Discussing Sexual Side Effects Caused by Cancer Care

Anne Katz, PhD, RN, Cancer Care of Manitoba, Winnipeg, Canada, shares how best to talk to patients about the sexual side effects they may experience during and after cancer treatments, a topic she presented at the 2022 GDU Women’s Oncology virtual meeting.

In her presentation, Dr Katz discussed the different treatments for breast, gynecologic, and colorectal cancers that can lead to sexual side effects, and how providers can best address these issues with patients.

Transcript

Hi, I'm Dr. Anne Katz, a Certified Sexuality Counselor at Cancer Care of Manitoba in Winnipeg, Canada. Women’s cancers have a profound impact on sexuality and sexual functioning, and we know that 80% or more of women are going to experience sexual difficulties as a result of their treatment. This applies to all treatments — radiation, surgery, chemotherapy and importantly for women with breast cancer, endocrine manipulation therapy.

One of the important things to keep in mind, particularly if you are a breast cancer surgeon, is the importance of breast sensuality in a woman's sexual response. This is not often talked about. When women present with breast cancer and they ask for mastectomy and removal of the unaffected breast, it's important to talk about the role that breast touch and/or breast play plays in their sexual response. Dr Jennifer Gass [MD, Women & Infants Hospital, Providence, RI] has done incredible work around this. Breast sensuality is something that we need to focus on.

The aromatase inhibitors and to a slightly lesser extent, tamoxifen, also have a profound effect on women's sexuality, particularly in vulvovaginal atrophy. While this is a controversial topic, only some local estrogen is really going to help. Moisturizers and lubricants tend to be band-aid solutions. What we see with gynecologic and colorectal cancer is that radiation and surgery to the pelvis can cause obvious issues with vaginal shortening and narrowing, problems with dyspareunia, and vulvovaginal atrophy.

These issues can make penetrative intercourse painful and distressing, all of which will have a profound effect on the women's sexual relationship or relationships. It is important to talk about this. I know often people are a little bit reluctant to raise this topic with women. Healthcare providers and oncology care providers don't want to appear to be intrusive. However, if we wait for patients to raise this topic, we can often wait a long time.

I believe that it is our responsibility, as the prescribers of these lifesaving therapies, to ask about these topics and to ask how the relationship is going, to ask about any emotional or physical side effects of the surgery that impact on the woman's sexual functioning. You will find that once you start asking these questions, it gets easier and easier to have the conversation.

I have found from 2 decades of practice in this area that it is life altering for me, in terms of my own growth and understanding of the human condition. I encourage you to have the courage to just ask. You will learn a lot from the conversation.

Source

Kantz, A. Sexual Side Effects of Cancer and Care. Presented at: Great Debates & Updates in Women’s Oncology. Sep 21-23, 2022. Virtual.