Cancers, as well as the therapies used to treat them, can cause permanent, devastating effects on sexual health. A growing group of psychologists, gynecologists, and sex therapists are urging oncologists to regard sexual dysfunction as a serious quality of life issue and to discuss the potential impact with patients before, during, and after treatment.

“Sexual health is an important aspect of human life, and cancer does not (and should not) change that,” the authors of a recent paper wrote.1 “Data suggest that issues related to sexual function are quite common among women treated for cancer. However, clinicians often spend little to no time on the topic.”

Advances in cancer treatment make sexual health problems increasingly widespread. As the number of survivors grows, so do the number of people living with the long-term effects of the disease or its treatment. Focusing its attention on women, the paper noted that “more than 7.5 million out of 14.5 million cancer survivors in the United States are women, and that number is expected to grow to 9,602,590 by 2024.”

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Therefore, the authors argued, the issue demands a proactive response from oncologists.

“Despite the data showing that most survivors have a good prognosis, current treatments can result in problems, including symptoms related to sexual health,” they wrote. “Cancer providers must be aware of this emerging issue and should be prepared to address the sexual health of their female patients, or at least should be able to refer them to locally available experts.”

Too often, though, they don’t.

“Until about 2 or 3 years ago we didn’t think of this as a problem because no one asked the patients about sexuality,” the paper’s lead author, Eleonora P. Preti, MD, told Cancer Therapy Advisor.

Dr Preti, assistant and sexual therapist of the preventive gynecological unit at the European Institute of Oncology in Milan, Italy, added that “doctors need to remove our own barriers about speaking about sexuality. That way, we permit our patients to speak about it. If we have barriers we don’t have the ability to improve the lives of our patients.”

Various cancers affect sexual health directly — breast, ovarian, testicular and prostate, for example. But cancer treatments, too, are known to cause a variety of problems that affect sex. The issues include vaginal dryness, narrowing, or shortening, which can contribute to painful intercourse. Removal of the ovaries or aromatase inhibitor therapy can cause early onset of menopausal symptoms including thinning of the vaginal walls.

Men face their own set of sexual issues including erectile dysfunction, painful ejaculation, and urine leakage during intercourse. Cancer therapies can affect testosterone levels, cause damage to the nerves that control erections, or damage vessels supplying blood to the penis.

The nature of sexuality, however, involves more than just physical ability. It involves a complex combination of physical, psychological, and emotional responses. Body image, the sense of attractiveness, depression and anxiety — about cancer, health in general, or sexual performance — can all have an impact.

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“Estimates of the incidence of sexual dysfunction range from 30% to 100% among female cancer survivors, depending on the population queried and on how sexual dysfunction is characterized,” Dr Preti and her co-authors wrote. “Sexual dysfunction affects both women with illness and women in the general population, and discussing sexual health in both populations remains difficult — for both patients and providers.”