— 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.

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↩!