Navigating the Intimate Terrain: Understanding Sexual Dysfunction Among Cancer Patients and How to Build a Comprehensive Team for Support

In the collective embrace of Prowl the LAB, we walk with courageous women and their partners as they confront the profound complexities of cancer—not only its assault on the body but also its impact on the intimate threads of their lives. Understanding the physical changes and the emotional tides that accompany a cancer diagnosis, we commit ourselves to offer a nurturing, multifaceted approach to vaginal health that honors the entirety of each woman's experience.

As we delve into the intimate concerns of women battling cancer, we recognize that this journey, though deeply personal, is shared by many. It is a path marked by challenges that affect not just physical well-being but also the essence of intimate connection. With empathy and expertise, we aim to shine a compassionate light on these issues, offering a guiding hand to empower and uplift.

Common Types of Sexual Dysfunction:                                                            

Vaginal Dryness and Atrophy

Vaginal dryness is a frequent, yet often overlooked, side effect for women undergoing cancer treatment. It can lead to a range of discomforts, from painful intercourse to an increased risk of infections. Dr. Deborah Coady, a gynecologic oncologist, shares that this condition is a common and distressing consequence that can hinder intimacy and emotional well-being.

Painful Intercourse (Dyspareunia)

"Affecting up to 60% of women with cancer, dyspareunia is a significant challenge that can stem from various factors, including vaginal dryness, atrophy, surgical scarring, and nerve damage." Dr. Sharon Bober, a clinical psychologist specializing in sexual health, emphasizes the importance of openly addressing dyspareunia and equipping women with strategies to manage pain and reclaim intimacy. Supporting her viewpoint, research in Psycho-Oncology reveals that breast cancer patients with dyspareunia may also contend with heightened risks of depression, anxiety, and body image concerns.

Decreased Libido

When battling cancer, many women experience a decline in libido. Factors such as hormonal shifts, fatigue, and emotional stress contribute to dwindling sexual interest. Dr. Don Dizon, a gynecologic oncologist, highlights the importance of acknowledging and supporting women as they navigate this complex aspect of their cancer journey. Studies show that a significant decrease in sexual desire following treatment is common for women with gynecologic cancers.

Body Image Concerns

"Cancer treatments can bring about substantial changes to a woman's appearance, giving rise to body image issues and impacting self-esteem." Dr. Leslie Schover, a clinical psychologist with expertise in cancer survivorship, points out the integral role of body image in sexual well-being and the importance of helping women feel confident in their bodies post-treatment. Research in the journal Body Image​ supports this, indicating that women who have undergone mastectomies or lumpectomies often report lower body satisfaction and sexual self-esteem.

Considerations for Different Cancer Diagnoses:Women undergoing cancer treatment, particularly for breast and gynecologic cancers, often face challenging side effects due to hormone therapy and other interventions. Reduced estrogen levels can lead to uncomfortable symptoms like vaginal dryness, atrophy, and a decrease in libido, while surgeries such as mastectomies may deeply impact body image and sexual identity. It's critical that healthcare providers proactively address these issues with effective treatments to support vaginal health and help women navigate the complex emotional landscape that accompanies changes in their bodies and sexual well-being.

Similarly, therapies for colorectal, anal, and hematological cancers result in complications like vaginal fibrosis and dryness, with radiation in the pelvic area causing additional discomfort and potential changes in sexual activity patterns. Moreover, treatments for cancers like lymphoma and leukemia may induce ovarian failure, increasing the likelihood of vaginal dryness and infections due to immunosuppression. In cases of vulvar skin cancer, local treatments can alter skin integrity and sensitivity, emphasizing the need for a holistic care approach. Across all cancer types, it is essential to integrate physical, emotional, and psychosexual care to ensure comprehensive support for women's overall health and quality of life.

Considerations for Effective Multidisciplinary Approaches

To address sexual dysfunction in women with cancer, physicians can employ a range of multidisciplinary techniques tailored to the specific type of cancer and the individual needs of the patient. Here are some approaches based on different cancer categories: 

Breast Cancer

• Collaborative Hormone Management: Endocrinologists and oncologists can work together to manage the side effects of hormone therapy, such as vaginal dryness and decreased libido.

• Reconstructive Consultations: Surgeons specializing in breast reconstruction can offer options that help restore a sense of body integrity and sexual identity.

• Psycho-Oncology Support: Psychologists trained in oncology can help women cope with changes in body image and sexual self-esteem post-mastectomy or lumpectomy.

  
  
  
  

Gynecologic Cancers (Cervical, Ovarian, Uterine, Vaginal, and Vulvar)

• Pelvic Floor Rehabilitation: Physical therapists can help women manage scarring and changes in vaginal elasticity due to surgery or radiation, improving comfort during intercourse.

• Sexual Health Counseling: Sex therapists or counselors can aid in addressing psychosexual concerns and helping women explore intimacy post-treatment.

• Menopause Management: Gynecologists can offer guidance on hormonal or non-hormonal treatments to alleviate symptoms of surgically or chemically induced menopause.

  
  

Colorectal and Anal Cancers

• Pelvic Radiation Management: Oncologists can collaborate with radiation specialists to minimize the impact of radiation on the vagina and provide therapies to maintain elasticity and reduce discomfort.

• Stoma Care Education: Stoma nurses can offer support and education to patients dealing with body image issues and sexual function following colostomy surgery.

  
  

Hematological Cancers (Lymphoma and Leukemia)

• Chemotherapy Side Effect Mitigation: A team that includes oncologists, gynecologists, and fertility specialists can assist with ovarian failure and vaginal dryness resulting from chemotherapy.

• Infection Prevention Strategies: Infectious disease specialists can help design preventive care measures to reduce the risk of vaginal infections due to immunosuppression.

  
  

Skin Cancers (Melanoma and Carcinoma)

• Local Skin Management: Dermatologists and oncologists can provide treatment options for skin cancers near the vulva that minimize changes in skin integrity and maintain sensitivity.

• Therapeutic Support: Psychologists and oncology social workers can offer emotional support to address the impact of skin changes on sexual function and body image.

  
  

​In treating sexual dysfunction among women with cancer, an integrated approach through multidisciplinary collaboration is key. Addressing the patient's physical, emotional, and psychological needs ensures comprehensive care. Healthcare providers must create a safe, open environment to discuss sexual health, combining patient education with therapies like lubricants, moisturizers, dilators, hormone therapy, and pelvic floor physical therapy to alleviate discomfort. Psychological support, including counseling services and support groups, is crucial for managing emotional complexities and relationship changes. Personalized care strategies, informed by the unique challenges of each cancer type and provided by a team of collaborating specialists, empower women to maintain sexual health and achieve a satisfying sex life during and after their cancer journey.

Connect with Prowl The LAB and become part of a community dedicated to nurturing vaginal health as an essential aspect of your well-being. Join us in celebrating the strength and joy that come from prioritizing your health in a vibrant, supportive environment where your journey to wellness is honored and encouraged.