Saturday, March 11, 2023

Sexual problems plague women after cancer diagnosis, but little is being done, docs report

Despite a wave of new research around cancer treatment and sexual health, women say their issues are still being dismissed.

That long subhead sits under the headline "When Cancer Upends Your Sex Life" on a story by Catherine Pearson in yesterday's editions of The New York Times.

The article states unequivocally that "cancer can devastate a woman's sexual function in countless ways, both during treatment and for years down the road."

Chemotherapy, it elaborates, "can cause vaginal dryness and atrophy…but it can also prompt issues like mouth sores, nausea, and fatigue."

Surgery such as "a hysterectomy or mastectomy can rob women of sensations integral to sexual arousal and orgasm," the piece continues, and "pelvic radiation therapy can lead to vaginal stenosis, the shortening and narrowing of the vagina, making intercourse excruciating, if not impossible."

In addition, Pearson's story says, "sadness, stress, and body image issues can snuff out any sense of sexual desire."

The article cites a 28-year-old Stage 3 breast cancer patient who "developed vaginal dryness so severe that her skin began to deteriorate and was covered in small, paper cut-like tears. Urinating was comfortable; sex agonizing" — but when she told her oncologist about the pain "and how her libido had evaporated almost overnight," he responded dismissively.

That, Pearson indicates, is not unusual.

Dr. Elena Ratner
The Times piece quotes Dr. Elena Ratner, a gynecologist oncologist with the Yale Medicine Sexuality, Intimacy, and Menopause Program," to the effect that "the damage that is done is not only physical…From the diagnosis to the fear of recurrence to how they see their bodies, they feel like their whole sense of self is different."

What can be done?

Physicians need to ask female patients abut sex more often —much as doctors ask male prostate patients. 

Until that occurs, the story maintains, the issue will remain the same. 

Pearson quotes Sharon Bober, psychologist and director of the Dana-Farber Cancer Institute's Sexual Health Program, as saying that such questioning must become routine — "so that it's not something special or different, and it's not based on a health care provider's perspective about whether someone is sexually active."

A 2020 survey of 391 cancer survivors found, according to the Times piece, "that 53 percent of male patients were asked about their sexual health by a health care provider, while only 22 percent of female patients were asked the same."

Dr. Jamie Takayesu, a radiation oncology resident physician at the University of Michigan Rogel Cancer Center and a lead author on the study, reportedly said "the research was inspired by her own nagging sense that she wasn't asking female patients about sex often enough, and she suspected her colleagues weren't either."

The reasons, she hypothesized, were that physicians might be more inclined to focus on quality of life issues with men because prostate cancer has a high survival rate; that there are "more formalized tools" to assess sexual function in men; and that "many cancer doctors…[get] little to no training in how to talk about sex," the story says.

Possibilities for more help lies in the proliferation of multidisciplinary sexual health programs — at least in large hospitals or urban cancer centers.

Online communities and advocacy groups also can be helpful resources.

The Times story also quotes Dr. Laila Agrawal, a medical oncologist specializing in breast cancer at Norton Cancer Institute in Louisville, Kentucky, to the effect that "the number of women affected by sexual health concerns after a cancer diagnosis is huge, and the need for the women to have access to medical care for sexual dysfunction after cancer is enormous…I really want women with cancer to know that sexual health problems are treatable medical problems, and they can get better…I just want to offer that out as hope."

More information on women's sexuality and disease can be found in Rollercoaster: How a man can survive his partner's breast cancer, a VitalityPress book that I, Woody Weingarten, aimed at male caregivers. 

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