In this video, Dr. Don Dizon gives an overview of sexual health and cancer, including the physical side effects and emotional issues that men and women may face. Dr. Dizon shares practical advice for discussing sexual health with the cancer care team and some personalized approaches to sexual health to consider.
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Full text transcript
Cancer.Net®: Doctor-Approved Patient Information from ASCO®
Sexual Health and Cancer: An Introduction
Don S. Dizon, MD: It’s been interesting to discover that men and women respond very differently to the experience of cancer when it comes to their sexual health. For men, it tends to be around issues of erectile dysfunction. Intimacy stems from the presence or absence of erectile dysfunction and we know from treating men with prostate cancer, that a man who is unable to have an erection also tends to withdrawal from his partner and that can again led to this concept that sexual health shouldn’t be something that the patient, him or herself, is dealing with, but we also have to consider who else is in their lives.
Contrast that with women who experience sexual health in a far more complicated way, where it can be anything from body image to the experience of arousal, to an experience of intimacy to satisfaction and issues related to orgasm and all of these can be together, presenting together at the same time or they can be isolated.
Women also can experience pain with penetration which is a very common symptom across cancers. But it doesn’t necessarily mean they will withdrawal from their partners. So the experience of intimacy is very much a separate experience from sexual intercourse. But for both men and women it falls under the characters of sexual health
Physical Side Effects Affecting Sexual Health
Dr. Dizon: The more common problems I see for patients treated with cancer are ones that are related to chemotherapy. A lot of it is due to side effects not related to their sexual well-being. It’s symptoms as common as nausea and vomiting, fatigue, neuropathy. All of these tend to dampen one’s enthusiasm to be intimate let alone being sexually active.
With those kinds of complaints, it’s important that the treating team do their best to try to manage these symptoms so that it can foster a sense of intimacy with their partners. And so, in a very indirect way we can actually help our patients feel better about themselves and with their partners.
For women, the issues tend to be, depend whether or not they are pre or post menopausal. Depends on what kind of treatments were received in the past, for example, women who receive chemotherapy at a young age tend to go into some degree of ovarian failure, which may or maybe be reversible. The experience of menopause that accompanies that can be very profound and can impact the ability to participate in sex comfortably.
And it can also lead to an ability to engage in an intimate way, whether that be towards difficulties with hot flashes, whether that be because of issues related to your inability or psychosocial distress.
Emotional Issues Affecting Sexual Health
Dr. Dizon: The emotional concerns that tend to accompany sexual dysfunction are the same ones that tend to occur by the mere nature of the diagnosis of cancer or their rediscovery of what it’s like to live after the diagnosis of cancer. So you are talking of issues related to depression, anxiety, insomnia, and a sense of overwhelming sadness, even if it doesn’t meet the criteria for say a major depression.
the presence of these symptoms tend to be associated with greater degrees of sexual dysfunction and greater problems with intimacy.
Personalized Approach to Sexual Health
Dr. Dizon: if there is an interest in preservation of sexual health or if there is an interest in addressing issues related to sexual health they all deserve that option met.
Not every woman or man is in a heterosexual relationship and so sometimes the way we approach patients with the assumptions that they are can be very damaging to the doctor patient relationship.
At the same time we need to be aware, women who are older, in their 70’s and 80’s can still have a sense of sexuality and we shouldn’t assume that patients past a certain age are not interested. Nor should we assume the single patient, male or female, is never going to be interested in finding a mate. Intimacy is important no matter whether or not you are in a current relationship, a stable relationship with a man or a woman.
Discussing Sexual Health with Your Cancer Care Team
Dr. Dizon: I do think it’s a responsibility for comprehensive and quality patient care that asking and offering assistance for patients who might have sexual health questions or difficulties with intimacy or even being engaged in sexual activity. They need to be given the information. They need to be given the option to discuss it. And we as clinicians need to be there for you.
For a lot of places, it will fall on the oncologist hand. And I believe that folks in a private practice or a smaller center where there may not be a navigator or in house social worker, they need to be prepared to answer these issues, or at least be comfortable exploring them initially.
For other places the oncologist may not be the front line to discuss these kinds of issues in addition to the psychosocial issues. There may be a wider net of resources available, such as a chemotherapy nurse or the nurse navigator or the nurse practitioner.
Where to Go for More Information
Dr. Dizon: There are many resources online for patients who are interested in more information in addition, there are several textbooks that have been written on this topic. Cancer.net has information for both men and women who are interested in learning more about sexual health and the impacts of treatment on sexual health, and it’s a great place to start.
[Closing and Credits]
Cancer.Net®: Doctor-Approved Patient Information from ASCO®
ASCO's patient education programs are supported by Conquer Cancer Foundation of the American Society of Clinical Oncology. ConquerCancerFoundation.org
Dr. Mary Wilkinson, Dr. Raymund Cuevo, and the staff at Medical Oncology & Hematology Associates of Northern Virginia
Carolyn B. Hendricks, MD, The Cancer for Breast Health
Hasbro Children’s Hospital
Helen F. Graham Cancer Center at Christiana Care Health System
The Adele R. Decof Comprehensive Cancer Center at The Miriam Hospital. The Miriam Hospital is a teaching hospital of The Warren Alpert Medical School of Brown University
Video Footage and photography courtesy of:
St. Jude Children’s Research Hospital Biomedical Communications
Moffitt Cancer Center
University Hospitals Case Medical Center Seidman Cancer Center
The opinions expressed in the video do not necessarily reflect the views of ASCO or the Conquer Cancer Foundation.
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