Sexual Difficulties Associated with Cancer in Women

• Who is affected?
• What factors affect sexual adjustment in individuals with cancer?
• How long might sexual problems persist?
• What sort of problems may arise and how common are they?

Who is affected?

Between 10 and 88% of patients diagnosed with cancer experience sexual problems following diagnosis and treatment.This varies according to the location and type of cancer, and what kind of treatment is used.

The concept of sexuality encompasses body image, mood, self esteem and sense of emotional connection and intimacy. Each of these facets may be affected directly and indirectly by cancer and its treatment. Concerns regarding body image have been reported by women with breast, gynaecological, laryngeal, blood, head and neck, and skin cancers.

Sexual problems are reported in patients with cancer that does not directly affect sexual organs, including lung cancer, Hodgkin’s disease, and laryngeal and head and neck cancers. On this basis, it is recommended in Australian clinical practice guidelines that, regardless of cancer site, issues of sexuality related to cancer and its treatment should be discussed with health professionals.

What factors affect sexual adjustment in individuals with cancer?

Factors affecting sexual adjustment in men with cancer include:

• Chemotherapy: May interfere with the production of the sex hormones oestrogen and testosterone, affecting sexual response and desire.
• Pre-existing problems in sexuality or relationships
• Age
• Altered body image due to weight changes, hair loss or surgical disfigurement
• Pre-treatment menopausal status and change in hormonal status due to treatment: Changes in sex hormones (androgens) affect libido and ability to orgasm. Chemical menopause may result in painful sexual intercourse (dyspareunia) and atrophic vaginitis.
• Treatments that directly impact on pelvic organs and sexual function: Sexual activity, satisfaction and desire may be significantly affected by radiotherapy in the pelvis and lower abdomen. Radiotherapy may lead to painful intercourse arising due to fibrosis (hardening) of vaginal tissue and lack of lubrication.

How long might sexual problems persist?

Sexual problems following cancer may persist long term. After bone marrow transplantation for the treatment of Hodgkin’s disease, sexual dysfunction may persist for up to 12 months. Following mastectomy, sexual dysfunction may persist for up to two years after surgery.

What sort of problems may arise and how common are they?

Loss of libido (sexual drive), change in sexual activity and decreased orgasm/satisfaction occurs with the following cancers:

• Breast: (10–50% of cases) Women aged under 50 years are twice as likely to experience these problems as those over 50 years. Women who have a mastectomy are also more vulnerable.
• Head and neck: 39% of patients with minor disfigurement, and 74% with major disfigurement, experience a reduced sexuality.
• Laryngeal: Associated with a significant decrease in sexual activity in 60% of cases.
• Lung: 48% of cases experience problems, and 27% experience severe problems.
• Gynaecological: (e.g. cervical cancer, vulval cancer)

Sexual dysfunction associated with vaginal dryness, pain, bleeding or narrowing, dyspareunia (painful intercourse), and atrophic vaginitis, occur in conjunction with:

• Gynaecological cancer: 66% of women sexually active before treatment experience problems.
• Colorectal cancer: (20% of colorectal cancer cases) Women whose sphincter muscle (which results in contraction around the vagina and anus) has been impacted are more likely to experience dyspareunia.

Concerns about existing or potential sexuality problems are associated with anxiety, and may be a major source of stress in the lives of individuals with cancer.

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