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
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
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
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.
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.
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 Last Editorial Review: 7/7/2004
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
The above information has been provided with the kind permission of the National
Cancer Institute (www.cancer.gov).