Dealing with breast cancer is not easy, for patients, families, and care providers alike. Even beyond the emotional and physical toll of cancer treatment, there are unacknowledged effects that every patient may face. Breast cancer survivors represent over 40% of all cancer survivors. Of these, around 50% report experiencing some sort of sexual difficulty, with 45% reporting sexual pain.
Chronic illnesses, such as cancer, can create a large burden on sexual health, which often goes unnoticed in care practices. This is not the fault of either the patient or healthcare professional, as not all individuals are comfortable discussing sexual health or think it’s related to cancer care. This is why this article aims to promote a more holistic approach to cancer care, emphasizing the importance of female sexual health in female breast cancer patients.
Sexual Health Impacts
Often, the effects of cancer and cancer treatment are intense. For example, chemotherapy, certain medications, and general fatigue related to cancer treatments can result in a loss of libido. This can be discouraging to many patients and may lead to sexual distress from feeling out of control of their body, sometimes adding another burden to sexual or romantic relationships on top of cancer-related stress.
Chemotherapy and hormone therapies may also cause early menopause, due to lower estrogen levels. This would lead to common menopausal symptoms, including vaginal dryness, which is known to cause painful sex. Additionally, in the case of genitourinary syndrome of menopause (GSM), women may experience dyspareunia or other vulvovaginal or urinary tract symptoms.
Additionally, in the case of mastectomy or lumpectomy, some women may feel less confident in sexual self, especially if the nipples and breasts were heavy erogenous zones for them. Weight gain (due to hormone therapies such as aromatase inhibitors or tamoxifen) may contribute toward a reduction in body confidence, as well as loss of body hair from chemotherapy. This can cause sexual distress and potentially lead to issues with arousal due to the psychological effects of body confidence on sexual health.
Helping Patients Address Cancer-Related Sexual Dysfunction
It’s important to make sure patients feel understood and supported when discussing sexual health. Often, patients may feel awkward or uncomfortable discussing sexual health. They may even feel as though they shouldn’t discuss sexual health with cancer providers. However, sexual health is a large part of a multidisciplinary approach to breast cancer treatment and may need to be approached by care providers first.
For estrogen-related issues, there are very few approved/recommended hormonal options for breast cancer, depending on the cancer’s hormone receptiveness. These options include topical lidocaine, DHEA (limited data on breast cancer patients), and local estrogen such as intravaginal estradiol. It may be beneficial to recommend these to patients if available.
Additionally, for menopausal or GSM-related issues, such as vaginal dryness water-based lubricants (such as SLiquid, Pre-Seed, etc.), paraben free, glycerin free silicone lubricants (such as Uberlube) vaginal moisturizers (for everyday use). For those struggling with sexual dysfunction like dyspareunia, dilators, or vibrators may be recommended to help address vaginal pain, as well as pelvic floor therapies.
In terms of psychological issues, it may be beneficial to recommend cognitive behavioral therapies, or other body confidence-related therapies, as well as recommending a sex therapist. For example, suggesting a patient introduce sexual activity into their life again in a gradual and exploratory manner. Additionally, couples therapy may be beneficial, in the case of disease-related relationship strain, as well as to help communicate changes to sexual functioning and needs.
Conclusion
The effects of breast cancer on survivors can feel quite debilitating. It’s important to consider sexual health as an essential aspect of cancer care in order to help patients fully adapt to their new life after treatment. Clinicians may need to start this conversation with their breast cancer patients in order to provide a holistic approach to care.
References:
Reclaiming your sex life after cancer. Journal of Oncology Navigation & Survivorship. (2019, September 9). https://www.jons-online.com/issues/2019/september-2019-vol-10-no-9/reclaiming-your-sex-life-after-cancer
Sexual health issues in women and cancer treatment - side effects. Sexual Health Issues in Women and Cancer Treatment - Side Effects - NCI. (2022, December 29). https://www.cancer.gov/about-cancer/treatment/side-effects/sexuality-women
Vegunta, S., Kuhle, C. L., Vencill, J. A., Lucas, P. H., & Mussallem, D. M. (2022). Sexual health after a breast cancer diagnosis: Addressing a forgotten aspect of survivorship. Journal of Clinical Medicine, 11(22), 6723. https://doi.org/10.3390/jcm11226723
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