Sexuality and Fertility after Cancer

 

 

As more people achieve long-term survival after cancer, sexual dysfunction and infertility have increasinglybeen recognized as negative consequences thatimpact quality of life

 

Cancer treatments cannot be exclusively targeted to tumor cells, damage to the reproductive system

will remain an important aspect of cancer morbidity. Problems with sexual function and fertility after cancer are not only ubiquitous, they are less likely to resolve with time than most other treatment side effects.

 

Although not every cancer survivor cares about remaining sexually active, long term sexual dysfunction has been documented in at least50% of those treated for breast, prostate, colorectal or gynecological

cancer.

 

What is the most common Sexual dysfunction from Cancer Treatment?

 

The most common sexual problems after cancer treatment include loss of desire for sex in men or women, erectile dysfunction (ED) in men, and pain with sexual activity in women.

 

Why does it occur?

 

Cancer treatments may damage one or more of the physiological systems needed for a healthy sexual

response, including hormonal, vascular, neurologic, and psychological elements of sexual function. Treatment also may entail removal or direct damage to parts of the reproductive organs.

 

Which type of cancers/cancer treatments are involved mainly in sexual dysfunction?

 

In men, radical surgery to treat cancer of the prostate, bladder, or rectum  has been modified to spare nerves that direct blood flow into the penis. Direct involvement of Penis ,testes & scrotum by malignancy

Radiation therapy to the pelvis begins a more gradual process of fibrosis that eventually may damage both the nerves and blood vessels involved in erection

 

In women malignancies involving pelvic organs(ovaries, uterus, cervix, vulva& vagina, intestines,rectum etc) & breasts affect the final sexuality. The autonomic nerves that direct blood flow into the genital area with sexual arousal may also be affected by pelvic surgery, but the impact on sexual function.

 

How significantly the sexual dysfunction is truly affected?

 

Rates of recovery of firm erections after surgery are far lower in large, long-term surveys than suggested by reports from selected cohorts in academic medical centers  Well-controlled studies of large populations of women have shown that benign hysterectomy, including removal of the cervix, does not impair women’s sexual pleasure or capacity to reach orgasm.  But after radical hysterectomy most sexual problems may take a year to resolve after surgery

 

Which cancer/cancer treatment  affect ovarian & testicular function?

 

Cancer involving ovaries/testes & chemotherapy affecting the gonads. Radiation causes dysfunction if the organ or the autonomic nerves supplying the organ fall in the radiation field Treatment with adjuvant chemotherapy accounts for much of the sexual morbidity of breast cancer, especially in women who experience an abrupt transition to menopause as a result of their cancer treatment selective estrogen receptor modifiers such as tamoxifen and raloxifene do not appear to decrease women’s desire for sex, vaginal lubrication, or ability to enjoy intercourse without pain.17

 

 

What is the final outcome on sexuality post treatment completion?

 

The only enduring difference between female cancer survivors and matched controls is some loss of desire for sex and reduced vaginal lubrication.  If pelvic surgery impairs vaginal expansion and

lubrication, it seems that women can compensate by using estrogen replacement or water-based lubricants. But after radiation therapy in fields that include the genital area, women fare more poorly than men. Young women treated with radiation therapy for cervical cancer are significantly more likely to have problems with dyspareunia and other aspects of sexual function than matched controls.

 

Despite the availability of a variety of treatments for ED and increasing rates of help-seeking for ED among prostate cancer survivors, most men are disappointed with the treatmentefficacy

 

 

Is any Sexual Rehabilitation possible after Cancer Treatment?

 

Despite the fact that sexual problems in cancer survivors typically have organic causes, successful sexual rehabilitation often requires a broader approach that incorporates behavioral changes and involves both partners in a committed relationship.One predictor of successful sexual rehabilitation is having a

sexually functional partner who still desires sex, 5 suggesting that simply being able to have firmer erections does not automatically result in more frequent and pleasurable sex. Sexual rehabilitation after cancer in women also cannot be reduced to a simple paradigm of hormonal replacement or a mechanical device Much of the loss of desire for sex in women with ovarian failure is linked to dyspareunia from vaginal atrophy. A safer hormonal treatment may be the use of low-dose estrogens in the form of a vaginal ring or suppository to treat pain that does not respond to appropriate use of water based

lubricants or vaginal moisturizers. Vaginal dilation is widely accepted as a treatment to prevent vaginal stenosis and agglutination in women who have pelvic radiation therapy. Yet dilation has not been

validated by empirical research Need of psychotherapist & ,behavioral specialist during the cancer treatment should be reinforced to the patient

 

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Sexual dysfunction: The Need for Better Communication in the journey of Cancer Treatment!

 

Sexuality issues has been cited as a major source of distress for cancer survivors in several surveys. It is time to shift the focus from the causes and prevalence of sexual dysfunction after cancer to creating, evaluating, and disseminating practical and cost-effective programs of sexual rehabilitation.

The current lack of randomized trials of such interventions is a major problem in psychosocial oncology

Clearly educational materials are needed to facilitate communication between health care providers and patients on this important topic. Also specialized therapist should be included to understand & intervene according to the need of the patient

 

 

Can fertility be preserved after cancer therapy ?

 

Reproductive health after cancer is only increasing in importance as the number of cancer survivors

multiplies and the length of their survival also improves. Sexual function and fertility can no longer be regarded by oncologists as irrelevant because our current cancer therapies damage reproductive health in ways that are profound and often permanent.

 

Interventions that prevent or reverse these problems will greatly improve the quality of life of our patients.

Women with very early stage or low-grade gynecologic cancer may be able to preserve fertility by having

limited surgery. Lateral transposition of the ovaries to remove them from the field of pelvic irradiation is an option that preserves ovarian function.

 

Sperm banking can be done males before the cancer treatment begins to preserve the fertility in males.

Better communication about fertility preservation is strongly needed between patient and oncologists, but organizations need to develop practice guidelines on when it is appropriate to bring up infertility, how to discuss new modalities that remain experimental

and often involve large out-of-pocket costs to the patient, and what options should be offered by cancer centers.

 

“ALWAYS DISCUSS THE SEXUALITY ISSUES WITH YOUR TREATING ONCOLOGIST AS HE /SHE IS SIMILARLY INHIBITED IN DISCUSSING YOUR CONCERNS IF NOT SPOKEN”

 

Key Points

·       Women with very early stage or low-grade gynecologic cancer may be able to preserve fertility by having limited surgery.

·       Sperm banking can be done males before the cancer treatment begins to preserve the fertility in males.

·       Better communication about fertility preservation is strongly needed between patient and oncologists

 

 

 

 

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