Masthead

Breaking the Silence: Talking to Your Doctor About Sexual Problems After Cancer

| Comments (2)

Bradford.jpgBy Leslie Schover, Ph.D., and Andrea Bradford, Ph.D.

According to a recent report from the Livestrong Foundation, 46% of cancer survivors have experienced a problem with their sexual function. Sound familiar? A survey at M D Anderson also found that 49% of men filling out the questionnaire had developed erectile problems since their cancer treatment and 45% of women had a loss of desire for sex and/or pain with sex.

Unfortunately, sexual health is not always "on the radar" in oncology health care, even at MD Anderson. But times are changing. As the number of cancer survivors in the United States approaches 12 million, their long-term health concerns are being recognized.Two clinical psychologists at MD Anderson are launching a series of posts on Cancerwise to share news, tips and important information about sexual health for cancer survivors.

By Leslie Schover, Ph.D., and Andrea Bradford, Ph.D.

According to a recent report from the Livestrong Foundation, 46% of cancer survivors have experienced a problem with their sexual function. Sound familiar? A survey at M D Anderson also found that 49% of men filling out the questionnaire had developed erectile problems since their cancer treatment and 45% of women had a loss of desire for sex and/or pain with sex.

schover.jpgUnfortunately, sexual health is not always "on the radar" in oncology health care, even at MD Anderson. But times are changing. As the number of cancer survivors in the United States approaches 12 million, their long-term health concerns are being recognized.Two clinical psychologists at MD Anderson are launching a series of posts on Cancerwise to share news, tips and important information about sexual health for cancer survivors.

Leslie Schover, Ph.D., is a professor in the Department of Behavioral Science who has spent much of the last 30 years focusing on the sexual and reproductive health of men and women with cancer. Schover is currently conducting research to test an Internet-based program for women with sexual concerns after breast and gynecologic cancers.

Bradford.jpgAndrea Bradford, Ph.D., recently joined the Department of Gynecologic Oncology and Reproductive Medicine. She has published several research studies on women's sexual health. Her clinical practice at MD Anderson focuses on women's cancer-related sexual and fertility issues, and she has published several research studies on women's sexual health.

In our first post, we wanted to provide suggestions on how to get help for a sexual problem.Studies show that patients would like their doctors or nurses to bring up the topic of sexuality. However, health care providers expect patients to ask questions about sex without being prompted. Thus, it is hardly surprising that sex is not often discussed in a busy cancer clinic.

Despite these communication breakdowns, many oncologists and nurses are sensitive to quality of life issues and are willing to help.

How to get help
If you need information on the causes of a sexual problem that developed after your cancer diagnosis, or suggestions for solving it, we offer the following strategies
  • When you make your appointment, mention that you would like a few extra minutes to ask some questions.
  • Write down your questions before you see the doctor and bring your list to your appointment. Try to be specific in describing your problem:
Example 1: It's been two years since my radiation therapy for prostate cancer, and I'm noticing that my erections aren't getting completely firm. I lose them easily, too. What can I do to solve this problem?

Example 2: I've been on Aromasin for three months and I'm having a lot of vaginal dryness. Intercourse hurts. What kind of help is available?
  • Most of us (including health care professionals) can be uncomfortable discussing sex. If you are worried about saying the words, calmly rehearse ahead of time. Try out your question with a spouse or good friend -- or at least say it out loud in front of the mirror.
Sexuality is an important part of your health. If your doctor does not have suggestions for solving your problem, ask for a referral to a specialist --typically a gynecologist if you are a woman, or a urologist if you are a man.However, make sure the specialist is knowledgeable about the sexual problems that cancer treatment may cause. A mental health professional trained in sex therapy can also work with your medical doctor to deal with the emotional side of the problem or to help with sexual communication.

2 Comments

I see all many articles on recovering sex life after prostate cancer but none of them address the biggest issue - the androgen deprivation treatment has stripped my husband of all desire and any interest in me. Not only am I dealing with the anxiety of his advanced disease, but I no longer have any sexual life. After a year of no sex, my pelvis caved in. I can't believe I am the only one in this situation. Where are all the women like me?

Leslie Schover, Ph.D.,provided this response to the question.

It is true that men on androgen deprivation therapy have a "double-whammy" compared to many men whose cancer treatment just damages local nerves and blood vessels needed for good erections.

Androgen deprivation affects sexual desire as it is perceived in the brain. I often think of one man who told me: "Imagine if someone put a delicious banquet in front of you. It smelled and looked appetizing, but you did not want to eat it because you were already full. That is how I feel about sex."

That said, many of us have noted that about 20% of men on androgen therapy manage to have reasonably normal sex lives. It takes more effort to get sexually excited--often both mental (like seeing a sexy film) plus physical stimulation. It may be more difficult to get a firm erection, but some men manage, as long as they don't try sex too often. They may need a few days in between tries. They also can have an orgasm, but again, with longer and more intense mental and physical stimulation. Who are these men? Usually they are on the younger end of the spectrum for men with advanced prostate cancer. Usually under age 60 and certainly under age 65.

Before they began hormone therapy, they had good sexual function and fairly high desire for sex. They have good sexual communication with their partners and both the man and his partner are willing to experiment with different types of lovemaking. What about the other 80% of men? Men who miss having sexual desire sometimes wish to try a medical treatment to improve their erections. If a treatment such as pills (or more likely penile injection therapy) works, they enjoy the fun and intimacy of sex with a partner. Other men, like the husband of "desertedwife" just give up.

Sometimes they have no idea that some sexual pleasure would be possible if they gave it a good try. Sometimes their interest in sex was not so strong before they began hormonal therapy. Some men are turned off by changes in their body such as breast swelling. They feel embarrassed, like they have lost their manhood. Another issue is that many men, especially older men with traditional relationships, do not show affection openly to their partners unless it is designed to lead to sex. If their sex life is damaged, they no longer reach out with compliments, cuddling, or kissing. Women often miss this part of the couple's routine as much or more than intercourse. Often women are concerned about trying to get some touching started because they fear humiliating their partner since he may not be able to "perform." I often call this pattern "When no erection equals no affection." When couples reach a state of silent alienation, it is time to do something to break the ice. Perhaps the woman needs to tell her partner how lonely and rejected she feels, not merely because he has an erection problem, but because the intimacy of their life together has disappeared.

If a couple often finds that talking about emotional issues leads to arguments and tension, such discussions may need a third party to keep them "safe." Of course I would suggest seeing a mental health professional familiar with the patterns of problems that couples experience after cancer, but if you are uncomfortable with that idea, what about seeking guidance from a religious counselor? Our chaplains at MD Anderson are particularly helpful with these types of issues if your own clergy do not have much experience. Another option is for one or both partners to try a support group for cancer patients and/or caregivers.

Leslie R. Schover, PhD
Professor of Behavioral Science

Leave a comment

Search

Connect on social media

Sign In

Archives