Sexual Health and Fertility in Cancer Care

Last Updated: August 26, 2020

A cancer diagnosis and treatment can cause physical and emotional changes that affect intimacy, sexual health, and fertility. In this video, Dr. Don Dizon offers guidance and encourages patients to talk with their oncology team about these important topics.  

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Sexual Health and Fertility in Cancer Care

Voiceover: A cancer diagnosis and cancer treatment can cause physical and emotional changes that affect many aspects of a person's life, including their sexual health and fertility.

Don S. Dizon, MD, FACP, FASCO; Medical Oncologist; Member, American Society of Clinical Oncology: For people who are undergoing treatment for cancer, or even before they start treatment for cancer, oftentimes, they will have some impacts on sexual health as well as on intimacy. Sometimes even starting at the point of diagnosis. This can be very subtle: difficulty having penetrative intercourse for couples who do that, related to pain or just generalized abdominal discomfort. But as people go through the treatments for cancer, whether that be surgery, chemotherapy, radiation therapy, or endocrine therapy, all of those modalities will also have an impact on how the patient physically can experience sexual activities, but also emotionally, how they can connect with their partner. And it also has an impact on that partner, who, all of a sudden, is mentally becoming more of a caregiver and less of an intimate partner.

Voiceover: Women and men can both experience changes in desire and interest, body image issues, and pain during sex. Women can experience a variety of other symptoms, such as effects of early menopause, including vaginal dryness and hot flashes. Symptoms in men include erectile dysfunction and premature ejaculation.

Dr. Dizon: In terms of specific therapies that cause specific symptoms, I wish it was that simple. But in fact, sexual health is a construct and it has multiple components to it. Everything from body image to the experience of desire to the experience of arousal and even orgasm and then of satisfaction. So when one thinks about sexual health, they oftentimes don't think of it in a multi-domain way, it's more, it's a computer and when I turn it on, everything works. That's what breaks when cancer enters into the picture.

So surgery, you might lose your breasts, if it's for breast cancer, or you might lose your prostate for prostate cancer, or you might lose your uterus, if you have have uterine cancer or even ovarian cancer. Some of these we know are obviously going to impact body image, which might have an impact on how someone interprets sensual feelings. But it also might impact on how someone deals with their partner on an emotional or intimate level. Other parts that are "lost" to surgery, the uterus, the prostate, it's not so obvious what that experience is going to look like. For some men, it's the bother, because erections may not be as robust as they were used to. For women, it may be vaginal shortening. So the entire experience of penetration becomes painful.

For chemotherapy, it tends to be a bit more generalized. Chemotherapy causes a lot of physical side effects, whether that be fatigue, whether that be nausea, whether that be lowering of the blood counts, but it also causes dryness in women. And that can be for women who already went through menopause.

Voiceover: Patients are encouraged to talk to their oncologists about any of these side effects. Many oncologists will make it part of their routine questions during patient evaluations, and have resources they can offer their patients.

Dr. Dizon: It should be something we all incorporate in just a general medical history. And I think that's important because, for the patient, that's the in that they will walk away from. So maybe they don't want to talk about it now, but they will remember that at one point, you asked about their sexual life, that you were open to hearing about their sexual life. And that's a really nice step to give them permission to talk about it. And it might not be a sexual health program embedded in the center where people are going for cancer treatment like we have at my institution and in select institutions across the country, but it might also be, "here are some pamphlets that have very good information, here are some folks locally who I have sent people to, who can address these issues." These are some things that are pretty simple to do. And it might actually make a whole heck of a lot of difference. But making sure patients know this is an area we care about as your cancer team, I think is the biggest way to impact on those side effects.

Voiceover: Related to sexual health, a patient's fertility can also be affected after cancer treatment. Depending on the type of cancer someone has, fertility issues can be a result of cancer surgery or cancer treatment or both.

Dr. Dizon: The definition of fertility is the ability to conceive children. So for men, it's-- fertility for men is the ability to make sperm, viable sperm that, when it enters an egg, it can be fertilized. For women, it's the ability to generate new eggs that can be the grounds for a new life.

Voiceover: There are some cases where fertility cannot be preserved, but in many cases, it can be if patients and physicians talk about fertility risks and fertility preservation options before their cancer treatment begins. Having this conversation early in the process gives you access to a larger range of options, including egg and embryo freezing and sperm-banking.

Dr. Dizon: And so, the point is to provide the risk discussion before you begin treatment, offer the options of fertility preservation before treatment decisions are made, and then having them explore those options and proceed as they'd like to with as little delay as possible. So the conversation has to be not only between the patient and oncologist, but we have to bring in the urologist for men, the reproductive endocrinologist for women.

ASCO has guidelines and multiple national organizations have endorsed them, or have similar guidelines which say if you're going to expose a younger person to potentially fertility-impacting treatments, we have to discuss it up-front and provide them the options to preserve their fertility before we begin treatment.

In both men and women we have the option to preserve fertility through other means. In men, it's by sperm collection and freezing and for women, it's about collecting eggs or embryos, and freezing them before we begin therapy.

Voiceover: Some patients are referred to fertility specialists to discuss different fertility preservation options available to them before their cancer treatment begins. Women may be referred to a reproductive endocrinologist and men may consult with a urologist. Consult with a fertility specialist about parenthood options, including donated or frozen eggs, embryos, or sperm, surrogacy, and adoption.

The emotional toll of cancer can be even more challenging when your sexual health or fertility may be affected by the very medications and procedures that are meant to save you. It is important to know that you are not alone, and that is normal to feel a mix of emotions. Surround yourself with a strong support system as you decide on your best course of action with open communication among your family and friends, support groups, counselors, and health care team.

Dr. Dizon: For more information about sexual health or fertility after cancer, visit Cancer.Net.

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