Cancer treatment has always focused on survival. Now doctors are increasingly focusing on side effects, including the effect of treatment on sexual function and satisfaction. However, many patients are shy about bringing up their difficulties, unaware there are ways to help. One of the nation’s top experts discusses.
- Dr. Leslie Schover, clinical psychologist and founder, Will2Love.com
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Cancer Treatment and Sex
Nancy Benson: About 1.6 million Americans will be diagnosed with cancer this year…and over the course of our lifetimes, roughly 40 percent of us will receive that bad news. Today, nearly two thirds of people diagnosed with cancer survive it. But for many, life will never be the same…sometimes in ways they hadn’t counted on.
Dr. Leslie Schover: At least 60 percent of people with cancer treatment end up with a sexual problem. And these problems unfortunately don’t go away by themselves most of the time, but rather they require some kind of treatment often a combination of medical and counseling to resolve well.
Benson: That’s Dr. Leslie Schover, a clinical psychologist who’s internationally known for work on sex and cancer at the Cleveland Clinic and M.D. Anderson Cancer Center. She’s the founder of a startup website, will2love.com, designed to help people solve sexual problems and infertility that result from cancer treatment.
Schover: The most common ones for men and women include a decrease in desire for sex and the ability to feel pleasure during sex. For women the second big one is dryness and pain during sexual activity and for men of course we often think about erectile dysfunction or E.D. as we tend to call it.
Benson: Those are topics that most people are shy about bringing up. This is no exception… and the reluctance comes from both ends.
Schover: Most oncologists get very little training in talking to patients about sex. Oncology nurses and social workers have a lot of motivation to help patients, but often also don’t have a lot of knowledge or training. And a lot of professionals assume that if a patient has a question about sex they will bring it up. But our research suggests that only happens maybe 10 percent of the time in medical settings. And that maybe 90 percent of the time people are too embarrassed or think it’s not appropriate or just don’t bring up their questions.
Benson: Some situations may promote even more reluctance.
Schover: Some people are gay or bi-sexual and may not want to disclose that in a medical setting. They may have been negatively judged in the past and we tend to assume that everyone’s heterosexual when we’re talking to them about sex in a medical setting.
Benson: When clinicians do bring up sexual issues, Schover says they typically do it only in the starkest terms, as if the mechanics of sex are all that matter. But she says people are worried about more than that.
Schover: Like, will I be able to enjoy a variety of sexual practices? Will my partner still find me attractive? If my cancer was related to a sexually transmitted virus am I still dangerous to my partner? Then they have the issue of dating after cancer and people often are reluctant and worried about how a new partner is going to accept the news that they have had a history of cancer and end up with some kind of damage to their sex life.
Benson: Seeking help after treatment is a good thing, since so many patients never do it at all, but Schover says it’s probably a little bit late. Addressing the issue actually should start as soon as a patient gets a cancer diagnosis. Survival is clearly their number one concern in choosing a treatment, and patients may think about side effects like nausea, as well. But Schover says sexual fallout is only sometimes considered at all.
Schover: When we do surveys it appears like about half of patients get something in their informed consent for treatment whether that’s surgery, chemotherapy or radiation therapy that mentions the possibility of a sexual problem, but that means that about half don’t. It’s true that breast and prostate are the sites we think of a lot, but what about colorectal, bladder cancer, and some systemic cancers? Intensive chemotherapy can cause premature menopause for women or damaged nerves or hormone levels in men.
Benson: Schover says especially when it comes to prostrate and breast cancer, a variety of different treatments are equally effective. However, they provide completely different sexual consequences, and doctors often don’t adequately explain them.
Schover: So for prostate there’s a question of radical prostatectomy, which probably leaves about three-quarters of the men with significant erection problems no matter how good the surgeon is, and even if the man starts out with good erections. With breast cancer there’s a lot of pressure now sometimes inappropriately to do a compete mastectomy and breast reconstruction without a lot of explanation that the reconstructed breast may look pretty, but it’s not going to have much of any sensation let alone erotic sensation.
Benson: One other facet of life that’s often affected by cancer treatment is fertility. Clinics are getting better about talking about it with younger patients, but only about a quarter of men who are eligible to bank sperm do so… and only about 10 percent of women preserve their eggs for later use.
Schover: There are a couple of major problems. One is that the decision to preserve eggs or sperm or create embryos before cancer treatment has to be made usually relatively quickly, like the whole process may only take anywhere from a couple of days to a couple of weeks for women but there are a few types of cancer like acute leukemia where it may not be safe to postpone retreatment even that much. For most other types of cancer it isn’t terribly dangerous to postpone treatment as far as we know, or research has shown, but patients and even oncologists have the mentality well, my god you have cancer, you should get treatment tomorrow. So although sometimes of course just scheduling cancer surgery or radiation therapy is going to take several weeks because of the schedules of the treatment settings. So that’s one barrier — the fear of delaying treatment.
Benson: Preserving eggs is an especially costly procedure, as well, and insurance often doesn’t cover it. But Schover says many cancer clinics—even some that are well known—are poorly equipped to deal with sexual and infertility problems in patients. SC hover’s extensive website, will2love.com, seeks to fill that gap by answering questions and even offering self-help and counseling services. You can find out more by visiting will-the-number-2-love-dot-com, or through a link on our website, radiohealthjournal.net. Our production director is Sean Waldron. I’m Nancy Benson.