Sexual Health After Gynecologic Cancer: An Often Overlooked Aspect of Care - Dr Kanika Batra Modi

Sexual health can be one of the most overlooked areas of concern for women who are recovering from gynecologic cancers, even though it is an extremely personal aspect of each individual’s life. When a woman is diagnosed with any of the following types of gynaecological cancer, Ovarian, Cervical, Endometrial, Vulvar, or Vaginal cancer, her road to recovery will not end when treatment ends.

Even with the extensive efforts of clinical teams to provide appropriate treatment for the disease, there are many, many sexual health issues that a survivor will face that are not addressed or talked about during the treatment period. As a result of this lack of discussion, a large percentage of these women are confused, reluctant, or feel they have no support and, therefore, are unable to make progress towards total health.

Why Should We Pay More Attention to Sexual Health in Cancer Treatment?

Sexual dysfunction is common in women being treated for gynaecological cancers; however, there are very few women who have received medical support related to improving this common problem. Surgery may hinder the process of sexual arousal because of modifications to the anatomy and/or nerve supply.

Radiation also leads to dryness of the vagina and/or stenosis (narrowing), while chemotherapy often results in hormonal imbalances. The above changes in the way women respond sexually affect their response to arousal, comfort, libido, and being able to experience pleasure.

Sexual health has historically been the last priority for cancer care delivery. Most providers focus on survivorship outcomes, notes of care, and assessments of risk, but often lack the time or training to discuss sensitive topics related to the quality of life of their patients. Conversely, most patients feel that bringing up sexual problems or difficulties would appear to be trivial and/or inappropriate. Consequently, this has created a vacuum in addressing this important component of recovery.

Another reason why treating sexual health in cancer survivors is critical is that it promotes feelings of self-esteem and self-worth, as well as enhances satisfaction in their intimate relationships and well-being.

Women who experience a deficiency in their sexual function may not feel "feminine," have concerns about being rejected because of their appearance, and may not communicate to their partners what they need. For many of these women, reclaiming control of their bodies is part of the healing process.

The Various Aspects of Sexuality Following a Cancer Diagnosis

Sexual recovery includes not only the physical component but also the emotional, hormonal, and relational aspects. Each woman will experience her own set of difficulties due to varying circumstances, age, and treatment type. Examples of some common issues include:

Sexual pain caused by vaginal dryness, reduced elasticity, or scarring on the vagina. The majority of the time, sexual pain stops when a woman no longer experiences pain while having sex.

Loss of desire for sexual activity, which can be caused by fatigue or hormonal changes.

Body image, which may change due to weight gain/loss or by having scars or altered anatomy.

Fear and anxiety may occur around the possibility of injury or having to endure pain.

Communication issues between partners, because both partners experience differing expectations as well as feelings.

In addition to the individual’s experience, partners also experience their own emotional journey. Many partners wish to help and provide support, but are fearful of creating greater pain for the woman. Without effective communication, misunderstandings can arise, which will result in withdrawal and feelings of guilt.

Creation of a More Conducive Clinical Environment

It is important to note that talking about sexual health in survivorship care does not mean putting sex before survival; rather, it is acknowledging that quality of life plays an important role. A clinician's responsibility is critical in this change; being comfortable with discussing these types of issues leads to more open discussions. Each follow-up visit should include questions such as "Have you had any pain while having sexual relations?" and "What do you think about your intimate relationship now?" This provides a precedent for ongoing conversations.

Moreover, there needs to be an emphasis on training oncology care teams (including oncologists, nurses, and social workers) in how to effectively educate and emotionally support patients regarding sexual wellness. The right resources (i.e., educational materials, support groups, and sexual wellness clinics) will help re-establish a survivor’s sense of self-worth. Survivors are more likely to seek assistance when they feel acknowledged and validated.

How Survivors Can Rebuild Their Sexual Health After Cancer

Various forms of sexual-health restoration exist for individuals who have experienced cancer, and there is no one-sized-fits-all solution for everyone; rather, multiple forms of treatment offer combined benefits that better help Cancer Survivors restore their sexual health. Vaginal creams and lubricants will provide moisture, while physical therapy on the pelvic floor can eliminate discomfort and restore function; for some, hormone therapy may help to re-establish both libido and comfort. Support from counsellors and therapists will also enable survivors to reconnect with their bodies and communicate freely with their partners.

It is also noteworthy to point out that intimacy and closeness do not always mean sexual intercourse. By redefining closeness in non-penetrative ways, the pressure to perform sexually can be alleviated, allowing couples to rebuild their trust and comfort within themselves and one another until they are ready to be intimate again naturally.

Reconceptualising Sexual Health as an Essential Component of Survivorship

Sexual health after gynaecological cancer has historically been viewed as an optional, secondary, or ‘inappropriate’ area of health to deal with. This cultural perspective should evolve to reflect the evolving understanding of survivorship. Survivorship is more than just living longer; it is about living well. When women are supported to reclaim their sexual health, it is not about being selfish: it is about healing a crucial part of their identity, dignity, and connectedness to others.

In sum, sexual health should not be viewed as just another detail of care; rather, it is an essential element of comprehensive cancer care. Clinics create the initial opportunities for the conversation, but it will also extend into the survivor's home environment, their relationships with others, and the societal/community cultures. To provide holistic care to survivors, we must acknowledge the many dimensions of their survivorship experience and allow the opportunity to support each one.

Disclaimer: The views expressed in this article are of the author and not of Health Dialogues. The Editorial/Content team of Health Dialogues has not contributed to the writing/editing/packaging of this article.