Strategies Available for Women’s Sexual Health Issues After Cancer, Better Access Needed
Published on September 15, 2023
Research suggests that more than 60% of women with a history of cancer have sexual health issues. A study reviewing treatments and strategies to ease these issues found certain techniques are effective, but noted that women need more information about the techniques and much more research is needed on how to best integrate these strategies into everyday practice.
The research was published on Aug. 3, 2023, by the Journal of Clinical Oncology. Read the abstract of “Clinical Practice Strategies to Address Sexual Health in Female Cancer Survivors.”
Sexual health after cancer
No matter the type of cancer they’ve been diagnosed with, many women report similar sexual health issues during and after treatment, including loss of libido, vaginal dryness, and thinning of the vaginal tissues.
Other side effects, including fatigue, lymphedema, and depression also can contribute to sexual health problems.
Although doctors usually talk to women about possible fertility and menopausal side effects of breast cancer treatment, they often don’t mention common sexual health side effects.
Listen to The Breastcancer.org Podcast episode featuring Sarah Tevis, MD, talking about how and when women receiving breast cancer treatment want to discuss sexual health issues with their oncologists.
Sexual Health Side Effects From Breast Cancer Treatment
Feb 17, 2023In this study, the researchers noted that figuring out how to integrate sexual health assessments and treatments into cancer care is one of the most important areas that scientists need to work on.
About the study
The researchers reviewed studies published since 2017 to evaluate the evidence on treatments for the following sexual health issues in females with a history of cancer:
low sexual desire
vulva and vaginal issues
negative body image
intimate partner relationships
There are two U.S. Food and Drug Administration (FDA)-approved medicines for low sexual desire in pre-menopausal women: Addyi (chemical name: flibanserin) and Vyleesi (chemical name: bremelanotide). The medicines work, but Vyleesi hasn’t been tested in women with a history of cancer. A study looking at Addyi in women with a history of breast cancer is ongoing and results are expected at the end of 2023. While waiting for the results, some doctors are prescribing it to women who’ve been diagnosed with breast cancer.
“In the MUSIC [Menopause, Urogenital, Sexual Health and Intimacy] Program we do often use flibanserin, which is a once-a-day pill for patients who are on endocrine suppression,” Kristin Rojas, MD, told Breastcancer.org. Dr. Rojas is a gynecologist and breast cancer surgeon at the Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine and founder of the MUSIC Program. “With tamoxifen it’s a little tricky because it can increase the side effects of this medication so we have to have a long discussion about that. But we oftentimes do also use these FDA-approved medications that are either a once-a-day pill or an injection given prior to sexual activity, and I’d say probably more than half of the patients respond.”
Listen to The Breastcancer.org Podcast episode featuring Dr. Rojas discussing some of the most troubling sexual issues women taking hormonal therapy experience.
Better Sexual Health for Women Taking Hormonal Therapy
Jun 7, 2023Studies showed that psychosexual counseling also was effective at treating low sexual desire.
A number of breast cancer treatments, including chemotherapy, radiation therapy, and hormonal therapy can cause changes in the vaginal area, including making the vaginal canal shorter and narrower, as well as thinning of the vaginal tissues, loss of elasticity, and telangiectasias (small dilated blood vessels). These changes can lead to a lack of lubrication, vaginal dryness, and painful sex.
Non-hormonal moisturizers, especially ones containing hyaluronic acid, used nightly for up to 12 weeks have been shown to be effective, as long as they are left on overnight and used after any sexual activity. For these moisturizers to work well, the labia (the folds of skin around the vaginal opening) and the vulvar vestibule (the smooth surface just below the clitoris that contains the opening to the urethra and the vaginal opening) also have to be moisturized.
In one study, a 4% lidocaine cream helped make sex less painful. Lidocaine is a topical anesthetic. Still, because lidocaine won’t improve the health of the vaginal tissues, women may need to use a non-hormonal moisturizer with it.
The researchers noted that laser treatment for vulva and vaginal issues has received a lot of attention. But research results have been disappointing: the laser treatment was no more effective than a placebo treatment.
What the researchers called sexual rehabilitation techniques, including dilators and pelvic floor muscle training with either core strengthening exercises or yoga, seem to be promising, but little research has been done.
Research suggests that when people have a negative body image, they’re more likely to have anxiety, depression, and sexual issues.
Cognitive behavioral therapy, a type of therapy that focuses on changing thinking and behavior patterns to help people cope with problems, has been shown to help with body image issues.
Psychoeducation, group exercise classes, and expressive writing seem promising treatments for body image issues, but more research is needed.
For any woman with a history of cancer who has a partner, sexual health issues usually happen during sex with the partner. So it’s critical that the partner be included when treating any symptoms. For example, if a partner has negative views about sexual aids, toys, or other strategies to manage sexual problems, it can limit how successful treatment is.
Research shows that education for couples, including information on how cancer affects sexuality and sexual response, as well as training on touching and communication, is effective.
Still, these strategies don’t help women without partners and they don’t help women whose partners won’t participate.
The researchers suggested that modifying the education and training for couples so it can be used by people — partnered or unpartnered — at home, without a counselor, would help many more people.
What this means for you
If you’re having sexual health issues after breast cancer treatment, it can help to know you’re not alone.
Still, what do you do if there isn’t a specialized program for female sexual health, like the MUSIC Program, at your cancer care facility?
When Breastcancer.org asked Dr. Rojas that question, she offered several solutions.
One is to look at the MUSIC Instagram feed, which is music_sexaftercancer.
“I post a lot about new treatments and these specific issues that women with cancer are experiencing and how to address them so that people anywhere can access this information,” Dr. Rojas explained. “And it’s actually been really interesting because I have people reach out to me from Thailand, the Philippines, South America, you know, saying that they haven’t been able to find someone who can address these issues so we really try to make that information accessible.
“And then with regards to patients bringing it up with their providers, I want to empower every patient to start the conversation,” she continued. “You have nothing to lose; you’ve gone through cancer treatment, [and] you are entitled to say almost whatever you want in the oncologist’s office. So bring it up. Say, ‘Hey, Dr. so and so, I’m having some issues, some side effects from this treatment. One of them is painful sex, I’m having some vaginal dryness, I’m having low desire, and low libido. Do you have any resources for me or advice? Can you refer me to anyone?’
“Even if they don’t have a solution for you right then or your oncologist all of a sudden looks very flustered and uncomfortable — which totally happens, we’re human — if five people asked that oncologist that day about their sexual health concerns, they’re going to go home, they’re going to find the resources, they’re going to put something together for patients, whether it’s hiring an expert or referring you to an expert on the outside, or putting together some information. So the more you bring it up, the more we’re going to talk about it and the more it’s going to be addressed, the better job societies are going to do teaching other providers. I just want everyone to feel empowered to start the conversation with their providers.”