During cancer treatments damage to the reproductive system is an important aspect of cancer morbidity.
As more people achieve long-term survival after cancer, sexual dysfunction and infertility have increasingly been recognized as negative consequences that impact quality of life. Problems with sexual function and fertility after cancer are not only ubiquitous; they are less likely to resolve with time than most other treatment side effects.
Surprisingly, not every cancer survivor cares about remaining sexually active; so long term sexual dysfunction has been documented in at least 50% of those treated for breast, prostate, colorectal or gynecological cancer.
What is the most common Sexual dysfunction from Cancer Treatment?
The most common sexual problems after cancer treatment include:
- Loss of desire for sex in men or women
- Erectile dysfunction (ED) in men,
- Pain during sexual activity in women
Why does it occur?
Cancer treatments may damage one or more of the physiological systems needed for a healthy sexual response, including hormonal, vascular, neurologic, and psychological elements of sexual function. Treatment also may entail removal or direct damage to parts of the reproductive organs.
Which type of cancers/cancer treatments are involved mainly in sexual dysfunction?
For Men: Radical surgery is performed to treat cancer of the prostate, bladder, or rectum that has been modified to spare nerves as they direct blood flow into the penis. There is a direct involvement of Penis, testes & scrotum by malignancy.
Radiation therapy to the pelvis starts a gradual process of fibrosis that eventually may damage both the nerves and blood vessels involved in erection.
For Women: Malignancies involving pelvic organs (ovaries, uterus, cervix, vulva & vagina, intestines, rectum etc) & breasts affect the final sexuality. The autonomic nerves that direct blood flow into the genital area with sexual arousal may also be affected by pelvic surgery, thereby impacting the sexual function.
How significantly the sexual dysfunction is truly affected?
Well-controlled studies of large populations including women have shown that benign hysterectomy, including removal of the cervix, does not impair women’s sexual pleasure or capacity to reach orgasm. But after radical hysterectomy most sexual problems may take a year to resolve after surgery.
What is the final outcome on sexuality post treatment completion?
All that cancer patients require is love and care. It is a difficult moment for them to recover because they know their body has gone through multiple changes. Post cancer treatment, the patient can have lack of desire for sex and reduced vaginal lubrication. If pelvic surgery impairs vaginal expansion and lubrication, then women can compensate it by using estrogen replacement or water-based lubricants.
If radiation therapy is used in the genital area, then women fare poor than men. Young women treated with radiation therapy for cervical cancer are significantly more likely to have problems with dyspareunia and other aspects of sexual function than matched controls.
Is any Sexual Rehabilitation possible after Cancer Treatment?
Yes. Understand that sexual problem in cancer survivors have organic causes that lead to behavioral changes. One predictor of a successful sexual rehabilitation is having a sexually functional partner who strives for sex. It is suggested that having firmer erections does not result in frequent and pleasurable sex.
Loss of desire for sex in women with ovarian failure is related to dyspareunia from vaginal atrophy. Dr. Ranga Rao suggests a hormonal treatment that involves the use of low-dose estrogens in the form of vaginal ring or suppository to treat pain that does not respond to water-based lubricants or vaginal moisturizers.
Vaginal dilation is accepted as a treatment to prevent vaginal stenosis and agglutination in women who have been given radiation therapy.
Can fertility be preserved after cancer therapy?
Women in an early stage or low grade gynaecologic cancer are able to preserve fertility by having limited surgery. Sperm banking in performed in males before the cancer treatment begins to preserve fertility in males. Sexual function and fertility can no longer be considered irrelevant by oncologists as our current cancer therapies damage reproductive health.