Don’t let sexuality concerns compromise quality of life during or after treatment.

"Communities and countries and ultimately the world are only as strong as the health of their women.”
– Michelle Obama

More than 7.5 million out of 14.5 million cancer survivors in the United States are women, and that number is expected to grow to 9.6 million by 2024. Around half of women treated for cancer report cancer-related sexual side effects. Surgery, chemotherapy, radiation, and hormone therapy have side effects that can interfere with normal sexual function in women. These effects can be long-lasting and involve physical, social, and psychological changes as a result of the diagnosis as well as its treatment. Sex and intimacy after cancer treatment are issues that bear the same relevancy and importance for people with cancer as they are for people who don’t have cancer, but unfortunately, they are not addressed for a variety of reasons. Sexual health in male cancer survivors, especially in cases of prostate cancer and other genitourinary cancers, is similarly affected.

Sexual problems can develop during, right after, or even years after treatment. These side effects can be temporary or permanent. There is strong evidence suggesting that sexual problems are not limited to women with breast or gynecologic cancer. Cancers that occur in the genital area, including uterine, ovarian, or cervical cancer, naturally affect sexual health and function but lots of people have changes in sexual function, from other cancers as well. Regardless of the type of cancer, your sex drive, body image, and sexual functioning can be deeply affected. For example, people with head and neck cancer may struggle with changes in body image and the fact that sexual activity and kissing are challenging when you can't make saliva or develop muscle atrophy due to radiation. Patients with bladder or colorectal cancer may receive pelvic radiation, which doesn't just impact sex organs, but may result in ostomies, which has a real impact on intimacy. Also, stem cell transplants can cause changes that have a profound impact on sex hormones. Physical changes related to unilateral or bilateral breast mastectomy, surgical scars, and radiation-related skin issues can create a burden that is difficult to overcome.

Unlike other treatment-related side effects that improve over time, such as pain or fatigue, unless treated, sexual side effects tend to persist for women with cancer, leading to long-term sexual distress and potentially negative consequences for a woman’s health, her relationships, and her overall well-being. Further, if unaddressed, sexual problems can also compromise cancer treatment or prevention. These side effects are among the key reasons for early discontinuation or non-adherence to estrogen-reducing treatments or ovarian suppression for women with breast cancer. Additionally, for women who carry a hereditary cancer mutation gene conferring high risk for breast and ovarian cancer, concerns about sexual side effects are a central reason for either delaying or ignoring recommendations for risk-reducing surgeries.

It is important that you talk openly and early in your cancer journey with your cancer care team about what to expect in terms of changes to your sexual health and the available treatment options. Here are some questions that will help you engage with your cancer care team:

• How might treatment affect my sexual life? Will it affect my sexual desire, response, or function? What can be done about these effects?
• Is it safe to have sex now? If not, when will it be OK to have sex?
• Are there any types of sex I should avoid?
• Do I need birth control or other protection during treatment? How about afterwards? For how long?
• Can my medications or treatment be passed to my partner through my body fluids?
• What safety measures do I need to take, and for how long?
• (If you are having surgery), how will this surgery affect my appearance?
• Does a body part or organ need to be removed? If so, will it be removed partially or completely? Can it be replaced, transplanted, or reconstructed?
• How big will my scar be?
• How soon can I have sex after my surgery?
• Are there any types of sex or positions I should avoid when I start having sex again?
• Will I be able to have children after surgery?
• How will this treatment affect my appearance?
• Will I lose my hair? If so, when and how much?
• Will I gain or lose weight due to the treatment?
• Can I exercise during treatment?
• Does my partner need to use birth control while I'm on treatment? What about afterwards? For how long?
• If I am getting certain types of radiation therapy, where is it unsafe to be physically close to my partner?
• Am I getting a treatment that might cause birth defects if I get pregnant?

Be sure to take a look at the checklist that you can download and take with you when you meet your cancer care team. It will help you take charge of your sexual health on your cancer journey.