Similar factors affect men. The American Cancer Society advises that “Many men report disappointment, fear, and distress when they have trouble with erections.2 They report that they don’t feel ‘like a man’ and that something important is missing. Men may report a general unhappiness with life and depression when they have problems with erections.”

“The problem is anatomical but also psychological,” Dr Preti said, “because the treatment of cancer completely alters our idea of life. After the cure, sexuality becomes a real problem because it completely alters the relationship with our partners and the relationship with ourselves.”


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Recognizing that cancer survivors may need help coping with those issues, the Dana-Farber Cancer Institute in Boston, Massachusetts, offers counseling, education, and treatment through a dedicated sexual health program.

“I think the big, overarching issue is that patients are really rarely given a heads-up that these things may be coming, so people are often caught by surprise,” the sexual health program’s director, Sharon Bober, PhD, said. “The sort of sudden nature of some of these changes really catches people off guard.”

Advising patients about some of the sexual side effects of the disease and its treatment gives them the opportunity to prepare themselves, emotionally and physically, for the changes that may result.

As the authors of a 2014 paper urging health care professionals to initiate discussions about sex with cancer patients stated, “multiple barriers exist to that can explain why providers may not engage in sexual health discussions. Time constraint was shown to be a real issue in a survey of gynecologic oncologists in New England, where less than 50% of doctors practiced taking a sexual history with new patients and only 20% felt they had sufficient time to discuss sexual concerns. Beyond time, studies also suggest clinicians often make assumptions about patients that ‘justify’ not inquiring about sexual health.”3

Dr Bober noted that “we know that patients overwhelmingly want clinicians to ask about this part of their experience in the same way that we ask about everything else. We ask about pain. We ask about nausea. Those are issues that used to be taboo. We now ask about them in a very routine sort of way. Patients want to be asked about this in the same sort of routine way.”

Patients, she said, need to know what may happen as a result of treatment and that help dealing with the effects on sexual health is available. Numerous therapies exist to mitigate many of the physical consequences, and psychologists and sex therapists can assist with individual and couples counseling.

RELATED: Updated NCCN Guidelines Encourage Clinicians to Initiate Communications Regarding Sexual Function

“As people are living longer and, as we know, survivors are increasing in number all the time,” Dr Bober said, “we really have a growing obligation to serve the whole patient in terms of survivorship, and sexual health is a quality of life issue for millions of people.” 

References

  1. Preti EP, Landoni F, Colombo N, Dizon DS. How to address sexual problems in female cancer patients. Oncology (Williston Park). 2017;31(4):258-62, 264.
  2. Cancer can affect a man’s erections. American Cancer Society website. https://www.cancer.org/treatment/treatments-and-side-effects/physical-side-effects/fertility-and-sexual-side-effects/sexuality-for-men-with-cancer/erections-and-treatment.html. Accessed May 2017.
  3. Dizon DS, Suzin D, McIlvenna S. Sexual health as a survivorship issue for female cancer survivors. Oncologist. 2014;19(2):202-10. doi: 10.1634/theoncologist.2013-0302