Sexual problems and cancer: Don't ignore it

In early April, the first guidelines on care for sexual problems were published by the National Comprehensive Cancer Network (NCCN).

These guidelines are included in their new Survivorship Guidelines.

Since cancer survivorship begins as soon as someone receives a cancer diagnosis, the guidelines can improve care for both patients who are still planning their cancer treatment and those who are undergoing cancer treatment or have finished active therapy.

Sexual problems are common among cancer patients
Sexual problems are, unfortunately, a very common side effect of cancer treatment. Sexual problems affect at least half of patients who've had prostate, breast or a gynecologic cancer; they also can occur after chemotherapy or radiation to the pelvic area or brain.

The problems are usually caused by physical damage to the nerves, blood vessels and hormones involved in a normal sexual response, although emotional issues also play a role.

Many of the negative emotions that come with a cancer diagnosis fade after successful treatment, but the sexual problems tend to linger without professional help. 

Unfortunately, few patients get the care that could make their sex lives satisfying again.

What new guidelines mean for treating sexual problems
Ideally, help should include therapies for medical issues like erection problems, pain with intercourse and loss of sexual desire, as well as counseling to help the cancer survivor and partner communicate openly and adjust their sexual routine.

According to the guidelines, your cancer care team should ask periodically about sexual problems, even if at first you say that everything is OK.

If a specific problem is found, you'll need a more in-depth assessment, and your doctor should suggest treatments.

For women, the guidelines mention loss of interest in sex, loss of sexual sensations, vaginal dryness or pain during sex and trouble reaching orgasm. These are indeed all common problems that we see.

For men, I was sad to see that the guidelines focus very narrowly on erection problems. It's true that erection problems are the sexual issue that most often prompts men to seek help, but we also see many men with loss of desire, pain during sex, or changes in their orgasm, including dry orgasms, weak orgasms or leaking urine during orgasm.

Treating sexual problems at MD Anderson
At MD Anderson, women with sexual problems can take advantage of our multidisciplinary team in the Department of Gynecologic Oncology and Reproductive Medicine. This team includes several expert gynecologists who focus on side effects of cancer treatment, Andrea Bradford, Ph.D., a clinical psychologist who treats sexual problems, and Terri Lynn Woodard, M.D., a specialist in cancer and fertility.

Men with sexual problems can get evaluated and treated by Run Wang, M.D., in the Department of Urology's Sexual Medicine Clinic.

Research on sexual problems
I've been working on web sites for both men and women that explain why sexual problems occur and describe self-help strategies and medical treatment options.