Research shows women are less likely to hear how cancer treatments might impact their sexual health. Experts weigh in on how women can explore these questions with their doctors and partners.
Women’s sexual health can feel like a taboo topic, both for women and their doctors. A recent study looked at a national sample of 391 cancer survivors who were asked via social media (Facebook and Twitter) about how their intimacy was affected by cancer. In preliminary results, women said they were counseled about their sexual health about half as often as men undergoing cancer treatment.
“Both men and women reported cancer’s effects on intimacy at higher rates than we expected,” says Dr. Nicole Simone, senior researcher on the study and a radiation oncologist specializing in breast cancer. “We expect 40-50% of patients to have sexual health side effects, but the results of our sample were closer to 90%. Men were much more likely to have had conversations with their doctors about sexuality,” says Dr. Simone, who is also co-leader of the Sidney Kimmel Cancer Center’s (SKCC) Cancer Risk and Control Program.
The results were presented at this year’s American Society for Radiation Oncology’s annual conference.
“I’m not that surprised that women had fewer conversations about sexual health,” says Andrea Braverman, PhD, a clinical professor of both OBGYN and psychology. “Female arousal isn’t a switch that goes on or off, and you can’t treat it with a pill. It’s often much more complex, and multifaceted – so it’s not going to be a simple conversation, although it is still an important one.”
“The good news,” says co-author on the study, Dr. James Taylor, who is chief resident in radiation oncology at the SKCC, “is that there are tools already in place to help physicians start the conversation with women in treatment.” Surveys and questionnaires filled out in private can be a great way to start the conversation, he says. He hopes this research will help change how doctors approach the topic.
In the meantime, there’s a lot women can do to work on their sexual health. We talked to experts in cancer care about how patients can find their way back to intimacy after cancer treatment. Here’s what they said:
Ask your doctors and nurses if there are medical options
Depending on type of cancer and treatment, women can experience changes in body shape, scarring, or other physical changes that impact sex.
Not everything can be treated medically, but there are a number of options available for some of the physical changes that result from cancer therapy. For example, “after pelvic radiation, some patients experience narrowing of the vaginal canal called vaginal stenosis, which can cause painful sex,” says Dr. Taylor. In these cases, he says, a physician might recommend a dilator. Other causes of painful intercourse can be treated with physical therapy, such as pelvic-floor exercises. Other treatments can cause severe vaginal dryness, for which a physician could discuss the use of lubricants.
It may not seem like an oncology doctor is the right person to ask these questions, “but there are actually a lot of options we can suggest to patients, depending on their cancer treatment,” says Dr. Taylor.
Don’t neglect the emotional side of intimacy
In the study, the three most commonly cited side effects from cancer therapy for women were painful intercourse (73%), body image distortions (54%) and inability to achieve orgasm (42%).
While some of these issues can stem from physical changes, many are influenced by how women feel about intimacy, and how those feelings change after cancer. “How do you, as a cancer survivor, reconnect with your body as a sexual being,” says Dr. Braverman. “If you’re with a partner, can you enjoy the physical sensation of being touched, of holding their hand?” It can take time to find what’s right for you, and it’s helpful to start small. “Starting slow can also help put aside the guilt that many women feel when they have not been sexual.”
Two books that Dr. Braverman recommends to patients and their partners are Healing Painful Sex and Come as You Are. The first discusses some of the physical and psychological aspects of painful sex and can help women zero in on causes. The second book delves into the emotional aspects of intimacy and explains why stress, mood, trust and body image are not peripheral, but central to a woman’s sexual wellbeing.
Check in with yourself about body-image changes
Body-image changes can have a major impact on women’s sense of self, which can in turn affect intimacy. “Tune in and listen to what you’re telling yourself. If you hear things like: ‘I’m not attractive anymore, no one will find me sexual, my body should function the way it always had,’ it might be time to delve deeper into those assumptions,” says Dr. Braverman. These thoughts are not easy to overcome on an emotional level, and can have an outsized impact on physical intimacy. “Patients have to look at their bodies anew and learn all over again how to love them. That can be hard work.”
One thing to try is to start from scratch in the bedroom, as if you’re dating again. “We are very goal oriented, which can be a major barrier for some people in the bedroom,” says Dr. Braverman. “It can be helpful to start by changing the goal. Perhaps it’s not orgasm but instead physical closeness and pleasure – or experimenting with different positions and finding what feels good.” What’s even more important is to try to have fun and be playful while you do this discovery, rather than setting it up as a success or failure.
Ask about support
Check out the resources available at your cancer center’s support center, many will be offered free of charge. “We normally refer our patients to our Welcome Center, where women can look into an array of free classes, seminars, workshops and other resources – some of which are focused on regaining intimacy,” says Celeste Vaughan-Briggs, an oncology social worker with the SKCC.
An oncology social worker can be a helpful resource in terms of figuring out a starting point that makes sense for you. “A lot of what we do with patients is listen to their concerns and help them formulate their question, their needs, and then help navigate to good resources,” says Vaughan-Briggs.
Young-adult cancer survivors have different concerns
For women who are dating, it can be difficult to know when to bring up cancer treatment in the conversation. If there are physical signs or scar, it can be useful to think through how you might bring them up with a romantic partner, says Dr. Braverman.
Vaughan-Briggs often suggests a few online forums like Young Survivorship Coalition, which offers tips as well as a community of survivors who can share in your experiences.
Additional Reading and Resources:
Young Survivorship Coalition’s page on sex and intimacy,