While advances have been made in the treatment of many different types of cancer, the disease still takes an incredible toll on a person, even before diagnosis. One part of a person’s life that can be affected dramatically by cancer is sexuality and sexual health.

What is sexuality? What does “sexual health” mean?

Sexuality is an inherent part of human-ness. It isn’t a singular notion, but a composite of multiple domains: intimacy, attraction, sensuality, body image, arousal, desire, climax, erection, and satisfaction. Men and women experience it differently, but it’s important for all of us, regardless of age and no matter how sick or healthy we are. That’s what feeds into the concept of sexual health—it’s the state of your own sexuality, and only you can determine that. When your sexuality causes you distress, your sexual health is affected and is described as dysfunctional.

How does cancer or cancer treatment affect a person’s sexual health and intimacy?

A diagnosis of cancer and all forms of cancer treatment can impact sexuality, intercourse, and intimacy—not only for the person with cancer but for their romantic partners. In fact, often, sexuality is negatively impacted before the diagnosis of cancer is even made. This might be due to systemic symptoms like fatigue, nausea, pain, or bloating—all of which can predate the diagnosis. At the point of diagnosis, there is significant psychologic distress where the patient’s attention is rightfully on the treatment plan. Often when you look for distress in people facing a new diagnosis—as we do here at Lifespan—sexuality is not one of the things the patient is most worried about. In a sense, sexuality takes a back seat to the critical time where we are helping the patient formulate a treatment plan.

Surgery can impact sensuality and desire in multiple ways. A common scenario might be removal (partial or complete) of a sensate organ, like the breast. We’ve shown that people undergoing surgery for breast cancer experience a loss of breast-specific sensuality, and as a result, lose a very important aspect of arousal. In some of the work I’ve been involved with, more than 70 percent of patients undergoing mastectomy and breast reconstruction experienced a lack of sensation or an unpleasant sensation when the treated breast is touched. Surgery on the pelvic area for women can cause shortening of the vaginal canal and removing one’s ovaries can cause significant vaginal dryness and thinning. For men, removal of the prostate can lead to urinary incontinence, impotence, or both. But it’s important to understand that the loss of intimacy and of desire is not isolated to surgery on “male” and “female” parts. People undergoing surgery for other cancers, including colon cancer and lung cancer, also experience sexual dysfunction.

Chemotherapy can cause systemic side effects that can alter intimacy, body image, arousal, and desire, including nausea, hair loss (total body), weight gain or weight loss, diarrhea, or nausea. An extreme example occurs in those who are treated with high-dose chemotherapy with stem cell transplant—their entire body image may be impacted by both the treatments and the medications to treat or prevent graft-vs-host disease. Endocrine treatments, like antiestrogens used in the treatment of breast cancer, and androgen deprivation therapy used to treat prostate cancer, all impact sexuality as well.

Radiation directly impacts the treated area and can change the way touch is experienced. The data I am most familiar with concern the impact of radiation to the breast or chest wall for breast cancer; 48 percent of patients experience lack of sensation or an unpleasant sensation when the treated breast is touched after breast conserving treatment (lumpectomy plus radiation).

Another aspect that needs to be recognized is the impact of cancer on the romantic partner, who often has a different role in their loved one’s cancer, whether that be emotional support or caregiver for medical needs. After particularly difficult experiences with cancer, such as when a partner has become very sick, hospitalized or requiring home care, it can be hard for romantic partners to reestablish intimacy. It can be very difficult to flip between romance and medical care, and this can weigh heavily on the couple.

Can people with cancer regain their sexual health?

Every patient deserves to have their sexual health restored. Cancer can take so much from a couple, but it does not need to claim sexuality. The treatment can vary depending on the issue. There are medications available: for men with erectile issues, the PDE-5 inhibitors are effective. For women with vaginal dryness, over-the-counter moisturizers (used five times a week) and lubricants for intercourse can be helpful. There is medication and/or dilators if someone is experiencing pain with vaginal penetration. Studies have shown that issues with body image can be helped with group therapy. For couples who need more, there are specialists who can help with other recovery factors.

Talking with health care providers about sexual health during cancer treatment

It’s well known that if your doctors don’t bring up sexual health, most people will not do so spontaneously. Needless to say, there’s a lot of work to do to encourage more doctors to bring up the topic proactively. If they do not, people should feel empowered to advocate for themselves. One way to do this is to ask your provider directly—"Who can I speak with about issues related to intimacy?” It’s a way to temper the expectation that your oncologist will have the answers. They might be able and comfortable to have this conversation with you, but more importantly, they should be able to point you to appropriate and useful resources.

What is the Sexual Health First Responders Clinic?

The Sexual Health First Responders Clinic is a specialized sexuality program for people with cancer and their partners, part of the Oncology Wellness Lifestyles and Survivorship (OWLS) program led by Dr. Christine Duffy and Cam Higel-McGovern, PA-C. Importantly, the clinic is not limited to people who are in remission or without evidence of their cancers. It’s open to anyone with issues related to their cancers who wants an opportunity to discuss further, regardless of where they are in their own cancer experience. Appointments are available once a week, at The Miriam Hospital.

If you are a cancer patient and concerned about or experiencing difficulties related to your sexual health, call 1-844-222-2881 to schedule an appointment or visit us online to learn more.

Don S. Dizon, MD

Don S. Dizon, MD

Dr. Don S. Dizon, FACP, FASCO, is an oncologist who specializes in women's cancers. He is the director of women's cancers at the Lifespan Cancer Institute and director of medical oncology at Rhode Island Hospital. His research interests are in novel treatments of women’s cancers and issues related to survivorship, particularly as they relate to sexual health after cancer for both men and women.