Cancer

The diagnosis "cancer" has a tremendous impact on any person’s existence. Once the initial shock has subsided, the affected individual may begin to focus on resuming life under changed circumstances. Often, trying to maintain sexual wellness has a low priority in this effort, even though it is a basic human need which significantly affects quality of life.

Sexual wellness in the cancer survivor is not only affected by the psychological impact of the diagnosis and the disease itself, but often also by the treatment necessary to fight the disease. Ask your oncologist what impact the cancer may have on your sexuality. It is important to discuss your concerns and the possible relief of sexual problems with the health professionals around you. If you have a partner, include him or her in these discussions.

Three facts are important to emphasize:

Cancer is not contagious.
Receiving radiation therapy does not harm others.
Undergoing chemotherapy does not put your partner at risk.

These are all potential misconceptions that can affect intimacy between cancer survivors and their partners.

Management of sexual problems

	Not only pelvic, gynecological, and breast cancer but any cancer can affect your feelings of attractiveness and your sexual wellness.
	Anxiety, depression, grief, emotional stress or fatigue may reduce your desire for sexual activity.
	Try to fill your need for emotional support and physical contact by a partner, family member or a friend.
	If you have a partner, hug, kiss, embrace each other. Do not hold back these gestures in fear of triggering sexual feelings.
	Try to be open with each other about how your life is affected by your disease.
	Talk about problems as they appear.
	Go to the doctor together. It will be easier to absorb all information, and you can give each other support.
	Side effects of current medications can affect sexual function, including erection, vaginal lubrication, and the ability to achieve orgasm. Ask your doctor for information about your medicines.
	Women who experience pain during intercourse should address this problem with their oncologist or gynecologist and ensure that the pain is not due to a malignancy. Pain during intercourse can sometimes be relieved if the female is on top, controlling the level of penetration and the amount of thrusting.
	Dry orgasms (retrograde ejaculation) happen in some men after pelvic surgery. Usually this is due to the ejaculate not flowing out through the urethra, but rather being emptied (flowing "backwards") into the bladder. This condition is not dangerous. Most men with dry orgasm claim that the sensation during orgasm is unchanged.
	If erectile function is severely affected there are several treatment methods available, including medications, vacuum pumps, sexual counseling or sex therapy, etc.
	Remember that erectile dysfunction does not prevent you from being sexually active and giving towards the one you love. This may be a good time to explore alternative ways of being intimate with your partner.

Fertility & pregnancy

	If you are in the reproductive age, fertility may be a concern for you.
	Consider getting genetic counseling.
	Women with cancer who wish to become pregnant in the future should discuss this concern with their oncologist. Possibly, the treatment plan can be adjusted accordingly.
	Men with cancer concerned about their reproductive potential should discuss this topic with their oncologist. Sometimes, it is appropriate to consider the freezing of sperm for future use in artificial insemination before cancer treatment begins. The testicles can be shielded from radiation delivered to the pelvic area.

Different treatment options for cancer and their possible impact on sexuality

The following information summarizes a wide spectrum of factors that may or may not affect sexual wellness. The information should not alarm you but rather be seen as a tool for those people afflicted with cancer who do experience and wish to understand sexual problems.

Oncologists will recommend the best treatment option for cancer on an individual basis. Different treatments include:

Surgery
Radiation therapy
Hormonal therapy
Chemotherapy.

Some of the treatment-related affects on sexuality are:

1) Following surgery:

Some types of pelvic surgery (removal of the prostate, uterus, ovaries, bladder, colon, or rectum) can damage nerves important for sexual function. Erectile difficulty in men and incontinence in both sexes may follow a radical pelvic operation. If a woman has had her ovaries removed due to cancer, menopause immediately sets in, often causing hot flashes and mood-swings. Pain during intercourse may sometimes be due to adhesions following surgery or inadequate lubrication.

2) Following radiation therapy:

Radiation administered to the pelvic area can affect hormone levels and fertility if testicles or ovaries are within the target area of the radiation. If possible, sex organs will be shielded from radiation. The techniques for administering radiation therapy are constantly being improved, reducing the size of the areas receiving radiation and therefore the amount of negative side effects.

3) Following hormonal therapy:

Hormonal therapy is usually directed against cancer cells that are sensitive to or depend on certain hormones (androgens, estrogens) for growth. Side effects of hormonal therapies include decreased sexual desire, hot flashes, cessation of menstruation in premenopausal women, urinary and/or erectile dysfunction, edema, vomiting, and nausea.

4) Following chemotherapy:

Chemotherapy may trigger menopause in women, causing vaginal discomfort (including soreness and dryness), hot flashes, mood-swings and decreased libido. Application of estrogen cream may reduce or relieve some of these side effects. Other side effects of chemotherapy include hair loss, weight loss, fatigue, anorexia (decreased appetite for food), nausea, vomiting, and bone marrow depression. Many of these side effects will cease over time following the completion of chemotherapy treatment.

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