagnosed with breast cancer can be at a higher risk for mental health issues like depression and anxiety, neither of which are conducive to a high libido, according to a study published in 2021.

Vaginal Dryness

When your estrogen takes a nosedive during and after treatment, your vagina can become very dry, says Dr. Minkin. Lack of lubrication in this area can make sex uncomfortable or even painful, according to the American Cancer Society (ACS).

Painful Sex

Painful sex can also arise from pelvic floor dysfunction, which means the muscles in and around your pelvis can be too tight or too loose. That’s according to the research published in the Journal of Clinical Medicine, which also found that women may experience chronic pelvic pain syndrome (unexplained pain in your pelvis) after breast cancer treatment.

Body Changes

If you have had surgery or other body changes during treatment, such as removal or reconstruction of one or both breasts, you may not feel like revealing the new you in a sexual encounter, and new or missing sensations can make it hard to get in the mood. “Many women who have lost breast tissue, particularly if they have lost nipples, may feel [less] sensation in their breasts, and many women find breast stimulation important for sex,” says Minkin.

How to Get Your Groove Back

This list may feel discouraging to read, but you shouldn’t lose hope. “The important thing is that we can help with most of these issues,” says Minkin.

Medications Minkin recommends nonhormonal (estrogen-free) medications to help with symptoms of early menopause. “An over-the-counter herbal product called Ristela can help improve pelvic blood flow and enhance libido,” Minkin says. One meta-analysis published in 2021 found that women who took Ristela and similar products that contain the amino acid L-arginine experienced more sexual arousal, better lubrication, more frequent orgasms, and less discomfort or pain. Many participants reported no side effects at all, but a few experienced an upset stomach, heavier menstrual bleeding, and headache.

“Women can also consult with their providers about using prescription nonhormonal medications called flibanserin (Addyi) or bremelanotide (Vyleesi),” Minkin says. Addyi may be less effective than other options, and can cause fatigue and drowsiness, according to a meta-analysis published in 2022 in Sexual Medicine. Vyleesi, on the other hand, has shown more promise, according to a study published in 2019, with uncommon mild side effects like nausea, flushing, and headaches.

If your low libido stems from feelings of depression or anxiety, medications, often in combination with psychotherapy, are an option you can discuss with your healthcare provider.

Vaginal moisturizers For vaginal dryness, Minkin often suggests over-the-counter nonhormonal vaginal moisturizers, like Replens and Revaree, which are inserted into the vagina with an applicator a few times a week. “[These] work very nicely for many women,” Minkin says.

Toys A vibrator or similar device could be a worthwhile investment. They can boost sensation and increase blood flow to your pelvis, says Minkin, both of which can amplify desire.

Therapy One or more sessions with a counselor can be helpful, says Minkin. Sexual health counselors often use cognitive behavioral techniques to discover the “why” behind your low libido, and help you unlock thought patterns that may be blocking your sexual drive, according to a study published in 2020. Therapy is also an effective treatment for depression and anxiety.

Vaginal hormones Hormone replacement therapy is often used to treat menopause symptoms. But if you’ve had breast cancer, it may increase the risk that it will come back, especially if your cancer is sensitive to hormones. With vaginal hormonal treatments, a cream, tablet, or ring containing low-dose estrogen is placed directly in your vagina to aid lubrication and strengthen the vaginal lining. Because much less estrogen gets into your bloodstream, this option is generally considered safe, according to the North American Menopause Society. Your healthcare provider can help you decide if hormone treatments are right for you.

Get Reacquainted With Your Body

Breast cancer treatment can leave you feeling like you’re living in a stranger’s body. “A stark change like a mastectomy can leave women feeling separated from themselves,” says Dr. Cartagena. But every woman can get to know and accept her new body.

Reintroduce Yourself Gradually

“The process to reknow your body takes time and begins in small steps,” says Cartagena, who suggests a first step could be to get dressed in the morning with the lights on. After a few days or weeks of this, you might try spending 10 seconds observing your body in the mirror.

“Exposing yourself to your body little by little can allow you to gradually grieve what is different and take notice of what is new that is still important to you,” explains Cartagena.

Reframe Your Sexual Desires

Sex after cancer may look different, and mourning lost sensations is very important, says Cartagena. Looking forward, he encourages breast cancer survivors to study what sex means to them by asking questions like, “What feels good now?”

“If penetrative sex still evokes pain, a patient can explore foreplay, different forms of stimulation, or other forms of intimacy to induce different, fulfilling sensations,” says Cartegena. Sex doesn’t have to mean one thing — it can be whatever you need or want it to be.

Complete Article HERE!

Sex after prostate cancer

— Prostate cancer treatments can have side effects that may result in changes that affect intimacy, desire and function. While these symptoms are often temporary, they can be distressing and it’s important to talk to your physician about what to expect and the steps you can take to improve them.

Why this happens

As men become sexually aroused, the brain sends messages through the nervous system to the muscular walls of the blood vessels in the penis. The vessels enlarge, allowing more blood to flow into the penis. The incoming blood makes the penis bigger and harder, causing an erection.

Even if your libido is normal, your hormones, nervous system, muscles and blood vessels need to work properly to get an erection. Cancer treatments may affect your hormones, which in turn can affect your libido as well as the nerves, muscles or blood vessels that play important roles in causing an erection.

Prostate cancer treatment and erectile dysfunction

Erectile dysfunction (ED) is one of the most common side effects of prostate cancer treatment. Nearly all men will have trouble getting an erection for a period of time after undergoing different types of treatment, such as:

  • Surgery. The nerves responsible for an erection (the cavernous nerves) travel very close to the prostate gland and may be injured during the removal of the prostate. Nearly all men who have their prostate removed will have trouble getting an erection for some time, even if they have a “nerve-sparing” operation. However, most men recover with time.
  • Radiation therapy. Damage to the delicate tissues involved in getting an erection, such as nerves, blood vessels or blood flow, can occur with radiation therapy. These side effects appear more slowly during the year after treatment. Men may have softer erections, lose their erection before climax (orgasm) or not be able to get an erection at all.
  • Chemotherapy. The drugs used in chemotherapy treatment of prostate cancer may affect your libido and erections if it affects testosterone production, but most men still have normal erections. Chemotherapy can also cause fatigue or distress, which can affect your sexual desire and ability to have an erection, but normal desire usually returns when treatment ends.
  • Hormone therapy. The prostate depends on androgens, such as testosterone, to do its work. Unfortunately, testosterone may help some prostate cancers to grow. The hormone treatment used in prostate cancer, called androgen deprivation therapy (ADT) blocks androgens to slow the growth of prostate cancer, but it can also decrease libido and sexual function. (ADT does not cure prostate cancer.)

Recovery after prostate cancer treatment

Time is the most important factor in recovery. The healing process for men who have had nerve-sparing radical prostatectomy (removal of the prostate) is often 18 to 24 months or more, because nerve tissue requires a longer time to heal. How much erectile function returns depends on several things:

  • The type of operation you had (one, both, or no nerves spared). Most men with intact nerves will see a substantial improvement within a year of treatment.
  • Your age: Men under 50 or 60 are more likely to recover their erections than older men.
  • Your erectile function before the operation. Men who had good erections before surgery are more likely to recover their ability to get an erection than those who had previous erection problems.

It is also common to need medications to assist with erectile function, even if you did not need them before your operation.

Rehabilitation and aids

Studies suggest that starting a program to promote erections about six weeks after surgery can help some men recover sexual function. Different methods are available, depending on your case, your level of motivation and the judgment of your surgeon. These penile rehabilitation programs focus on increasing blood flow to the area to encourage healing and help men have regular erections that are hard enough for penetration. Having two to three erections a week, even if there is no sexual activity, helps keep the tissues in the penis healthy.

Several options are available to treat ED, and they may or may not be part of a rehabilitation program:

  • Medication: sildenafil/Viagra®, tadalafil/Cialis® or vardenafil/Levitra MUSE™(a prostaglandin suppository that you insert into your urethra)
  • Vacuum erection devices
  • Penile implant
  • Penile self-injection with a prostaglandin: alprostadil/Caverjet™/Edex™

Complete Article HERE!

How to keep your sex life thriving after prostate cancer

— Poor sexual function is the most common consequence of prostate cancer treatment, but support through the NHS is patchy and many men suffer in silence.

By Laura Milne

When BBC presenter Gabby Logan and her husband Kenny, the former Scotland rugby union winger, experienced difficulties with their sex life after he had his prostate removed last year, rather than keep it under wraps, they decided to make a podcast about it.

The couple, who have been married for 22 years, discussed their issues in an interview about Kenny’s prostate cancer diagnosis and subsequent erectile dysfunction on Gabby’s podcast The Mid Point.

Kenny, 51, who won 70 international caps representing Scotland, said his wife, 50, had expected the passion in their relationship to be reignited “immediately” after his operation and when he was unable to perform, it knocked his confidence badly.

He said: “When we first tried to have sex after the operation, Gabby said, ‘Oh, it’s not working, that’s it, it’s not working’. You didn’t even give me a chance. What actually happened from that was my confidence went rock bottom.

Gabby and Kenny’s experience is far from unusual. In the UK, prostate cancer is the most commonly diagnosed cancer in men and more than 395,000 were living with it, or had been successfully treated for it, in 2018.

According to the Life After Prostate Cancer Diagnosis (LAPCD) study of 35,000 men in the UK, funded by men’s health charity Movember, poor sexual function is the most common consequence of prostate cancer treatment (79 percent with prostate cancer compared with 48per cent of men in the general population).

Unfortunately, the problem remains one that is either not addressed routinely or at all in prostate cancer care.

The LAPCD study found that 56 per cent of men were not offered any help with sexual dysfunction following their treatment.

Problems with sex can lead to stress, anxiety, anger and even shame.

Some men don’t like to talk about vulnerable feelings because they think they should be “strong and silent”. Others avoid talking because they’re overwhelmed or trying not to burden their partner.

But learning how to face these challenges and work through them can strengthen your sexual wellbeing, explains Dr Karen Robb, Implementation Director for Cancer at Movember. “Sexual wellbeing – the balance between the physical, social and emotional aspects of sex – has not always been a common topic of conversation, but fortunately that is changing,” she says.

“Talking about sex after prostate cancer can be uncomfortable but open communication between you and your partner, if you have one, is a key part of sexual recovery following treatment. Acknowledge what has changed for you so that you can do something about it, with the right support.”

Almost every kind of prostate cancer treatment, including surgery, can cause sexual dysfunction, the most common of which is erectile dysfunction or ED, following a prostatectomy (surgical removal of the prostate).

This means that although you may feel aroused or in the mood for sex, chances are you’ll have difficulty getting an erection.

Why does ED happen after prostate cancer surgery?

“Surgery to remove the prostate affects the nerves and blood supply around the penis,” explains Karen. “The penis needs a healthy blood flow to get an erection. Without this, it won’t become as hard as it did before surgery.”

During surgery, the entire prostate is removed. The nerves that help create erections run down the left and right sides of the prostate gland. The surgeon can usually take out the prostate without causing permanent harm to the nerves on either side.

But if your cancer is too close to the nerves, they may need to be cut out.

How long does ED last after surgery?

It might take some time to improve, and the level of function you get back depends on a number of things including your age, lifestyle, any medications you take and whether you had nerve-sparing surgery.

As Karen explains: “Some things you can work on, such as exercise and keeping a healthy weight.

“Some are a bit more out of your control. However, all are things you can talk about with your doctor and see what recommendations they have that can help.”

What can you do about ED after prostate cancer?

Sex and intimacy after prostate cancer can look different for everyone, but there are options to keep your sex life thriving. Exploring new ways to have sexual pleasure and intimacy is essential after treatment and can even be a way of improving your erections.

There are different types of ­medication and sexual aids that you can try, all with pros and cons.

Everyone is unique so you may need to try out a few options a number of times and perhaps in combination to settle on the best solution for you. Discuss this with your healthcare provider.

To support men and their partners following prostate cancer treatment, Movember has launched an evidence-based online guide
called Sex and Intimacy After Prostate Cancer.

Informed by sexual health experts, it covers ED, dealing with physical changes after surgery, connecting with a partner, restoring intimacy, and coping with stress and anxiety. It also provides practical strategies, such as exercises, information about medication and devices, and how to have conversations with your doctor or care team.

“It’s vital to talk and not to just ignore it”

Chris Pedlar, 56, took early retirement from the Environment Agency in 2022 after 33 years, and lives with his partner in Devon. Nine years ago, Chris became the third generation in his family to bediagnosed with prostate cancer.

“My grandfather died from prostate cancer and my father was treated for it when he was 60. He went on to live for another 25 years, cancer free. He made sure that I started having PSA tests at 45 and I was picked up as having medium-risk cancer at 48.

“I opted for surgery rather than radiotherapy as I knew I would have the option of additional radiotherapy later on.

“Due to my father’s experience, I knew beforehand what to expect. Although I recovered quickly from the surgery itself, I had some of the usual side effects, including erectile dysfunction and some minor urinary problems, which I’ll have for life. I tried all the usual interventions such as injections, which made me feel terrible, and pumps which, while they serve a purpose, are a huge commitment. It didn’t put me off seeking advice though.

“Sex is an important part of a relationship and just because you’ve had a cancer diagnosis, it doesn’t mean that part of your life is over.

“Cancer can put a massive strain on a relationship – it affects both partners and you need to be able to talk about it honestly with each other. My partner and I have found that humour is the best way to deal with the problems we had, and I was determined from day one, this was not going to get me down.

“Because of the stage my cancer was at when it was discovered, I wasn’t able to have nerve-sparing surgery. That meant drugs like sildenafil (Viagra) shouldn’t have worked for me because of the nerve damage caused by the surgery. Everyone’s situation is different, but I never gave up hope, and after three years I asked my doctor if I could give sildenafil a try to see if it would help in any way, and I was pleasantly surprised to find it worked for me.

“From the beginning, I decided to be very open about my cancer. I recognise that not everyone deals with the experience in the same way. A lot of men bury their heads in the sand and won’t ask for help, even though it is having a negative impact on their lives.

“I was comfortable with talking to my doctor about ED because I wanted to find a solution – but a lot of men are reluctant to even mention it and so they just suffer in silence, which can have a negative effect on their mental health and their relationships.

“We need to work harder to break down those barriers that prevent men from talking about problems seeking help and seeing their GP when they need to.”

Complete Article HERE!

What Your Penis Says About Your Health

— Changes in penis performance or appearance may signal heart issues, diabetes and more

Your penis serves some big roles in your body. Of course, it houses a drainage system that allows your body to get rid of urine. It’s also a key player in the reproductive process and the act of making whoopie.

But did you know your penis also offers a window to your health? It turns out the performance or appearance of your penis can provide clues about what’s happening to you physically and mentally.

So, what secrets can the appendage reveal? Let’s look at six potential learning opportunities with urologist Ryan Berglund, MD.

1. Heart health

Erectile dysfunction, or the inability to get or maintain an erection, isn’t an unusual occurrence. Your penis may just decide to not cooperate at times for a multitude of reasons, many of which are no big deal.

But if you consistently have trouble getting or keeping your penis up, it might signal heart disease and blood flow issues.

A 2018 study linked erectile dysfunction (ED) to increased risk of heart attack, cardiac arrest and stroke. Dr. Berglund notes that almost two-thirds of people who’ve also had heart attacks also experience ED.

“Erectile dysfunction, particularly if you’re younger, should be regarded as a warning sign for heart disease,” he adds.

2. Diabetes

Difficulty getting or maintaining an erection also may signal the onset of diabetes, which can damage the nerves, blood vessels and muscle function that work in tandem to get your penis up.

Research shows that someone with diabetes is three times more likely to report instances of ED. In addition, ED often occurs 10 to 15 years earlier and is more severe in those with diabetes.

3. Mental health issues

The mind plays a very large role in the function of the penis, says Dr. Berglund. Psychological issues such as depression, anxiety and stress can lower sex drive and keep your penis from performing as it should.

Relationship troubles can hinder operations below the belt, too. Ditto for alcohol, smoking and drug use.

4. Scar tissue

Having intercourse with a less-than-firm erection can damage your penis and lead to the development of Peyronie’s disease, a disorder in which scar tissue within the penis causes a curvature.

The condition can lead to a noticeable bend in your penis. A curve greater than 30 degrees is considered severe. The loss of length or girth is possible, too.

ED can cause more flaccid erections that increase your risk of Peyronie’s disease. Talking to a healthcare provider about difficulties getting a hard erection and getting treatment could reduce your chance of sustaining the injury.

5. Infection

Lumps and bumps aren’t unusual on a penis. Blood vessels, pimples and pearly penile papules (small, pearl-like bumps) are just a few of the things you might notice on your penis, shares Dr. Berglund. In most cases, they’re nothing to worry about.

But how can you tell if there’s something more serious going on?

If the bump is painful or there’s an open or weeping sore, get it checked out ASAP. It may be a sexually transmitted infection such as herpes or syphilis. Less pain but lots of itchiness could signal genital warts or molluscum contagiosum (a viral skin infection).

6. Cancer

A discoloring of your penis along with painless lumps, crusty bumps or a rash could be a sign of penile cancer. Symptoms typically appear on the penis head or foreskin and should get checked by a medical professional.

The rate of penile cancer is relatively low in the United States, at 1 in 100,000. But it’s much more common in Africa, Asia and South America.

Final thoughts

It’s important to pay attention to what’s happening downstairs. Changes in the performance or appearance of your penis may be a sign of a larger health issue.

Is the topic comfortable to talk about? Maybe not. But if something with your penis feels or looks different, tell a healthcare provider. It’s a discussion that’s important for your overall health.

Complete Article HERE!

The Health Issues Men Don’t Talk About

— (But They Really Should)

It’s taken a long time. But there is finally a growing awareness of the importance of discussing health issues openly and honestly.

By Northern Life

A lot of men shy away from discussing their health concerns because of social stigmas and embarrassment. Sometimes it’s because they simply don’t know where to turn for help. Addressing these issues openly and providing the necessary information and support is crucial.

Testicular Cancer

Testicular cancer is another health issue that often goes unaddressed due to embarrassment or fear. However, early detection is crucial for successful treatment and improved outcomes. It happens when abnormal cells develop in the testicles.

Common symptoms include a painless lump or swelling in one or both testicles. You might notice a feeling of heaviness in the scrotum or that your testicles have changed shape or weight. These symptoms can also be caused by other conditions, it’s true, but you need to talk to a doctor if you notice any of them.

Regular self-examinations are recommended. By familiarizing themselves with the normal size, shape, and weight of their testicles, men can quickly identify any changes or abnormalities. If a lump or other concerning symptoms are noticed, it is crucial to consult a doctor promptly.

While the topic of testicular cancer may be uncomfortable to discuss, early detection and treatment can significantly improve the chances of a full recovery. Men should prioritize their health by raising awareness and openly discussing this issue.

Erectile Dysfunction

Erectile Dysfunction (ED) affects a significant number of men, but it remains shrouded in silence. ED refers to the inability to achieve or maintain an erection sufficient for sexual intercourse. It can stem from various factors, including physical, psychological, or lifestyle-related causes. It’s normal to have trouble getting or maintaining an erection sometimes. But persistent problems can have a significant impact.

One common physical cause of ED is the restricted blood flow to the penis. Diabetes, high blood pressure, or cardiovascular disease can be potential causes. You might also suffer from ED if you are dealing with stress, anxiety, or depression. It’s probably not too surprising to learn that smoking, drinking too much booze, and not having an active lifestyle can increase the risk of developing it.

The first step in addressing ED is to have an open conversation with a healthcare professional. Doctors can help identify the underlying causes and recommend appropriate treatment options.

It is essential to recognize that ED is a treatable condition. By breaking the silence and seeking medical assistance, men can regain control over their sexual health and improve their overall well-being. If you want to learn more about treatments for ED, then you can check out what’s available at The Independent Pharmacy. They are a regulated online pharmacy that can help you find the right prescription and over-the-counter treatment.

Mental Health

Societal expectations that encourage men to be stoic and tough can create barriers to seeking help. However, mental health issues can affect anyone. It doesn’t matter what your gender is.

Depression, anxiety, and stress are widespread right now. Men need to understand that seeking help for these kinds of issues is a sign of strength. Mental health professionals are trained to provide support and guidance in managing these conditions. There’s therapy, medication, or a combination of both. Lifestyle changes such as regular exercise, healthy eating, and practicing stress-reducing techniques like meditation or mindfulness can also help to

By breaking the silence surrounding mental health and seeking appropriate support, men can effectively manage their mental health conditions and lead fulfilling lives.

Prostate Health

Prostate health is a critical aspect of men’s overall well-being. But it can be so tough for people to talk about it openly. Prostate cancer is the most common cancer among men, and it is essential to address it openly. Early detection is crucial for successful treatment and improved outcomes. However, the fear, stigma, or lack of awareness surrounding prostate cancer can discourage men from discussing it or seeking regular screenings.

Regular prostate screenings are recommended for men over the age of 50. You should get one earlier if you have a family history of prostate cancer. These screenings can help detect any abnormalities in the prostate gland and identify potential cancerous cells.

By breaking the silence and openly discussing prostate health, men can become proactive in monitoring their prostate health, addressing any concerns, and seeking timely medical intervention when necessary. Open conversations and awareness about prostate health can help save lives and ensure a better quality of life for men as they age.

Sexual Health And STDs

Sexual health is integral to overall well-being, and men should prioritize discussions about it. Safe sexual practices and regular check-ups can help prevent and detect sexually transmitted diseases. They also mean that you can enjoy an active sexual life.

Engaging in unprotected sexual activity or having multiple sexual partners can increase your risk of catching something. Open and honest communication with sexual partners about sexual health is essential. Discussing sexual history, STD testing, and using barrier methods such as condoms can help reduce the risk of contracting or spreading STDs. Regular STD testing is recommended, especially after engaging in unprotected sexual activity or changing sexual partners.

If diagnosed with an STD, it is crucial to seek prompt medical treatment and inform any sexual partners to prevent further transmission. A lot of STDs can be treated with antibiotics or antiviral medications. Additionally, healthcare providers can offer guidance on preventive measures, safe sexual practices, and regular screenings.

Men can reduce the stigma surrounding STDs, increase awareness, and take necessary precautions to protect themselves and their partners by promoting open conversations about sexual health,

Substance Abuse And Addiction

Substance abuse and addiction are significant health concerns that affect men disproportionately. Societal expectations and pressures can sometimes lead men to turn to substances such as alcohol, tobacco, or drugs as coping mechanisms, as we saw a lot during the pandemic. There can be serious mental and physical consequences when any of those substances are abused.

Breaking the silence surrounding substance abuse and addiction is essential. Men should be encouraged to seek support. There are treatment options out there, from counseling to detox and rehab programmes.

Men can smash the stigma associated with seeking help and create a supportive environment for those struggling with these issues when they talk about them. Addiction is a treatable condition, and men can embark on a journey towards recovery and regain control over their lives with the right support,

Wrapping It Up

Addressing the health issues men often avoid discussing is crucial for their well-being. By breaking the silence and encouraging discussions about these topics, men can take control of their health, seek appropriate medical assistance, and lead healthier, fulfilling lives. Remember, it’s time to break the barriers and prioritize men’s health through open dialogue and support. There is no such thing as an embarrassing health concern. And you might just be amazed by how much better you feel once you start talking.

It’s taken a long time. But there is finally a growing awareness of the importance of discussing health issues openly and honestly. The idea of “embarrassing” health problems is being challenged more and more frequently. But some topics still get swept under the carpet, especially when it comes to men’s health.

A lot of men shy away from discussing their health concerns because of social stigmas and embarrassment. Sometimes it’s because they simply don’t know where to turn for help. Addressing these issues openly and providing the necessary information and support is crucial.

Complete Article HERE!

How Does Chemotherapy Affect Your Sexual Health?

— Chemo is a powerful cancer treatment, but there are side effects you should be looking out for.

Chemo is a powerful cancer treatment, but there are side effects you should be looking out for.

By Jennifer Sizeland

Chemotherapy is the chemical treatment of cancer using drugs. The primary purpose of chemo is to kill cancer cells, shrink tumors, relieve symptoms of untreatable cancer and prevent it from returning.ƒhealth

It can be administered in several different ways but is usually given through a needle or tube inserted into a vein or orally—by mouth in capsule, liquid or tablet form—over a period of time. This treatment can be used in conjunction with other therapies, such as radiation therapy, immunotherapy and surgery. Progress is monitored by an oncologist, a cancer specialist who will perform various tests to see how the cancer responds to chemotherapy.

While chemotherapy has come a long way, it still has side effects that can influence all areas of your life.

How does chemotherapy affect general health?

Aside from the symptoms and problems caused by the cancer itself, chemotherapy can have myriad side effects.

“One of the most common side effects of chemotherapy is myelosuppression, or lowering the blood counts,” said Mohamad Cherry, M.D., the medical director of hematology at Atlantic Medical Group Hematology Oncology in Morristown, New Jersey.

He noted that this treatment can impact the body in the following ways:

  • Lowering platelets can cause bleeding.
  • Lowering the red blood cells can cause anemia and lead to fatigue.
  • Lowering the white blood cells can affect the immune system and increase the risk of infections.

Different chemotherapeutic agents create different side effects. These can vary depending on the type and stage of cancer, he added.

Some of the other common side effects of chemotherapy include the following:

  • Appetite loss
  • Bleeding
  • Bruising
  • Constipation
  • Hair loss
  • Mouth soreness
  • Nausea
  • Vomiting

Cherry recommended talking with your doctor about the best way to treat the symptoms of chemotherapy, as there are medications and other tools to help manage these side effects. Methods like cooling caps can help prevent hair loss, and antiemetic medication can reduce vomiting and nausea.

It is important to look after your mental health, he added, as this is an aspect of cancer treatment that is often ignored. Some cancer sufferers find that speaking to a therapist is helpful.

How does chemotherapy affect sexual health?

“Chemotherapy can, unfortunately, impact sexual health in many ways, although not everyone has these symptoms,” said Anne Peled, M.D., a breast cancer surgeon and the co-director of the Breast Care Center of Excellence at Sutter Health California Pacific Medical Center in San Francisco.

She explained that women can experience the following sexual side effects as a result of chemo:

Men can experience:

“Chemotherapy can also impact future fertility, which is unfortunately not always discussed before treatment when options like sperm and egg harvest are potentially available,” Peled added. 

If you would like to have children, this is something you can discuss with your doctor before chemotherapy starts.

Whitney McSparran, L.P.C.C., a counselor who specializes in relationships, stress, grief, anxiety and self-esteem at Thriveworks in Cleveland, Ohio, explained that there are other forms of intimacy partners can share that don’t involve intercourse.

“Exploring non-sexual forms of physical intimacy like massage, cuddling and hand-holding can be helpful in maintaining a sense of intimacy when sexual activity isn’t on the table,” she said.

Complications and related conditions

The powerful nature of chemotherapy means it can cause serious complications.

“Certain chemotherapeutic agents can affect the heart, causing congestive heart failure or arrhythmias, and others can affect the lungs, causing shortness of breath,” Cherry said.

Chemotherapy drugs can especially affect the kidneys and liver, he added, which can result in increased liver enzymes or a decrease in kidney function. These organs will be closely monitored throughout treatment.

If any severe complications arise as a result of chemotherapy, your doctor will adjust your schedule or prescribe supportive medication to help your body to better cope or recover.

Living with chemotherapy

While undergoing chemotherapy, it’s important to build a support network of friends and family to go along with a healthcare team. Cherry recommends asking for social worker support as well.

It is important to be open and honest about your cancer and treatment, even when you feel uncomfortable talking, in order to maintain those relationships, McSparran said.

“Many healthcare systems may have social workers or nurse navigators that can answer questions or help facilitate these difficult discussions,” she said.

Many people find that they can live relatively normal lives while on chemotherapy and even continue their day-to-day responsibilities.

Dating and relationships with chemotherapy

“Transparency, boundary setting and communication are important in all dating relationships but are especially important when navigating dating and chemotherapy,” McSparran said.

Her advice for managing romantic relationships while undergoing chemo includes:

  • Accept that your priorities or values may change.
  • Be aware that your relationship may change as a result of cancer and cancer treatment.
  • Be clear on your expectations of the relationship.
  • Be clear about the time and energy you have to commit.
  • Be open to talking about what is and isn’t working.
  • Explore possible solutions to your feelings and problems.

Practicing safe sex is very important during chemo, as these drugs can severely harm a pregnancy in the first trimester.

It may help partners to join a support group where they can speak to others whose relationships have been impacted by cancer.

Supporting someone and aftercare

“Don’t rely on the person going through chemo to tell you what they want or need. Know the type of support you can provide and be consistent,” McSparran said.

She stressed the importance of looking after yourself, as being someone’s support during cancer treatment can take its toll.

McSparran recommended these strategies as the most important so that you look after yourself while you’re caring for someone on chemo:

  • Find a professional to talk with if you need to.
  • Lean on your own support network.
  • Practice self-care.

Chemotherapy and cancer can have unexpected impacts, so it is vital to keep checking in with yourself as well as the person you’re caring for.

Whatever you’re going through, there is likely someone else who has been through a similar experience. Charities, groups and online resources can provide emotional, financial and practical help during your time of need.

Resources for patients and caregivers

Here are some great resources to start learning more about chemotherapy and its potential effects:

Complete Article HERE!

For cancer survivors, sexual intimacy can pose unexpected issues

— ‘I feel as if my body has betrayed me,’ one survivor says

Brenna Gatimu and her husband, Nimmo Kariuki, tend to their youngest son, Kylian, in Casper, Wyo. Gatimu was diagnosed with Stage 3 breast cancer in 2020.

By Netana H. Markovitz

Brenna Gatimu, 34, of Casper, Wyo., was diagnosed with Stage 3 breast cancer in 2020. She quickly had chemoradiation, and both her breasts and ovaries were removed. She now takes a medication that suppresses any remaining estrogen in her body.

“I feel as if my body has betrayed me, like all the things that make me biologically a woman — the estrogen, the progesterone, my ovaries and my breasts — everything had to be removed and stopped,” Gatimu said.

Gatimu’s experience is not uncommon. As cancer survival rates in the United States improve, many survivors are left with permanent changes to their body — outwardly and functionally. Some feel particularly unprepared for persistent changes in their sexual functioning.

“Sexuality is a very big issue, and unfortunately, the avenues to get help are often limited because people are concentrating on helping [patients] live through cancer, and really concentrating on quality of life but devoid of sexuality,” said Don Dizon, a professor of medicine and surgery at Brown University and the founder of the Sexual Health First Responders Clinic at the Lifespan Cancer Institute.

Sexual health and quality of life

In 2022, approximately 18 million people with a history of cancer were living in the United States. The number is expected to increase over time.

“As people live long lives after cancer … these questions on the permanent, long-term side effects of treatment are something we have to address,” said Sharon Bober, founding director of the sexual health program at the Dana-Farber Cancer Institute and an associate psychiatry professor at Harvard Medical School.

“I feel as if my body has betrayed me, like all the things that make me biologically a woman — the estrogen, the progesterone, my ovaries and my breasts — everything had to be removed and stopped,” Gatimu says.

“We are looking not just at what people do functionally, but we’re also thinking about people’s experiences of themselves being whole, having a sense of integrity in their body — even after things change,” Bober said. “We’re talking about an experience of how people relate to a partner, we’re talking about dating, we’re talking about emotional and sexual relationships that undergo changes themselves.”

“We’re also thinking about people’s experiences of themselves being whole, having a sense of integrity in their body — even after things change.” — Sharon Bober, founding director of the sexual health program at the Dana-Farber Cancer Institute

Some cancer centers have created programs dedicated exclusively to sexual health for patients with cancer — such as Massachusetts General Hospital and Memorial Sloan Kettering in Manhattan. These centers are still relatively rare, but their numbers are increasing.

Those without access to a comprehensive center should consider seeking out “specific practitioners who have relevant expertise, such as certified menopause specialists, urologists or urogynecologists who specialize in sexual medicine, pelvic floor physical therapists or certified sex therapists in the community,” Bober said in an email.

Gatimu holds some of the medications she takes while Kylian asks if he can have the pills, too.
A family portrait on Gatimu’s wall shows husband Nimmo Kariuki, stepdaughter Paisley Grundhoffer, and sons Malcolm, James and Kylian. The family had the photo taken the day Gatimu completed chemotherapy.

Patients can also access a growing body of information.

“There are really more resources now than there ever have been and there are a lot of organizations that now have really good information and education on their websites,” Bober said. “I would just say people should feel free to access the growing amount of supports that are out there. And that’s the case both for patients and providers.”

For example, the Scientific Network on Female Sexual Health and Cancer has a host of resources, including webinars, a page with links to several online resources and a “find a provider” page to search for help by location. The American Cancer Society also has a fairly comprehensive overview of navigating sex and cancer.

Jacob Lowy in his living room in New York.

Even before intimate encounters, body image can be an issue. Jacob Lowy, 31, a fourth-year medical student at the University of Michigan, was diagnosed with metastatic sarcoma in 2021. Since then, he has had to deal with dating.

“It definitely messed with my psyche a lot to talk to people because it feels like you’re hiding something at first,” Lowy said. “But there’s no real advice for how to do it properly.”

Besides fatigue and surgical complications from his two abdominal surgeries, he has experienced decreased libido and erectile dysfunction.

“I went from feeling … invincible and very strong to my body feels like a wreck on the inside,” Lowy said.

Physicians often don’t discuss sexuality with patients for many reasons, Dizon said. “Partly it’s because I don’t think oncologists are trained in talking about sexuality,” he said.

Lowy spends time with friends on the Lower East Side in New York on March 4.

When sexuality is discussed, much of the talk often focuses on what’s safe — for example, when it is safe to have sex during chemotherapy. Bober said “potential sexual side effects and sexual rehabilitation really is not routinely incorporated into care. So a lot of people struggle on the other side of treatment and feel pretty isolated.”

“I went from feeling … invincible and very strong to my body feels like a wreck on the inside.” — Jacob Lowy

But when the topic is broached, doctors often have treatment recommendations.

Sarah E.A. Tevis, an assistant professor of surgery at the University of Colorado, recently started asking her patients about sex after a patient questionnaire she distributed flagged the issue.

“This wasn’t a common thing I talked to all of my patients about, and ever since I’ve started bringing it up, I feel like almost every single patient I talk to is having some problem that we can probably help with,” Tevis said.

Ask for help or a referral

Even if your oncologist does not know how to help, someone is probably out there who can.

“This is something that people should be empowered about — that as with other aspects of our health, if you’re having issues, give it voice, ask for specific assistance,” Dizon said. “And if your doctor doesn’t know or doesn’t want to discuss it, then ask for a referral.”

For Gatimu, she has done her best to adapt to a new normal but still struggles.

Since treatment, she has experienced vaginal dryness, difficulty achieving orgasm and lack of libido. She also has no sensation in her reconstructed breasts. Gatimu has sought advice through a combination of doctors and friends who are cancer survivors.

Gatimu helps Kylian wake up to get ready for day care on March 1.
Gatimu’s son Malcolm walks past a photo wall his mom and dad put together of past family moments, photos and sayings as he gets ready for school on March 1.

“I still have times where I really struggle with the comparison or the wishful thinking of ‘Oh my gosh, if only this didn’t happen and I didn’t have to live through this, where would [I] be?’ On the positive side, I have gained such a self-awareness and such a self-confidence within myself,” Gatimu said.

One 44-year-old man who was diagnosed with Stage 3 rectal cancer in 2018 underwent chemotherapy and radiation before having surgery that resulted in an ostomy pouch, a bag that collects stool outside the body.

“It’s tough for me not to view my body as … broken,” said the man, who asked not to be named for privacy reasons.

For him, sex with his partner now involves going to the bathroom to empty out the ostomy pouch and ensuring that it is as flat as possible so it does not get in the way. He also takes Viagra for the erectile dysfunction he has had since treatment.

A photo of Gatimu and Kariuki attending an adult prom in Casper, Wyo., that raises money for childhood cancer research.

“I am very fortunate that I have a loving partner who loves me for who I am and we’ve adjusted, but now sex is really tough to have spontaneously,” said the man, who lives in Chapel Hill, N.C.

A common misconception is that only certain cancers affect sex.

“We tend to think of sexual health as an issue [only] for people treated for sex-related cancer,” Dizon said. “But that’s actually not true. There’s a growing literature that even people treated for, say, colon cancer and lung cancer — they actually have issues related to sexuality.”

He points out, for example, that chemotherapy itself can affect the vaginal mucosa, which can cause pain with sex.

Unfortunately, many cancer patients feel alone in their struggles.

No one mentioned sexuality to the Chapel Hill resident, except for a brief, awkward conversation with his radiation oncologist regarding the possibility of infertility after treatment.

“People often will equate sexuality and fertility, but those are very different conversations,” Dizon said.

Lowy organizes his pills for the week.

“Their goal is to save a life.” the Chapel Hill resident said. “And they were very good at doing that. I willingly put my life in their hands, but sex was an afterthought.”

Once he got the courage to broach the subject, he was prescribed Viagra, which has been working well.

“I think the biggest advice I would give is, do not be afraid to ask questions,” he said. “If something isn’t right, talk to the doctors about it.”

Complete Article HERE!

When Cancer Upends Your Sex Life

— Despite a wave of new research around cancer treatment and sexual health, women say their issues are still being dismissed. Here’s how and where to get help.

By Catherine Pearson

Débora Lindley López was 28 when she was diagnosed with Stage 3 breast cancer. Within three weeks, she began chemotherapy and was thrust into medically induced menopause. Ms. Lindley López developed vaginal dryness so severe that her skin began to deteriorate and was covered in small, paper cut-like tears. Urinating was uncomfortable; sex, agonizing.

But when Ms. Lindley López, now 31, told her oncologist about her vaginal pain and about how her libido had evaporated almost overnight, she said he responded dismissively, telling her that if he had a penny for every time he heard these complaints he’d be a rich man sitting on a beach. He suggested that she confide in the nurse about those symptoms, Ms. Lindley López said.

“It was awful,” she said, tearing up. “It made me feel like, how could I even be thinking about anything else other than cancer? The fact that I would even ask felt shameful.”

Cancer can devastate a woman’s sexual function in countless ways, both during treatment and for years down the road. Chemo can cause vaginal dryness and atrophy, similar to what Ms. Lindley López experienced, but it can also prompt issues like mouth sores, nausea and fatigue. Surgery, like a hysterectomy or mastectomy, can rob women of sensations integral to sexual arousal and orgasm. Pelvic radiation therapy can lead to vaginal stenosis, the shortening and narrowing of the vagina, making intercourse excruciating, if not impossible. Sadness, stress and body image issues can snuff out any sense of sexual desire.

“The damage that is done is not only physical, though women certainly experience damage to their bodies from the cancer and from the treatments,” said Dr. Elena Ratner, a gynecologic oncologist with the Yale Medicine Sexuality, Intimacy and Menopause Program. “From the diagnosis to the fear of recurrence to how they see their bodies, they feel like their whole sense of self is different.”

Over the past decade, and particularly in the last few years, there has been a marked increase in studies on how cancer upends women’s sex lives, during treatment and after. Dr. Ratner and other experts who work at the intersection of cancer care and sexual health feel encouraged that the research world has finally begun to grapple with those complex side effects — ones that had been all but ignored in previous generations of women, she said.

Just last year, for instance, a study found that 66 percent of women with cancer experienced sexual dysfunction, like orgasm problems and pain, while nearly 45 percent of young female cancer survivors remained uninterested in sex more than a year post diagnosis. Researchers also found a high prevalence of issues like vaginal dryness, fatigue and concerns around body image among women with lung cancer — findings that highlight the toll all types of cancer (not just breast or gynecologic) can take.

And yet, some of that very same research — combined with stories from patients, advocates and doctors — suggests that the increase in scientific interest has not made much of a practical difference for women. While Ms. Lindley López’s story offers an extreme example of provider indifference on the topic, experts say the challenges she faced when trying to seek help for her issues are not unique.

“The number of women affected by sexual health concerns after a cancer diagnosis is huge, and the need for these women to have access to medical care for sexual dysfunction after cancer is enormous,” said Dr. Laila Agrawal, a medical oncologist specializing in breast cancer at Norton Cancer Institute in Louisville, Ky.

“There’s a gap between the need and the availability for women to get this care.”

Why better research hasn’t really led to better treatment

Sharon Bober, a psychologist and director of the Dana-Farber Cancer Institute’s Sexual Health Program, said several factors have helped move the needle on research. For one, survivorship is growing (in 2022, there were 18.1 million male and female cancer survivors in the United States; by 2032, there are projected to be 22.5 million). There is also a greater understanding within medicine and society at large that sex and sexuality are an important component of overall health, Dr. Bober said. Since 2018, she added, the American Society of Clinical Oncology has urged providers to initiate a discussion with every adult cancer patient — female and male — about the potential effects of cancer and cancer treatment on sex.

But some women say they’re still greeted with silence.

Cynthia Johnson, a 44-year-old from Texas, who was diagnosed with Stage 2 breast cancer at age 39, said she was “grateful for life and lifesaving treatments.” But that does not negate her frustration that not one of her doctors ever brought up her sexual health.

“They don’t tell you going into it that you are going to experience dryness. They don’t tell you that you are going to experience lack of desire,” Ms. Johnson said. “They don’t tell you that if you do, on the off chance, get in the mood to do something, it’s going to feel like razor blades.”

Surveys support her experience and also suggest there are significant gender discrepancies in who gets queried about sex. A 2020 survey of 391 cancer survivors found, for instance, that 53 percent of male patients were asked about their sexual health by a health care provider, while only 22 percent of female patients said the same. And findings presented last year at the annual meeting of the American Society for Radiation Oncology, focusing on 201 patients undergoing radiation for cervical or prostate cancer, concluded that 89 percent of men were asked about their sexual health at their initial consult, compared to 13 percent of women.

Dr. Jamie Takayesu, a radiation oncology resident physician at the University of Michigan Rogel Cancer Center and a lead author on the study, said the research was inspired by her own nagging sense that she wasn’t asking female patients about sex often enough, and she suspected her colleagues weren’t either. She has a few hypotheses about why: Prostate cancer has a high survival rate, she said, so doctors may be more inclined to focus on quality of life issues with treatment. But she also noted there were “better” and “more formalized tools” to assess sexual function in men, and that many cancer doctors — herself included — got little to no training in how to talk about sex.

Doctors say that until that changes, these types of conversations are unlikely to become standard in practice.

“This must be rolled into routine inquiry, so that it’s not something special or different, and it’s not based on a health care provider’s perspective about whether someone is sexually active,” Dr. Bober said. “I’ve had so many women say to me over time, ‘Nobody asked.’”

How and where to get help

Despite those significant headwinds, effective treatment options and interventions do exist.

Both Dr. Ratner and Dr. Bober work in multidisciplinary sexual health programs that, in many ways, represent the gold standard of care. A patient might see a gynecologist, a pelvic floor therapist who can help with treatment options like dilator therapy and a psychologist who can address emotional struggles. (Dr. Bober said that, until very recently, she could probably count the number of these centers on one hand; now she estimates there are “more than 10 and under 100” nationwide.)

A year and a half after her cancer diagnosis, Ms. Lindley López drove to one such center at Northwestern University in Chicago. At her visit, she saw a clinical sexologist who teared up during the pelvic exam. “She said, ‘You’re 29 and your vaginal area looks like you’re about 80,’” Ms. Lindley López recalled. The sexologist gave her information about laser therapy vaginal rejuvenation and recommended several estrogen creams to help with vaginal atrophy.

It was comforting “just sitting down in that office, and having someone put her hand on my shoulder and say: ‘Hey, this is important. And anybody who tells you that this is not important, is wrong,’” Ms. Lindley López said.

While they are becoming more plentiful, these types of programs still tend to exist in large hospitals or major urban cancer centers and many women in the United States may not live close enough, or have the resources or health insurance coverage, to regularly access such care. But even if going to a sexual health center is not possible, most women just need a “home base,” said Lisa Egan, a physician assistant with a focus on gynecologic oncology who leads the Sexual Health in Women Impacted by Cancer Program at Oregon Health & Science University.

Who that “home base” is can vary; it just needs to be a provider that offers help and support. Ms. Egan said it could be the patient’s primary care doctor or a cancer doctor or nurse; Dr. Bober said it might be a gynecologist or a sex therapist. Dr. Agrawal also noted that the International Society for the Study of Women’s Sexual Health had a database of providers who focused at least partially on female sexual health issues, so it could be a useful jumping-off point. To ascertain if providers are in a good position to help, it may be useful to ask outright about what their experience has been helping women with sexual dysfunction during and after cancer, and if they would feel comfortable helping you put together a plan for addressing your concerns — even if that means referring you out to other clinicians, Dr. Bober said.

All of the doctors interviewed for this story also noted that online communities and advocacy groups could be helpful resources. Ms. Johnson, for instance, is an ambassador at For the Breast of Us, which provides community and support for women of color impacted by breast cancer; Ms. Lindley López works for the Young Survival Coalition, a nonprofit focusing specifically on the needs of young adults with breast cancer. These kinds of groups offer a platform for women to swap information, connect with providers and find solidarity — particularly as the medical world struggles to fully address their needs.

“I really want women with cancer to know that sexual health problems are treatable medical problems, and they can get better,” Dr. Agrawal said. “I just want to offer that out as hope.”

Complete Article HERE!

Maintaining Your Sex Life After Prostate Cancer

Sex may be different after prostate cancer treatment, but it can still be enjoyable

If you have prostate cancer and your healthcare provider recommends treatment, you might be wondering how your sex life may or may not be affected. You’re not alone if you have questions about this, as this is a common concern.

“Treating prostate cancer is about treating the whole person,” says urologist Raevti Bole, MD. “We have many effective therapies to help you resume intercourse if that’s your goal. But we want you to feel like you can talk to your provider and partner about your issues or concerns.”

Dr. Bole explains how your sex life may evolve after treatment and answers some commonly asked questions.

Can you have sex after prostate cancer?

Sexual and urinary side effects are common after prostate cancer treatment. “But yes, we can help most people get back to a satisfying sexual experience, though this may look different after treatment,” says Dr. Bole.

There are two gold-standard treatments for prostate cancer:

  • Radical prostatectomy removes your prostate gland and the two small glands at the base of your prostate called seminal vesicles. Pelvic lymph nodes may also be removed as part of this operation.
  • Radiation therapy delivers radiation to your entire prostate to destroy cancer-specific cells, and often the pelvic lymph nodes as well. If you opt for radiation therapy, you may receive androgen deprivation therapy to reduce testosterone in your body. This combined approach provides improved overall treatment.

New treatment options, such as high-intensity focused ultrasound therapy and cryotherapy, are being investigated for the potential to treat focused areas of the prostate gland and potentially lessen sexual side effects. But these treatments are typically only an option for certain types of prostate cancer, and you may eventually need a prostatectomy or radiation therapy down the line. Consultation with a urologist who specializes in prostate cancer is the best way to determine if you’re a candidate for any type of focal therapy.

Sex after prostate biopsy

To confirm a diagnosis of prostate cancer, you need to have a biopsy. During this test, your healthcare provider collects a sample of prostate tissue to look for cancer. They can do this in one of two ways:

  • Transrectal biopsy: This biopsy occurs by inserting an ultrasound probe into your rectum and then using a needle to pass through that probe to get the sample cells from your prostate.
  • Transperineal biopsy: This biopsy is taken by inserting a needle into the skin of your perineum (the area of skin between your genitals and your anus) to remove sample tissue cells from your prostate.

Though you may be sore for a couple of days, there aren’t any restrictions on sexual activity after having a biopsy. It’s common to notice old blood in your ejaculate for up to a month or two. This typically goes away on its own as you heal and isn’t associated with pain. Infection is a risk after a biopsy, though the risk is much lower when it’s taken through your perineum.

“For the vast majority of men undergoing an uncomplicated biopsy (either transrectal or transperineal), long-term sexual function should not be affected,” reassures Dr. Bole.

In most cases, if you’re feeling well, you should be able to ejaculate or have sex again when you feel ready. If you participate in receptive anal sex, you should wait for two weeks or until you’re fully healed, especially if you had a transrectal biopsy. But if you experience any blood, pain or swelling, you should refrain from sexual activity until you meet with your healthcare provider.

Sex after prostatectomy and radiation therapy

Once your provider confirms a diagnosis, they’ll discuss your treatment plan with you. Both prostatectomy and radiation therapy can affect your sexual performance in the following ways:

Anal sex safety

Your anus doesn’t create its own lubricant, so the tissue inside of your anus is delicate and susceptible to tearing. Luckily, that tissue heals relatively quickly. If you have anal sex, it’s important to let your surgeon know before you have your prostate removed. Your surgeon will help you determine when it’s safe to insert anything anally. In most cases, it’s OK to participate in anal sex after six weeks.

“Know your body and take your time,” advises Dr. Bole. “If you’ve waited to heal after prostate removal, but you have anal intercourse and notice pain or blood, talk to your surgeon who may advise you to wait longer.”

In some cases, having your prostate removed may affect your ability to enjoy receptive anal sex.

Erectile dysfunction after prostate cancer treatment

For some people, undergoing prostate cancer treatment can result in some difficulty getting or maintaining an erection. This erectile dysfunction (ED) occurs because the nerve bundles that help control erections sit behind your prostate.

Surgeons make every effort to leave these nerve bundles intact, but the nerves may become damaged. If the tumor has grown into your nerve bundles, your surgeon may remove the nerves entirely.

“Erectile dysfunction is not uncommon after prostate cancer surgery, but the level of effect is variable in the short and long term,” explains Dr. Bole. “Your prognosis depends on your erectile function before treatment, your age and whether your nerves were spared. Erectile function can improve for up to two years after surgery, but it’s possible that it does not return to normal. This is also affected by natural aging and any other health conditions you have.”

Radiation therapy can also affect the nerves around your prostate depending on the type of radiation, your age and health conditions. According to Dr. Bole, in general, five years after radiation therapy, about half of people have some level of erectile dysfunction.

Orgasm after prostate cancer treatment

You can orgasm after prostate cancer treatment, but it usually results in a dry orgasm. With a dry orgasm, no fluid comes out of your urethra when you climax. But you can still feel the pleasurable sensation of climax.

Why do you have a dry orgasm? If you had a prostatectomy, the procedure removes the seminal vesicles (which produce and hold your semen) and cuts the vas deferens, so there isn’t any semen to come out. And radiation therapy causes the tissues in and around your prostate, including your ejaculatory ducts, to become fibrous, or stiff and dense. Although there isn’t a reliable treatment to improve a dry orgasm, it’s a common condition where up to 90% of people who receive radiation therapy can develop dry orgasms over time.

Climacturia after prostatectomy

Climacturia is when you leak any drops of urine during an orgasm. Though this number can vary, on average, climacturia can occur in about 25% of people after prostate removal. Studies have found that of these people, only half of them have enough climacturia to be bothersome.

Lack of interest in sex after prostate cancer treatment

Androgen deprivation therapy often accompanies radiation therapy and reduces testosterone production in your body. When you have low testosterone, you could experience a decrease in your sex drive (libido). “The general stress and anxiety of treatment may also affect your desire to have intercourse,” notes Dr. Bole.

Infertility after prostate cancer treatment

If you’ve had your prostate removed, you can’t get someone pregnant through intercourse. After surgery, you no longer produce semen, which carries sperm when you ejaculate. Radiation therapy also reduces semen production and affects your ability to make sperm.

If you’re considering having children, talk to your healthcare provider before prostate cancer treatment. There are several options for preserving fertility before cancer treatment or retrieving sperm (if you have them) after treatment.

Treatment options for ED after prostate cancer treatment

Sex is often different after prostate cancer treatment, but it can still be enjoyable. “Treatments for ED are often focused on penetrative intercourse,” says Dr. Bole. “But the sexual experience is often not just about penetration. We work with you to discuss your goals for sexual health or intimacy with a partner.”

Treatments for ED include:

Erectile dysfunction medications

There are many medications to treat ED, including Viagra® and Cialis®. “These medications are often the first treatment we recommend,” says Dr. Bole. “They are inexpensive, and if you don’t like them, or they don’t work well for you, you can stop taking them at any point.”

Penile rehabilitation

The goal of penile rehabilitation is to reduce the risk of permanent ED before you have treatment. It focuses on increasing oxygenation and preserving the structures of the erectile tissues to prevent long-term damage. The theory is that helping people regain erections earlier than later after treatment could prevent long-term damage. Think of it as a “use it or lose it” approach.

This is an active area of research and there’s no standard protocol that’s been proven best for every person, says Dr. Bole. Your oncology team may recommend their preferred protocol, such as oral medication, to promote the early return of erectile function and, hopefully, longer-term recovery.

Penile injections

Medication you inject into the base of your penis, called intracavernous injections, can improve your ability to stay erect. Your healthcare provider can teach you how to inject the medication for times when you want an erection.

“The medication takes about 10 or 15 minutes to take effect and may not be the best option if you have a fear of needles,” notes Dr. Bole. “But if you’re looking for a better erection after prostate treatment, and the oral medications are not working, injections can be very effective.”  

Vacuum constriction device

A vacuum erectile device (also known as a penis pump) draws blood into your penis to help you get an erection. Usually, it comes with a rubber ring you slip down over the base of your penis to hold the blood in. It can be a good option if medications aren’t working well or you don’t want surgery.

Surgery

There are several types of penile implants to improve erections, including:

  • Malleable prosthesis, a noninflatable implant that’s always semirigid and you bend it up or down.
  • Inflatable implant, a device placed in your penis that inflates using a pump in your scrotum.

Climacturia treatment

If you have climacturia, pelvic floor muscle therapy can help you improve urinary control. This noninvasive treatment involves simple exercises to strengthen the muscles that help regulate urination.

Surgery is another option. Your healthcare provider can insert a sling made from synthetic mesh-like surgical tape around the area of your urethra to reposition it. The pressure caused by the sling often helps prevent leakage.

People with climacturia may also experience erectile dysfunction. “In the instance you experience both, we can do a combined surgery to put in a penile prosthesis and a sling to address both problems,” says Dr. Bole.

Therapy for you and your partner

Sex therapy, couples therapy and support groups are important resources for people who’ve undergone prostate cancer treatment and their partners. Sex can often be an uncomfortable topic, especially if you or your partner are experiencing changes in sexual behavior and are unsure of how to communicate your feelings. If you’re experiencing shame or embarrassment, or feel like you’re inadequate, please know that these side effects of prostate cancer treatment are common and (in most cases) treatable with the right tools and therapies.

Some therapeutic options that can be beneficial after your treatment include:

  • Couples therapy centers around your relationship with your partner. It can help resolve conflicts and find ways to communicate better about things that are upsetting to you and your partner. A couples therapist can help you discuss these issues, so they don’t interfere with your relationship.
  • Sex therapy focuses on sexual intimacy and helping couples show affection with and without penetration. That may include the use of sex toys or other activities you may not have considered before. Some sex therapists even specialize in working with people who have or who’ve had cancer.
  • Support groups connect you with others going through the same experience as you. They can help you understand what to expect and how others have handled specific challenges. Many people find support groups as a source of hope and comfort, and your healthcare provider can help connect you to these resources should you need them.

“Our goal is to make sure you live the longest, healthiest and most fulfilling life possible,” says Dr. Bole. “We treat cancer to protect your life, then we help get back your quality of life. If intimacy and intercourse are important to you, we can help you get back to experiencing those again safely.”

Complete Article HERE!

Sex After Cancer

— The Midlife Woman’s Edition

Help for sexual side effects from cancer treatment is out there — but you may need to ask for it.

The impact of cancer treatment on women’s sexual health, and how to mitigate it, was highlighted at the 2022 North American Menopause Society annual meeting.

By Becky Upham

When it comes to sexual dysfunction caused by cancer treatment, most women suffer in silence.

With significant advances in oncology care, the majority of women and girls diagnosed with cancer will go on to become long-term cancer survivors. An estimated 89 percent of female cancer survivors are age 50 and older, according to the American Cancer Society.

That is no small number of women, and the North American Menopause Society (NAMS), a leading medical association dedicated to promoting the health and quality of life of all women during midlife and beyond, focused on women facing the issue at this year’s annual meeting in Atlanta in October. Sharon L. Bober, PhD, an associate professor at Harvard Medical School and the director of the sexual health program at Dana-Farber Cancer Institute in Boston, presented on the topic of sex and cancer.

Cancer Treatment Can Impair Sexual Function

Every major type of cancer treatment — surgery, radiation, chemotherapy, and hormonal therapies — has the potential to disrupt or impair sexuality and sexual function, according to Dr. Bober.

More than two in three women with cancer, or 66 percent, will experience sexual dysfunction, according to a meta-analysis published in January 2022 in the International Journal of Reproductive Biomedicine. This can encompass various aspects of sexual function, such as desire, arousal, and orgasm as well as other aspects of sexual health such as sexual satisfaction and perceived body image.

Yet, despite how common these issues are, most women cancer survivors do not receive adequate information, support, or treatment, says Bober. Studies suggest that most oncology providers lack training in this aspect of patient care, are not familiar with validated tools to efficiently identify patients with sexual problems, and do not feel knowledgeable about available resources.

Ask About Potential Sexual Side Effects

Both patients and oncology providers report they do not want to make each other uncomfortable, which means that the problems go unaddressed. Women undergoing cancer treatment should ask their providers about sexual side effects. “I think women need to ask their oncology providers if treatment will result either in menopause or an increase in menopausal symptoms so they can be proactive about seeking help if necessary,” says Bober. Chemotherapy or radiation therapy to the pelvis are examples of cancer treatments that may trigger menopause, she says. This can lead to genitourinary symptoms of menopause (GSM), which can include vaginal dryness or burning, issues with urination, recurrent UTIs, tightening of the vagina canal, and discomfort with intercourse.

Commonly Reported Problems During and After Cancer Treatment

In addition to GMS, other commonly reported symptoms can include psychological distress (including distraction and avoidance), decreased desire and sexual satisfaction, body image distress, loss of sensation and body integrity, relationship stress, and dating challenges.

Because support for sexual health and sexual recovery is not yet a standard part of oncology care, it’s especially important to be able to identify changes that are bothersome and then specifically seek out resources as needed, says Bober.

Sexual Aids Can Help Address Symptoms That Contribute to Sexual Dysfunction

Sexual health resources can include vaginal lubricants and moisturizers, dilator therapy (a tube-shaped device that can help stretch the vagina), and pelvic floor exercises, all of which may help women with genitourinary symptoms, says Bober.

In a survey of 218 female cancer survivors published in the August 2017 Breast Cancer Research and Treatment, most women reported knowing about these options, but nearly 1 in 5 women, or 19 percent, had never tried any.

Online Resources for Finding Help With Sexual Dysfunction

Depending on your issue, Bober recommends finding an expert who can help; for example, a provider certified in menopause care or a therapist who has experience with sexual health after cancer.

“This is often where resources online can be helpful, including the NAMS practitioner finder, the Scientific Network on Female Sexual Health and Cancer and the American Association of Sexuality Educators, Counselors, and Therapists (AASECT) to find a certified sex therapist,” says Bober.

Sexual side effects of treatment do not typically resolve on their own; that’s why being proactive is so important, she emphasizes. For some women, a physical therapist who has specialized training and expertise around the pelvic floor may be useful, says Bober. Not every PT has this type of training, she cautions. The American Academy of Pelvic Health Physical Therapy offers a guide to nearby therapists who are certified in pelvic health. Sexual dysfunction is also associated with anxiety, depression, relationship stress, and loss of self-efficacy (belief in one’s ability to complete a task or achieve a goal).

Sexual issues that arise as a result of cancer treatment don’t just impact quality of life; they can also impact adherence to cancer treatment, says Stephanie S. Faubion, MD, the Penny and Bill George Director of the Mayo Clinic’s Center for Women’s Health and the medical director of the North American Menopause Society. In fact, sexual symptoms are the primary reason for premature discontinuation of treatment or failure to initiate therapy. “If women are actually stopping their therapies because of sexual dysfunction, that doesn’t help anybody,” she says.

More Cancer Centers Offer Treatment, Support for Sexual Dysfunction

Bober recommends an approach that takes into account the physical, mental, social, and cultural issues that contribute to sexual dysfunction related to cancer, which she calls a biopsychosocial model.

On a positive note, there is evidence that this may be changing for the better, says Bober, with increased interest in the treatment of cancer-related sexual dysfunction, including medications, physical therapy, and counseling options. Some of these options are being offered at cancer centers.

At the Dana-Farber Cancer Institute where Bober is the director of the sexual health program for cancer patients and survivors, the healthcare team includes a psychologist specializing in sexual rehabilitation counseling for men, women, and couples, a gynecologist specializing in female sexual health, a urologist with expertise in male sexual health, an endocrinologist who focuses on hormonal changes after cancer treatment, a reproductive endocrinologist who specializes in fertility issues after cancer, and a fertility expert specializing in fertility and reproductive health during and after cancer treatment.

Complete Article HERE!

Breast Cancer and Sex

— How Can Breast Cancer Affect Sexual Health

By Serenity Mirabito RN, OCN

Physical changes in your body due to breast cancer treatment paired with feelings of loss and fear can reduce libido (sex drive) and ultimately lead to depression.

It’s important to have open communication with your healthcare provider if you’re experiencing sexual problems after a breast cancer diagnosis.

This article will discuss how breast cancer affects sexual health and ways to prevent or treat sexual problems associated with breast cancer

Connection Between Sexual Problems and Breast Cancer

Although chemotherapy, hormone therapy, surgery, and radiation are needed to treat, cure, or prevent breast cancer, they can also cause sexual dysfunction. Due to hormone fluctuations, medication side effects, and poor body image, sexual health is greatly affected by breast cancer. Intercourse is not usually dangerous; however, sex can be painful for women, and men may experience erectile dysfunction.

Does Breast Cancer Treatment Cause Sexual Problems

The following are ways breast cancer treatment can cause sexual dysfunction in men and women:12

  • Chemotherapy: Certain chemotherapy agents (anthracyclines and taxanes) have toxicities that reduce sexual arousal and desire. These medications cause fatigue, nausea, and diarrhea, all of which can lead to decreased interest in sex and intimacy.
  • Hormone therapy: Hormone receptor-positive breast cancers are often treated with aromatase inhibitors and selective estrogen receptor modulators, which cause hot flashes, vaginal dryness, insomnia, and painful intercourse in women. Men on hormone therapy for breast cancer can experience low libido and erectile dysfunction.
  • Surgery: Breast surgeries (mastectomy, which is removal of the breast, and lumpectomy, which is removal of the cancerous tumor) and sentinel lymph node dissection (lymph node removal) result in emotional and physical distress. Pain, numbness, and swelling of the surgical site can cause discomfort, while the scars from surgery can lead to poor body image.
  • Radiation: Radiation therapy can result in persistent pain, lymphedema (swelling), reduced flexibility, and pain in the affected breast, arm, and axilla (armpit). Studies show these side effects correspond with poor quality of life, including sexuality.

How Are Sexual Problems With Breast Cancer Treatment Alleviated?

Following your treatment regimen is essential to surviving and thriving with breast cancer. These tips may help prevent or alleviate sexual problems from breast cancer treatment in men and women:3

  • Be open and honestly communicate your feelings with your partner.
  • Try sex in different positions until you find one that’s comfortable.
  • Intimacy isn’t just about sex. Kissing, snuggling, and touching can also provide intimacy.
  • Use lubrication to help make sex more comfortable.
  • Some antidepressants are used to improve sexual desire.
  • Sexual rehabilitation/therapy can help assess and treat sexual dysfunction in people with breast cancer.

Studies show that healthcare providers don’t always provide sex education to patients with newly diagnosed cancer. Be sure to discuss this topic with your oncology team before treatment starts so you know what to expect.4<

Symptoms and Gender Differences

While breast cancer is the most common cancer in women (after skin cancers), male breast cancer is rare. However, both genders experience symptoms of sexual dysfunction with breast cancer.

Men

Because male breast cancer makes up less than 1% of the total breast cancer cases yearly, information about breast cancer in men is significantly lacking. One study found education about sexuality was the most frequent unmet information need reported by male breast cancer survivors.5

Common sexual problems men with breast cancer may experience include:

  • Loss of libido
  • Erectile dysfunction
  • Poor body image
  • Feeling emasculated
  • Infertility

You will likely need to ask your healthcare provider how your treatment will affect your sexuality, as little information is shared with men on this topic.

Women

Symptoms of sexual problems in women with breast cancer include:

Although there is a great deal of information about how breast cancer affects the sexual health of women, you will likely need to ask for education on this topic as well.

How Are Sexual Problems With Breast Cancer Treated?

The first step in treating sexual problems with breast cancer is to speak to your healthcare provider. Whether male or female, sharing your new or worsening sexual side effects with your oncology team is vital. Additionally, being referred to a sex therapist or for sexual rehabilitation can help assess and diagnose the dysfunction and formulate a treatment plan that fits your individual needs.

It may also help to do the following:

  • Premenopausal women with breast cancer may improve libido by using Addyi (flibanserin), a prescription medication that increases sexual desire.
  • All women with breast cancer should use lubrication to prevent painful intercourse. Ask your healthcare provider about topical lidocaine if lubrication doesn’t improve comfort during sex.6
  • Men with breast cancer experiencing sexual problems may find relief from oral medications that help get and keep an erection. Other medical options include penile injections, urethral pellets, vacuum erection devices, and penile implants.6

For both men and women, the following may help improve sexual problems associated with breast cancer:

Check with your healthcare provider before implementing any new treatments for sexual dysfunction.

Summary

Whether you’re male or female, you will likely experience sexual problems if you have breast cancer. The consequences of cancer treatments such as chemotherapy, hormone therapy, surgery, and radiation can cause sexual dysfunction leading to depression. Speaking to your healthcare provider about how breast cancer will affect sexuality is important as there are ways to prevent or alleviate these side effects.

A Word From Verywell

Changes in appearance from breast cancer surgery can greatly influence body image and self-esteem in both men and women. Weight gain or loss, hair loss, breast removal, and scars can make you feel self-conscious. It’s important that you don’t feel rushed into sex until you’re ready. Enjoying other ways to feel close to your partner is equally as satisfying. Be sure to seek help from your healthcare provider if new or worsening sexual problems occur.

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

  1. American Cancer Society. Treating breast cancer in men.
  2. Boswell EN, Dizon DS. Breast cancer and sexual functionTransl Androl Urol. 2015;4(2):160-168. doi:10.3978/j.issn.2223-4683.2014.12.04
  3. Breast Cancer Now. Sex and breast cancer treatment.
  4. American Cancer Society. Cancer, sex, and the female body.
  5. Bootsma TI, Duijveman P, Pijpe A, Scheelings PC, Witkamp AJ, Bleiker EMA. Unmet information needs of men with breast cancer and health professionalsPsychooncology. 2020;29(5):851-860. doi:10.1002/pon.5356
  6. Carter J, Lacchetti C, Andersen BL, et al. Interventions to address sexual problems in people with cancer: american society of clinical oncology clinical practice guideline adaptation of cancer care ontario guideline. JCO. 2018;36(5):492-511. doi:10.1200/JCO.2017.75.8995

Complete Article HERE!

Let’s talk about sex

— Tailoring prostate-cancer care for LGBT+ people

Workers with the UK National Health Service take part in the London Pride Parade in 2019.

By Julianna Photopoulos

In 2007, 55-year-old Australian sociologist Gary Dowsett was diagnosed with prostate cancer. On the basis of his relatively young age and his test results, his physicians told him that radical prostatectomy — surgery to remove his prostate completely — was his best option. The procedure went well, but Dowsett had questions — he wanted to know how it would affect his sex life as a gay man, and how to negotiate the physical, sexual and emotional changes that would result from his treatment. For the most part, his questions went unanswered. “Medical professionals were sympathetic, but most knew next to nothing about gay men,” says Dowsett.

Having worked in social HIV/AIDS research for about 40 years, Dowsett, an emeritus professor at the Australian Research Centre in Sex, Health and Society at La Trobe University in Melbourne, was shocked to discover how far behind prostate-cancer physicians and researchers were in understanding men’s sexuality. “It was all about erections, as if sex starts and ends there,” he says. There were no patient-education materials available for men who have sex with men; nor was there much scientific literature. “There was quite a bit for heterosexual men in terms of intimacy with their wives,” Dowsett says. But for gay and bisexual men, who are more likely than heterosexual men to be single when diagnosed with prostate cancer1, and might engage in different sexual practices, little of that applied. “That’s really what got my dander up,” he says.

Physicians might not realize that the needs and concerns of gay and bisexual men are different from those of heterosexual men, says Channa Amarasekera, a urologist and director of the Gay and Bisexual Men’s Urology Program at Northwestern Medicine in Chicago, Illinois. Although the biology of prostate cancer is the same for all, the impact that the disease and its treatments have on a person can vary significantly depending on their sexual orientation and preferred sexual practices.

Dowsett started working in prostate-cancer research after his treatment. He and other researchers have made considerable progress in documenting the experiences of people from sexual and gender minority groups, and uncovering the impact that prostate-cancer treatments have on them. “The quality of life is really affecting some people, and we need to recognize that,” says Daniel Dickstein, a radiation oncologist at Icahn School of Medicine at Mount Sinai in New York City. However, evidence of the problems facing gay and bisexual men will not by itself enable clinicians to advise their patients properly: empowering physicians with evidence-backed guidance, and improving communication, will also be crucial.

Understanding the impact

The prostate, a gland which lies along the urethra between the bladder and penis, is the second most common site of cancer in men worldwide, trailing only slightly behind lung cancer. About one in six gay and bisexual men will develop prostate cancer; there is little research into its incidence in transgender women. But it is only in the past decade that research into prostate cancer specifically in gay and bisexual men has gained interest, says Simon Rosser, a behavioural psychologist at the University of Minnesota in Minneapolis.

Prostate cancer is typically treated by removing the gland through surgery, or by killing cancerous cells using radiation. These can be combined with androgen-deprivation therapy, in which the person’s levels of testosterone are reduced to slow the growth of the tumour.

Common side effects of these treatments include urinary incontinence, erectile dysfunction, a reduced libido and impaired ability to ejaculate. These are broadly similar for all patients, but some differences have been noted between heterosexual men and gay and bisexual men. One study, for example, showed that gay and bisexual men have worse urinary, bowel and hormonal function than heterosexual men after treatment for prostate cancer, but better erectile function2. Similarly, a study led by Jane Ussher, a clinical psychologist at Western Sydney University in Australia, found that gay and bisexual men are more likely than heterosexual men to be able to get and sustain an erection after prostate-cancer treatment3. “One of the reasons for that is that they are more likely to do something about it — like to go and get counselling, try penile injections and suction devices, or use Viagra,” she explains.

In many cases, the impact of sexual dysfunction arising from prostate-cancer treatment is magnified in gay and bisexual men. “Due to differences in sexual practices, they may have additional concerns, and some sexual side effects will be more bothersome or challenging to manage,” says Sean Ralph, a consultant therapeutic radiographer at Leeds Cancer Centre, UK, and co-founder of Out with Prostate Cancer, the United Kingdom’s first prostate-cancer support group for gay and bisexual men and transgender women.

For example, an erection must be 33% firmer for anal intercourse than for vaginal intercourse4. This makes any loss of erection hardness more of a problem for men who engage in insertive anal intercourse — not purely the preserve of gay and bisexual men, but nonetheless a part of many such relationships.

Channa Amarasekera talks to a seated patient while a nurse takes his blood pressure
Channa Amarasekera (right) consults with a patient at Northwestern Medicine in Chicago.Credit: Northwestern Medicine

The prostate also acts as an organ of sexual pleasure and orgasm for some people through anal stimulation. “Many men think prostate stimulation is the be-all and end-all in gay sex,” says Rosser. If the prostate is removed, in many cases so, too, is the pleasure for men who have receptive anal intercourse5. Rosser also estimates that one-third of these men experience anodyspareunia, or pain during anal intercourse — double the rate before treatment. And removing the prostate puts a stop to ejaculation. “That was a real blow for me,” says Dowsett. Visible semen can be a sign of a satisfying sexual experience. In a 2013 study, Dowsett and his team found that men who have sex with men were more distressed by the loss of ejaculate than were heterosexual men6.

Communication blockage

A 2016 study led by Ussher found that gay and bisexual men with prostate cancer report significantly lower quality of life and satisfaction with treatment than do heterosexual men1. In some cases, the psychological impact might be made worse by the fact that many people are not made aware of all of the consequences of their therapy beforehand.

Dowsett notes that the loss of the ability to ejaculate after a radical prostatectomy was absent from much of the public-health literature at the time he was diagnosed — he learnt of it only after he went for a second opinion. Similarly, Ussher says that many people are not told that their penis can shorten after a radical prostatectomy, or that this is sometimes temporary. Failure of health professionals to discuss these highly relevant effects of treatments with their patients often leads to lasting anger, distress and harm, says Rosser. “It’s an ethical violation in my mind,” he says.

Physicians also commonly overlook the specific side effects for people from sexual and gender minorities — essentially taking away their ability to make an informed decision about their treatment, Amarasekera says. When physicians do consider a person’s sexuality, there are actions that might improve quality of life. For example, Dickstein suggests that inserting a hydrogel spacer between the prostate and rectum, which reduces the amount of radiation the rectal wall is exposed to, might improve a person’s ability to engage in receptive anal intercourse.

There are also risks that particularly affect gay and bisexual men that could be avoided if physicians are made aware. For example, men are usually advised to resume sexual activity soon after prostate-cancer treatments to help with erectile function, but receptive anal intercourse can cause damage. Clinicians should also consider the use of drugs called poppers in this group of people, Dickstein says. These inhaled drugs, made from chemicals called alkyl nitrites, are commonly used by gay and bisexual men to relax their anal sphincter muscle and enhance sexual pleasure. However, if they are combined with Viagra — often prescribed for erectile dysfunction — the results could be devastating, warns Dickstein. Both drugs lower blood pressure, and the mixture could cause serious cardiovascular problems.

Unfortunately, most physicians do not ask people about their sexual orientation or practices7. “This sets up a don’t-ask-don’t-tell dynamic where patients can’t be honest with you about who they are and what their problems are,” says Amarasekera. Urologists have reported concern about offending their older, more conservative patients by asking about their sexual orientation. “But the majority are not offended,” says Rosser. “All you need to do is ask.” The fact that transgender women are at risk of prostate cancer is also often forgotten (see ‘Targeting treatment for transgender women’).

Targeting treatment for transgender women

Prostate cancer in transgender women is thought to be rare — but it does occur. “Trans women will have a prostate, even if they’ve had gender-affirmation surgery,” says Alison May Berner, an oncologist and gender-identity specialist at the Tavistock and Portman NHS Foundation Trust in London. However, advice for physicians on caring for this population is lacking.

“A lot of physicians forget to check trans women’s prostate,” says Channa Amarasekera, a urologist and director of the Gay and Bisexual Men’s Urology Program at Northwestern Medicine in Chicago, Illinois. And even when they do, subsequent care cannot follow an identical path to that for cisgender men. For example, gender-affirming surgery that some transgender women undertake could be more difficult if they have already had radiotherapy for prostate cancer. “Surgeons do not like operating on parts of the body when they have been treated with radiotherapy,” explains Sean Ralph, a consultant therapeutic radiographer at Leeds Cancer Centre, UK.

There is also no level of prostate-specific antigen (PSA) — a common biomarker for prostate cancer — that is agreed to be cause for concern in transgender women. Gender-affirming hormone therapy artificially suppresses PSA levels, meaning a low PSA reading in a transgender woman might not mean a clean bill of health, as physicians might otherwise assume.

But there are potential positives. Worries that treatments are in some way feminizing might not be an issue for some transgender women or non-binary people. In addition, some scientists think that gender-affirming hormone therapy might actually protect against prostate cancer. A study by researchers in the Netherlands of 2,281 transgender women who received androgen-deprivation therapy and oestrogens found they had a lower risk of prostate cancer than did cisgender men10. “Gender-affirming hormones reduce the testosterone to the prostate which usually drives the cancer,” explains Berner. However, the hormones used in other parts of the world can differ, so the data might not be transferable to other countries.

In many cases, the problem is a lack of education and training among clinicians. Amarasekera has found that many urologists have received less than five hours of instruction on how to treat people from sexual and gender minorities7, and most felt that they needed more.

There is, for example, a lack of guidance on how to discuss the various sexual roles that a gay or bisexual person can take on in anal intercourse, and the implications for treatment. “One might identify as a top or insertive partner, a bottom or receptive partner, or might be versatile and engage in both, and that may change the treatment discussion,” explains Dickstein. In some cases, changing roles after treatment could improve quality of life. However, such a change will not be acceptable for everyone. “It’s not as simple as, I’ll just change a role — both the psychological and social consequences of that are much more complicated and long-term,” warns Dowsett.

It is therefore important that conversations between physicians and patients go deeper than covering just sexual orientation. “You have to move past orientation and understand sexual preferences or interests if you really want to take into account the whole post-treatment experience,” Dowsett says. And this goes for people who are heterosexual, as well — even though the average age of diagnosis is 66, Dowsett says that many people might be willing to try new things, including sexual aids, to improve their quality of life after treatment if physicians are able to discuss it. “It’s very hard to shift the urology and oncology fields to stop thinking about straight men with prostate cancer as being their grandfathers,” Dowsett says.

Culture of trust

Another obstacle to tailoring treatment to gay and bisexual men is that some people might not be forthcoming about their sexual orientation because of mistrust or past trauma. Many people will have had negative experiences with health-care services, says Ralph. For example, one gay man in his support group had surgery without disclosing his sexual orientation because he was worried that his operation would be performed in a careless manner if the clinicians knew he was gay. Others will choose to wait until they have met the physician to decide whether they feel safe to discuss it with them, or simply assume that the physician would be able to tell without having to discuss it openly.

To address this, last year Amarasekera launched a programme specifically to help people from sexual and gender minorities to access care. “There was a significant number of patients who identified as gay or bisexual who felt like there wasn’t a space where they could be open about what their issues were when it came to prostate-cancer treatment,” he says. In 2019, the UK National Health Service (NHS) adopted the rainbow-badge initiative, in which staff can opt to wear a badge that marks them as an ally for LGBT+ people and a safe person to talk to. Clinicians applying for the badge do not receive specific training, but are expected to read some brief information and pledge to promote inclusion. “However, the onus is still on the patient to disclose their sexual orientation or gender identity,” says Ralph.

The guidance available to prostate-cancer clinicians and patients is also improving. The American Society of Clinical Oncology and the US National Comprehensive Cancer Network note that discussions on sexual activity and sexuality are important for cancer treatment, although they still do not address specifics of how to tailor screening or treatment to gay and bisexual men.

In 2021, Ralph published recommendations on anal-sex practices before, during and after prostate cancer interventions8. The advice is based on the opinions of 15 clinical oncologists and 11 urological surgeons in the United Kingdom. It includes recommendations on how to long to wait before engaging in receptive anal sex after radical prostatectomy and radiotherapy, as well as after a biopsy and before a test for prostate-specific antigen — a blood test that is commonly used in screening, but which can be invalidated by prostate stimulation.

To provide further recommendations for clinicians, much more research on people from sexual and gender minorities is required, Dickstein says. “It’s difficult to offer patients advice,” he says. “I can’t say this is the treatment that you should choose because it’s better for having anal receptive intercourse — I seriously do not know.” Evidence for how different treatment approaches might affect problems such as anodyspareunia, for instance, is lacking.

Research into gay, bisexual and other men who have sex with men has been hampered by small sample sizes, says Rosser. The largest such research sample, collected by Rosser in 2019, included 401 people9. “Cancer registries do not routinely collect data on gender diversity and sexuality,” says Ussher. “We don’t know how many people out there with cancer identify as queer, bisexual, gay or lesbian, or who are trans or have an intersex variation.”

We still have a long way to go, says Rosser — not just in terms of research, but also in educating patients and clinicians on how to communicate with each other about sexual orientation and practices. “This might take a while,” he says. But it is essential that prostate-cancer treatment is tailored to each person’s needs. Equitable care does not mean treating everyone the same, Dowsett says, and any clinician who holds that opinion is wrong. “You can still treat people fairly and equally, but must recognize differences that require different responses.”

Complete Article HERE!

Few Patients With Breast Cancer Are Educated on Treatments’ Impacts on Sexual Health

Although very few patients are informed about the effects that breast cancer treatments may have on their sexual health, many patients expressed wanting that information throughout all stages of their treatment, according to study findings.

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Few patients with breast cancer receive adequate information about the potential effects that treatment may have on their sexual health, according to newly released study results.

The data — which were published in the Annals of Surgical Oncology — also identified that the education patients receive about the effects of breast cancer treatments is insignificant.

The study consisted of a questionnaire as well as interviews and focus groups. In total, 87 patients filled out the questionnaire and 16 patients were interviewed by the investigators.

The patients were mostly younger than 65 (85%), married (67%), White (83%) and heterosexual (98%), but the amount of time since their initial diagnosis varied from less than one year to more than four years.

More than half of the survey respondents reported that they underwent surgery (86%), received chemotherapy (71%) and/or endocrine therapy (66%). Most of the respondents (93%) reported a symptom that negatively affected their sexual health.

The most common symptoms the respondents said they experienced included decreased sexual desire (69%), vaginal dryness (63%) or less energy for sexual activity (62%).

When asked by the investigators about when they would ideally like to receive education on the effects breast cancer treatment has on sexual health, most (73%) said they wanted to be informed of the risks early after their diagnosis.

Most of the respondents noted that their oncology team or health care providers failed to give them any information about the possible sexual health side effects associated with breast cancer treatment.

For patients who received any information, it was more focused on fertility preservation and menopause and not sexual health or pleasure.

“(Patients should) understand that these symptoms and side effects of treatment are incredibly common and that there are ways to mitigate and treat these symptoms,” study author Dr. Sarah Tevis, a breast surgical oncologist at the UCHealth Diane O’Connor Thompson Breast Center in Aurora, Colorado, said in an interview with CURE®.

Tevis urged patients that they should not be afraid to raise the topic of sexual health with their oncology team.

Give Patients Options

The patients in the study suggested that many different educational resources be offered to patients, including the creation of support groups, videos, pamphlets and documents to be distributed at the doctor’s office, and the implementation of routine sexual health questions during their appointments.

One interviewee reported, “I feel that it would be best to have several avenues available. Then you could choose what you feel most comfortable with.”

As a result of the survey responses and subsequent interviews, Tevis noted that the University of Colorado is partnering with the nonprofit organization Catch It In Time to create sexual health videos for both patients with cancer and health care professionals.

“The video series will cover what to expect with breast cancer surgery and how to actively prepare for surgery, managing sexual health symptoms related to breast cancer treatments, and navigating relationships and dating,” Tevis explained. “We hope to have the videos completed by the end of the summer and plan to pilot test the videos in women with breast cancer this fall. If patients find the videos acceptable and appropriate, we plan to make them widely available online.”

She said that there will be four videos in this series with the potential to cover other cancer types and treatments in the future.

Complete Article HERE!