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Women’s Sexual Health
Sexuality and Intimacy Following Cancer
a report by
Megan Kunz, MA
1
and Don Dizon, MD, FACP
2
1. Medical Student, Albany Medical College; 2. Co-Director, Center for Sexuality, Intimacy, and Fertility, Program in Women’s Oncology,
Women and Infants’ Hospital, Warren Alpert Medical School of Brown University
While cancer continues to affect over one million people in the US Radiation Therapy
annually, approximately 62% of cancer survivors are expected to live at The effects of radiation therapy on a woman’s sexuality have been well
least five years after their original diagnosis and, as of 2000, close to 10 described. In women with breast cancer, radiotherapy induces skin
million cancer survivors were alive in the US.
1
It is no longer appropriate changes that result in thickening, contractures, or changes in texture and
to assume that a patient can resume a ‘normal’ pre-cancer existence, color, or, in some cases, chronic breast pain, any of which can affect a
particularly at the end of treatment, which usually consists of multiple woman’s desire or ability to enjoy sexual activity. For women treated with
modalities including surgery, chemotherapy, endocrine treatment, and/or pelvic radiation, vaginal fibrosis may result, which can also have an
radiotherapy. Among the many issues facing cancer survivors, issues impact on a woman’s capacity for penetrative intercourse, as well as
around sexuality and sexual dysfunction are among the most common affecting her genital, pelvic, and clitoral sensitivity during sexual activity.
complaints, with up to 90% of women treated for cancer being
affected.
2
In this article we will review the impact of cancer treatments In one study, women with cervical cancer who were treated with surgery,
on women’s sexual function. radiation, or combined surgery and radiation were evaluated.
5
Fewer than
1% of those who underwent surgery had complaints consistent with
Surgical Therapy vaginal shortening. Nearly 80% of women who had received radiotherapy
Removal of pelvic organs may result in both physiological and psychological reported sexual changes related to their vagina.
6
injury, which in turn can interfere with sexual function. In addition, an
irreversible menopause occurs in women who have undergone an Chemotherapy
oophorectomy and this sudden loss of estrogen induces hot flashes, vaginal Among the treatments for cancer, the use of cytotoxic therapies is
thinning and dryness, and, psychologically, a negative change in her self- perhaps the biggest factor in inducing sexual dysfunction. In pre-
view, which may be associated with the loss of reproductive capacity. Work menopausal women, chemotherapy has the capacity to induce ovarian
has demonstrated that such changes in the hormonal milieu affecting both failure, leading to an acute and sudden loss of estrogen. This has multiple
estrogen and testosterone are a likely etiology of women’s sexual side effects, including thinning of the vaginal membrane with attendant
effects.
3
For women with early ovarian cancer followed up to two years, dryness, premature menopausal symptoms, and lack of interest. Due to
estimates are that over 50% feel that their sex life was negatively affected these changes, a woman may experience dyspareunia and chafing during
and up to 75% feel their sex life is no better than adequate.
4
Of greater penetration, which can sometimes result in bleeding.
concern is that more than one-third report a ‘moderate’ to ‘great’ sense of
loss regarding the loss of sexuality.
Megan Kunz, MA, is a fourth-year medical student at Albany
Medical College. She is applying for residency in general surgery
Women undergoing surgical treatment for cervical, vaginal, or vulvar and plans on pursuing a fellowship in surgical oncology or
cancers also experience anatomical changes that may induce dyspareunia
breast surgery. Her undergraduate degree is in African and
African American Studies from The University of Chicago, and
(painful intercourse) by shortening the vaginal length or inducing surgical
she holds a masters degree from Boston University.
scarring and fibrosis, with attendant effects on mobility. As a result,
avoidance of vaginal penetration can occur as finding a comfortable sexual
position may become difficult and challenging.
Don Dizon MD, FACP, is Co-Director of the Center for Sexuality,
Intimacy, and Fertility, a specialized program for women with
Surgery for breast cancer can also result in sexual dysfunction and both cancer, located within the Program in Women’s Oncology at the
lumpectomy and mastectomy have been associated with changes in
Women and Infants’ Hospital of Rhode Island. He also serves
as Director of Medical Oncology and Integrative Care for the
sexuality. The reasons range from the psychological, including significant
Program. His clinical focus is in women’s oncology and he
changes in body image and self-esteem, or anatomical, resulting from loss specializes in the treatment of ovarian, endometrial, and breast
of feeling or hyperesthesia in the area treated surgically. Lymphedema,
malignancies. Dr Dizon also serves as Vice President of the
National Consortium of Breast Centers, and is an active
which can be a complication of surgery, can also affect comfort during
member of the Society of Gynecologic Oncology and the
sexual activity and may make sexual intimacy difficult or even painful. This American Society of Clinical Oncology (ASCO).
can cause larger problems beyond sexual function and can also affect
E: ddizon@wihri.org
partner relationships.
© TOUCH BRIEFINGS 2008
21
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