Cancer and Sexual Health (cont.)

Assessment of Sexual Function in People with Cancer

Sexual function is an important factor that adds to quality of life. Patients should discuss their problems and concerns about sexual function with their doctor. Some doctors may not have the appropriate training to discuss sexual problems. Patients should ask for other information resources or for a referral to a health care professional who is comfortable with discussing sexuality issues.

General Factors Affecting Sexual Functioning

When a possible sexual problem is identified, the health care professional will do a detailed interview either with the patient alone or with the patient and his or her partner. The patient may be asked any of the following questions about his or her current and past sexual functioning:

  • How often do you feel a spontaneous desire to have sex?


  • Do you enjoy sex?


  • Do you become sexually aroused (for men, are you able to get and keep an erection, or for women, does your vagina expand and become lubricated)?


  • Are you able to reach orgasm during sex? What types of stimulation can trigger an orgasm (for example, self-touch, use of a vibrator, shower massage, partner caressing, oral stimulation, or intercourse)?


  • Do you have any pain during sex? Where do you feel the pain? What does the pain feel like? What kinds of sexual activity trigger the pain? Does this cause pain every time? How long does the pain last?


  • When did your sexual problems begin? Was it around the same time that you were diagnosed with cancer or received treatment for cancer?


  • Are you taking any medications? Did you start taking any new medications or did the doctor change the dose of any medications around the time that these sexual problems began?


  • What was your sexual functioning like before you were diagnosed with cancer? Did you have any sexual problems before you were diagnosed with cancer?

Psychosocial Aspects of Sexuality

Patients may also be asked about the significance of sexuality and relationships whether or not they have a partner. Patients who have a partner may be asked about the length and stability of the relationship before being diagnosed with cancer. They may also be asked about their partner's response to the diagnosis of cancer and if they have any concerns about how their partner may be affected by their treatment. It is important that patients and their partners discuss their sexual problems and concerns and fears about their relationship with a health care professional with whom they feel comfortable.

Medical Aspects of Sexuality

Patients may be asked about current and past medical history since many medical illnesses can affect sexual function. Lifestyle risk factors such as smoking and high alcohol intake can also affect sexual function as well as prescribed and over-the-counter medications. Patients may be asked to fill out questionnaires to help identify sexual problems and may undergo a variety of physical examinations, blood tests, ultrasound studies, measurement of nighttime erections, and hormone tests.

Treatment of Sexual Problems in People with Cancer

Many patients are fearful or anxious about their first sexual experience after cancer treatment. Fear and anxiety can cause patients to avoid intimacy, touch, and sexual activity. The partner may also feel fearful or anxious about initiating any activity that might be thought of as pressuring to be intimate or that might cause physical discomfort. Patients and their partners should discuss concerns with their doctor or other qualified health professional. Honest communication of feelings, concerns, and preferences is important.

In general, a wide variety of treatment modalities are available for patients with sexual dysfunction after cancer. Patients can learn to adapt to changes in sexual function through reading books, pamphlets, and Internet resources or listening to and watching videos and CD-ROMs. Health professionals who specialize in sexual dysfunction can provide patients with these resources as well as information on national organizations that may provide support. Some patients may need medical intervention such as hormone replacement, medications, or surgery. Patients who have more serious problems may need sexual counseling on an individual basis, with his or her partner, or in a group. Further testing and research is needed to compare the effectiveness of various treatment programs that combine medical and psychological approaches for people who have had cancer.

Fertility Issues

Radiation therapy and chemotherapy treatments may cause temporary or permanent infertility. These side effects are related to a number of factors including the patient's sex, age at time of treatment, the specific type and dose of radiation therapy and/or chemotherapy, the use of single therapy or many therapies, and length of time since treatment.

Chemotherapy

For patients receiving chemotherapy, age is an important factor and recovery improves the longer the patient is off chemotherapy. Chemotherapy drugs that have been shown to affect fertility include: busulfan, melphalan, cyclophosphamide, cisplatin, chlorambucil, mustine, carmustine, lomustine, cytarabine, and procarbazine.

Radiation

For men and women receiving radiation therapy to the abdomen or pelvis, the amount of radiation directly to the testes or ovaries is an important factor. Fertility may be preserved by the use of modern radiation therapy techniques and the use of lead shields to protect the testes. Women may undergo surgery to protect the ovaries by moving them out of the field of radiation.

Procreative Alternatives

Patients who are concerned about the effects of cancer treatment on their ability to have children should discuss this with their doctor before treatment. The doctor can recommend a counselor or fertility specialist who can discuss available options and help patients and their partners through the decision-making process.

The above information has been provided with the kind permission of the National Cancer Institute (www.cancer.gov).


Last Editorial Review: 7/7/2004