Q&A: Sexual intimacy problems in cancer patients

Sexual problems are one of the most common long-term side effects that cancer patients face. In a survey of MD Anderson cancer patients, almost half of men and women said they had new sexual problems after treatment. Common problems include:

• Erection problems in men
• Vaginal dryness and pain in women
• Loss of sexual desire

Below, Leslie Schover, Ph.D., professor in Behavioral Science and Gynecologic Oncology and Reproductive Medicine, answers common questions about sexual problems affecting cancer patients and how to address them.

Why do cancer patients often experience sexual side effects?
A major cause of these issues is physical damage or changes from cancer treatment. Radiation or surgery in the pelvic area can make sex painful or difficult, and may damage blood vessels or nerves critical for male performance.

In women, chemotherapy may cause premature menopause, and hormone therapies can be linked to discomfort or pain.

Aside from physical causes, a cancer patient’s emotional state can affect sexual desire. These problems can be worse in couples without open sexual communication.

How can sexual problems affect the cancer experience?
Losing the desire for sex or feeling unlovable can add to the grief and anger that cancer patients may feel. While caregivers and partners aren’t physically affected by the treatments, they share the emotional burden of sexual problems.

Couples may stop showing affection and discussing their worries. Fertility concerns also can cause anxiety.

These can all strain relationships, which are important sources of strength for those working to overcome cancer.

What treatment options are available to cancer patients dealing with sexual problems?
The best therapy for cancer-related sexual problems is a combination of medical treatment and brief counseling.

At MD Anderson, men can seek help from Run Wang, M.D., in Urology’s Sexual Medicine Clinic.

We also have several gynecologists who specialize in helping women with the side effects of their cancer treatments.

Our expert psychologist and sex therapist, Andrea Bradford, Ph.D., who sees women, men and couples, too.

Why don’t more patients and survivors seek out assistance?
It can be uncomfortable to talk about sexuality. Many people are afraid to bring it up due to cultural taboos or because they don’t realize how common these problems are.

And though it’s something to talk about with your doctors, these issues often don’t get brought up, unless the cancer patient does so.

What research are you doing to help cancer patients cope with sexual issues?
MD Anderson offers programs to provide counseling for sexual problems, including peer-based and online programs. Internet counseling provides the opportunity for self-help, which can alleviate some of the privacy or embarrassment concerns.

We are currently enrolling men in a study called “hardtimes: Cancer and Men’s Sexual Health.” It is open to men ages 18 and older with any cancer type, and provides access to self-help personal and couples counseling with the option for supplemental phone coaching.

What’s your advice for cancer patients with sexual problems?

Talk to your doctors or nurses about your problems. Sexual health is an important part of your quality of life no matter how old you are. If your team can’t answer your questions, ask for a referral to the Sexual Medicine Clinic or one of the specialists mentioned above.

Also be sure to openly talk to your partner about your problems. The more you involve your partner, the more likely you are to have a good outcome.