Sex after cancer brings its own kind of debilitation.
Women who have faced and beaten gynecologic or breast cancer often survive with a problem rarely discussed. The surgeries and treatments have left them with concerns about their sex life, but they don’t know where to turn for help.
“It is sort of a ‘don’t ask, don’t tell’ situation,” says sex therapist Dr. Shirley Baron, who is an assistant professor of clinical psychiatry and behavioral sciences at Northwestern University. “The patient is hoping that her doctor will bring up the subject, and doctors aren’t quite sure they have the information to give them.
“But 65 percent of cancers involve sexual organs, and it makes sense that if you cut or remove or radiate sexual organs, and perhaps put a woman into surgical menopause and abruptly change her hormones, it could affect her sexuality, both physically and psychologically,” Baron says. “There are many studies that show that women want to talk about their sexual problems with medical providers.”
To fill that gap in communication between women and healthcare professionals, in 2008, the University of Chicago Medical Center launched the Program in Integrative Sexual Medicine (PRISM) for Women and Girls with Cancer. As one of the few centers in the United States that identifies, prevents and treats sexual health problems that are the aftereffects of cancer surgery and treatment, it offers women access to a wide array of medical professionals.
Dr. Stacy Lindau, an associate professor of obstetrics/gynecology and medicine-geriatics, who is the director of PRISM, says, “Simply educating a woman and letting her know that she is not alone and that the problems she is experiencing are not just in her head, and helping her cope with the changes that might have occurred, can be very impactful.”
Patients who find that sexual intercourse has become extremely painful because of severe vaginal dryness resulting from estrogen deprivation can find help at PRISM. “Many women who have cancers that are not hormone sensitive are eligible for estrogen therapy that can be applied locally to the vulva or the vagina,” explains Lindau. “We can counsel patients who are not good candidates for estrogen therapy because their cancers are estrogen sensitive about the use of lubricants and about techniques to address muscle dysfunction in the pelvic floor that sometimes contributes to pain. We can also discuss alternative ways of having intercourse that may be less painful.”
Women who have had mastectomies have their own concerns. “Studies have shown that for many women, breasts are a very important sexual organ,” says Lindau. “Some women do retain some sensation in the breast area that can still be sexually stimulating, while others feel a real sense of loss, and we help women work through these issues.”
Baron, who is also a clinical associate in the department of obstetrics and gynecology associated with PRISM says, “The psychological and the physical are often intertwined.” She points out that studies show that it is important to include the woman’s partner in these conversations about the effects of cancer surgery and treatment rather than talking to the patient alone. “When a woman goes through cancer it’s not just affecting her, it’s affecting the couple, so it’s important to involve both of them in the treatment,” she explains.
Therapy sessions with women who have had mastectomies underscore that importance. “Breast cancer surgery often affects a woman’s body image, and it may affect her response to stimulation because for a lot of women, breast stimulation is a way of becoming aroused, so it not only affects her image of herself but how she is used to responding,” Baron says.
“Often, couples really haven’t talked about the surgery, and the woman hasn’t talked about how she is feeling about herself. If she gets the reassurance that her partner is still attracted to her, she will feel more attractive, but the issue is also physical for her because if she is used to getting aroused by breast stimulation, they have to find new ways to be sexual together.”
Baron also sees women who experience lack of desire. “If a woman is experiencing pain during intercourse, suddenly or gradually she becomes less interested in participating… instead of anticipating pleasure and a positive experience, she’s anticipating pain and disappointment, so that definitively affects her desire.”
Educating a patient about common ways to eliminate pain can help to reduce the symptoms as well as to reduce the anticipatory anxiety and avoidance of sex. In some cases, when women are fearful of intimacy, Baron uses cognitive behavioral therapy. “I may make suggestions of some exercises they can do at home, starting with nonsexual kinds of touch and massage, which is less threatening, and then gradually adding more sexual touch,” she explains.
Baron, who has been practicing as a sex therapist since the mid-1980s, finds that people are much more informed about sexual problems today and that the stigma involved in seeking help has decreased.
“I find that if you ask the questions, people really want to talk about their problems,” she says.
Published in Chicago Health Winter 2012