Sexual health is an important contributor to quality of life for many patients. A study of 3515 adults in the United States found that 62% of men and 43% of women reported that sexual health is highly important to their quality of life.1 Patients in better health reported greater sexual satisfaction than patients in poor health. For patients diagnosed with cancer, a major long-term survivorship issue is sexual health.2 It is estimated that between 40% and 100% of patients with cancer — depending on the type of cancer and its treatment — experience sexual dysfunction.3

Among patients with cancer, sexual dysfunction can include disorders of desire or response for both men and women, regardless of sexual orientation.3 These disorders occur as a direct result of cancer treatment or due to psychosocial factors associated with diagnosis and/or treatment.2

Mechanisms of Sexual Dysfunction

For both men and women, cancer treatment can result in disfigurement and/or anatomical changes that can impair sexual functioning; physiological changes such as changes in hormone levels that can decrease desire or sexual functioning; and psychosocial changes such as poor body image, feelings of distress, anxiety, or depression, and changes in intimacy.3,4

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Women

Surgical interventions, particularly of the reproductive organs, can result in anatomical changes that make sexual functioning challenging.5 For example, a radical hysterectomy typically includes removal of the upper portion of the vagina. Some procedures, such as removal of vulvar or vaginal tumors, can damage nerves that are important for sexual arousal and orgasm. Radiation therapy can also cause nerve damage, as well as changes to the pelvic organs such as vaginal atrophy or fibrosis.

Systemic cancer treatment can also directly or indirectly cause sexual dysfunction among women. Chemotherapy and some hormonal therapies used to treat breast cancer can induce postmenopausal-like symptoms including vaginal dryness, itching, and pain during sex. Other adverse effects of chemotherapy, including hair loss, nausea and vomiting, and fatigue, can impair sexual health.

Men

Surgical interventions for men with cancer, particularly prostate cancer, rectal tumors, and bladder cancer, can damage nerves or blood supply that is important for sexual function.5 Radiation therapy can cause erectile dysfunction and penile fibrosis caused by radiation can persist for years after treatment.

Chemotherapy can cause similar sexual dysfunction issues in men as in women and can have an indirect effect on sexual health due to the psychosocial effect of common side effects. In addition, a common treatment for prostate cancer is androgen deprivation therapy, which lowers testosterone to castration levels. This can decrease the size of the penis and testicles, lower libido, and cause erectile dysfunction.