By Sue Rochman
Sexuality After Cancer
Many men and women are quietly facing sexual difficulties after cancer treatment. Why? And what can be done?
By Sue Rochman
As the number of cancer survivors continues to grow, more attention is being paid to the long-term physical and emotional issues they face. Even so, one aspect of survivors’ lives remains all too commonly unaddressed: the long-term physical and psychological impact of treatments on libido and sexual functioning.
Sex is, arguably, one of the most difficult topics to discuss with a doctor. If a cancer specialist doesn’t broach the topic first, many patients won’t. And, as studies show, not all of these doctors do. That’s because cancer specialists aren’t necessarily comfortable talking about sex. Nor do they typically have a co-worker to whom they can refer patients. In fact, a recent survey found that less than 15 percent of National Cancer Institute–designated cancer centers had someone on staff who provides sexual counseling to patients. The end result: All too often, cancer survivors and their partners don’t get the information or assistance they need to overcome the barriers to sex and intimacy that cancer has brought into their lives.
You’d probably get little argument if you suggested that there were differences between women’s and men’s sexuality—from what is sexually arousing and how they feel about sex to their ability to achieve orgasm. But some things are, indeed, the same. In both women and men, for instance, sexual functioning is age-dependent: The older a person is, the greater the likelihood he or she will have some type of sexual dysfunction.
In addition, for both women and men, sexual functioning is most likely to be disturbed by the cancers and treatments that involve or affect the pelvic organs. In women, this can lead to both decreased libido and problems with sexual functioning. In men, the problem is typically not a lack of desire, says Eric Horwitz, a radiation oncologist at Fox Chase Cancer Center in Philadelphia, but an inability to get and maintain an erection firm enough for sexual intercourse.
Prostate, colorectal and bladder cancer are three of the four most common cancers in men; they are also the ones most likely to affect sexual functioning. Studies have found that up to 80 percent of prostate cancer patients who have their prostate surgically removed or irradiated experience erection problems as a result. Although many people believe that sexual problems develop because the prostate gland was removed, that’s not the case.
The problem, explains Horwitz, is that erectile functioning is controlled by nearby nerves and blood vessels, which are often removed during prostate surgery or damaged by radiation. These nerves and blood vessels can also be affected by bladder cancer surgery (which may include removal of the prostate gland), as well as radiation therapy for colorectal cancers that are low in the rectum. In addition, treatment for some pelvic cancers may leave a man with an ostomy bag to collect urine or stool, making him self-conscious and inclined to avoid sex. Some surgeries, such as those for colorectal cancer, may require removal of the rectum, which can preclude the ability of a man to have receptive anal sex.
In some cases, as with early stage prostate cancer, men may be able to choose among treatment options like surgery or radiation. As a result, doctors say, they frequently address sexual functioning with these patients during discussions of potential side effects. “I explain to men with prostate cancer that the impact of surgery is immediate, and that a man might then go on to recover functioning,” says Horwitz. He also explains that, with radiation, “about two-thirds of men who did not have problems before will be able to get an erection afterward, but then, over the next months or years, it may get worse.” If problems do develop over time, he notes, it can be difficult to ascertain if they are due to treatment or to aging.