Sexual Health and Gynecologic Cancer Treatment

Sexual health & gynecologic cancer treatment at a glance

• Women who have undergone gynecologic cancer treatment have sex less often after treatment than before, according to a study by the University of Colorado Anschutz Cancer Center.
• There are many reasons sexual function is affected in patients and survivors of gynecologic cancers, including:
• However, treatments for gynecologic cancers do not directly impact the muscles and nerves needed for a woman to achieve sexual climax.
• Early discussion, as well as psychological counseling, about treatment affects can help women cope with sexual problems during and after their cancer treatment.
  • the areas treated, such as the vagina, ovaries, uterus, vulva and cervix, are directly involved in sexual activity and may be disturbed or physically altered
  • the treatments for these malignancies interrupt genital nerve activity
  • psychological issues can arise from diagnosis and treatment that affect a woman’s self-esteem and reduce her interest in sex and the pleasure derived from it.

Want more information on sexual health after a cancer diagnosis? CU Anschutz’s Dr. Saketh Guntupalli literally wrote the book. 

Sex & Cancer: available on Amazon.

Sexual health & gynecologic cancer treatment overview

Women of all ages and with all types and stages of gynecologic cancers can experience sexual health issues resulting from their treatment. These range from lack of desire to pain during intercourse and dissatisfaction with sex.

A CU Anschutz Cancer Center study conducted by Dr. Saketh Guntupalli showed that before treatment, women with gynecologic cancers had sex anywhere from 6.1 – 6.8 times a month. After treatment, the frequency ranged from 2.6 – 4.9 times a month, a marked decrease.

The CU Anschutz study also noted that younger women and those receiving chemotherapy were more likely to experience sexual dysfunction. Other studies estimate that sexual complaints after gynecological cancer treatment are voiced by 40–90 percent of patients.

Patients are often reluctant to bring up the issue, but gynecologic oncologists are increasingly addressing sexual function before treatments begin. The main concern and objective, as with all cancer treatments, is making the greatest effort possible to maintain a patient’s quality of life. And a woman’s sexuality is often a very important aspect of her quality of life.

Gynecologic oncologists suggest that counseling for patients during cancer treatment may help with their sexual function during and afterward. It’s also important for women to tell their oncologist about issues they notice related to sexual health as soon as possible. Interventions at that point are very beneficial, particularly for younger couples.

CU Anschutz Gynecologic Oncology gives a survey about sexual issues after treatment to patients willing to participate. As part of Dr. Guntapalli’s ongoing research into the issue, the surveys are also sent to other gynecologic cancer patients across the country in an effort to better understand and address women’s sexual health.

The gynecologic oncologists at the University of Colorado Anschutz can refer their patients to on-site therapists who can provide psychotherapy, medication and education to assist with their treatment. Patients may also be referred to the CU Anschutz Cancer Center physical therapy department, where they can receive pelvic physical therapy. This is a unique program to help patients increase pelvic health with a nonsurgical option.

Causes of sexual dysfunction from gynecologic cancer treatment

Powerful cancer treatments involving a woman’s sexual organs can directly disrupt her sexual function and the sensations a woman experiences during sex. Treatments for some women can cause them to enter menopause, affecting sexual function and causing anxiety.

In a broader sense, it is normal for women with different types of cancer — perhaps more so with gynecologic cancers — to feel bad about their body image and to have a drop in sexual desire. Sexual dysfunction can result from the physical effect of the cancer therapies or from the psychological effects of the cancer diagnosis and treatment.

The most common sexual problems are:

• Lack of interest in sex
• Pain during sexual penetration
• Inability to have an orgasm
• Dissatisfaction with sexual activity

Lack of interest in having sex is caused by a multitude of reasons. Side effects of chemotherapy and other treatments can make it difficult to even consider sexual intimacy. Bleeding after intercourse may be caused by treatments and this can introduce fear and anxiety, also reducing sexual desire. Treatments can alter skin thickness, color and texture in the pelvic region, as well as loss of pubic hair, adding to body image concerns.

Physical changes to the sex organs from treatment can result in pain during penetration. Certain sexual activities or positions may no longer be pleasurable due to changes that can involve scarring, decrease or absence of vaginal lubrication and narrowing or shortening of the vagina, particularly with hysterectomy. These changes can also alter neural stimulation during sexual activity, reducing a woman’s ability to be aroused.

Operations and treatments can cause women to have poor perceptions of their body image that can damage their self-esteem, affecting their interest and satisfaction with sexual activity. Hormonal changes from cancer treatments can reduce a woman’s sex drive and sensations normally enjoyed during sex. Bowel and bladder changes can also follow gynecologic cancer treatments, causing change of attitude toward sex and enjoyment.

Coping with sexual function & cancer treatment

• Sexual activity during cancer treatment is usually okay, depending on the woman’s interest and comfort level.
• Sexual intimacy can involve other things besides penetration, such as holding, touching and caressing.
• A woman should talk with her partner about what feels good and what doesn’t, and make it known if she is tired or uncomfortable.
• Women should try to improve blood flow to the vagina and pelvic region by stimulation, which is sometimes disrupted by cancer treatments. A vibrator, a willing partner and products such as the Eros Therapy device can help restore blood flow to the clitoris and genitalia, which can aid in orgasm, vaginal lubrication and overall sexual satisfaction.
• Patients should go easy after surgery and allow time for the pelvic region and sex organs to recover so sex isn’t painful.
• Avoid penetration of the vagina and anus if the patient’s platelet or white blood cell counts are low, due to risk of infection and bleeding.
• Take steps to combat vaginal dryness, one of the most common sexual complaints after gynecologic cancer treatment and a cause for discomfort or pain. The following can help:
  • use a lubricant such as KY-Jelly, but not Vaseline or skin lotion, and apply it to all things involved in sex (penis, vagina, fingers)
  • use a vaginal moisturizer 2-3 times a week
  • use a vaginal dilator after radiation therapy to reduce scarring and help keep the vagina open
  • patients may want to talk with their oncologist about using vaginal estrogen.