Sexual Dysfunction

CURE, Fall Supplement 2009, Volume 8, Issue 0

Why cancer patients need to be aware of sexual dysfunction and suggestions for helping to overcome this rarely discussed side effect.

It’s not a topic most physicians want to discuss, but the loss of sexual function can be a major issue for survivors. The cause may be physical, emotional, or a combination of both, and those who have been there recommend getting help from professionals.

Research suggests about half of breast cancer patients who have received chemotherapy experience long-term sexual dysfunction, such as vaginal dryness, libido changes, or premature menopause, and up to 90 percent of prostate cancer patients experience erectile dysfunction after radical prostatectomy, with as many as 85 percent experiencing this side effect following external beam radiation. Research has also shown that up to half of testicular cancer patients report some type of sexual impairment after treatment. In women, chemotherapy disrupts female sexuality more than other treatments, explains Patricia Ganz, MD, professor of health services and medicine and director of the division of cancer prevention and control research at the Jonsson Comprehensive Cancer Center in Los Angeles.

“Chemotherapy can cause premature menopause. This may result in ovarian failure, and decreased estrogen as well as diminished androgens such as testosterone, libido changes, and lubrication problems,” says Ganz.

Radiation treatment can also impact sexuality by causing fatigue, nausea, skin changes, and hair loss. Other important factors that affect sexual function include emotional well-being, body image, and communication between partners.

For those who require treatment for sexual dysfunction, the process is twofold: physiological and psychological. To help combat the physical aspects of sexual dysfunction, women may use lubricants; for the psychological aspects, they might participate in counseling.

Both men and women may become anxious or fearful about having sex after treatment due to numerous reasons that may include physical changes or loss of libido.

To resolve possible sexual avoidance, the National Cancer Institute suggests self-stimulation to allow “the individual to become comfortable with his/her sexual response and arousal without the added pressure of performance anxiety.” If improvement does not occur after several months, other methods can be used, and survivors should seek professional help.

While nerve-sparing surgical techniques have reduced erectile dysfunction for men undergoing prostate surgery, those who do experience this outcome have options that include oral medications such as Viagra (sildenafil) and Levitra (vardenafil), penile injection therapy, and penile prostheses.

When these options fail, sex therapists can offer alternatives.

For women, self-image can often be at the core of sexual issues. Debbi Hampton, a 56-year-old breast cancer survivor from Tennessee, speaks from experience. “Sexuality is an important aspect of human life and relationships. Not to address it adds one more loss to cancer,” she says.

After a modified radical mastectomy in 1994, Hampton says she focused on living and raising her daughter. She also adjusted to seeing herself without breasts. Crying after not finding a dress that fit her properly, Hampton decided to reclaim how she looked and felt before cancer, describing breast reconstruction as “a reunion with self.”

Four years later, a recurrence brought up more challenges with sexuality due to hormonal changes from her treatments. She found comfort in her breast cancer support group, where members talked openly about sexual concerns. After consulting with a gynecologist and a psychiatrist, who prescribed estradiol vaginal tablets and topical testosterone, Hampton says, “I got my sex life back!”