- 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?
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.
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
- 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.
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.
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.
- National Breast Cancer Centre and National Cancer Control Initiative. Clinical practice guidelines for the psychosocial care of adults
with cancer. Camperdown, NSW: National Breast Cancer Centre; 2003.
- Gamba A, Romano M, Grosso IM,Tamburini M, Cantú G, Molinari R, et al. Psychosocial adjustment of patients surgically treated for head and neck cancer. Head Neck. 1992; 14(3): 218-23.
- Schain WS, d’Angelo TM, Dunn ME, Lichter AS, Pierce LJ. Mastectomy versus conservative surgery and radiation therapy. Psychosocial consequences. Cancer. 1994; 73(4): 1221-8.
- Maguire GP, Lee EG, Bevington DJ,Kuchemann C, Crabtree RJ, Cornell C. Psychiatric problems in the first year after mastectomy. BMJ. 1978; 1: 963-5.
- Cull A, Cowie VJ, Farquharson DI, Livingstone JR, Smart GE, Elton RA. Early stage cervical cancer: Psychosocial and sexual outcomes of treatment. Br J Cancer. 1993; 68(6): 1216-20.
- Corney RH, Everett H, Howells A, Crowther ME. Psychosocial adjustment following major gynaecological surgery for carcinoma of the cervix and vulva. J Psychosom Res. 1992; 36(6): 561-8.
- Alagaratnam TT, Kung NY. Psychosocial effects of mastectomy: Is it due to mastectomy or to the diagnosis of malignancy? Br J Psychiatry. 1986; 149: 296-9.
- Hughson AVM, Cooper AF, McArdle CS, Smith DC. Psychosocial consequences of mastectomy: Levels of morbidity and associated factors. J Psychosom Res. 1988; 32(4-5): 383-91.
- Spranger MAG, Te Velde A, Aaronson NK, Taal BG. Quality of life following surgery for colorectal cancer: A literature review. Psychooncology. 1993; 2(4): 247-59.
- Mock V. Body image in women treated for breast cancer. Nurs Res. 1993; 42(3): 153-7.
- Hopwood P, Lee A, Shenton A, Baildam A, Brain A, Lalloo F, et al. Clinical follow-up after bilateral risk reducing (‘prophylactic’) mastectomy: Mental health and body image outcomes. Psychooncology. 2000; 9(6): 462-72.
- Curran D, van Dongen JP, Aaronson NK, Kiebert G, Fentiman IS, Mignolet F, et al. Quality of life of early-stage breast cancer patients treated with radical mastectomy or breast-conserving procedures: Results of EORTC Trial 10801. The European Organization for Research and Treatment of Cancer (EORTC), Breast Cancer Co-operative Group (BCCG). Eur J Cancer. 1998; 34(3): 307-14.
- Anderson BL, LeGrand J. Body image for women: Conceptualization, assessment, and a test of its importance to sexual dysfunction and medical illness. J Sex Res. 1991; 28: 457-78.
- Sullivan AK, Szkrumelak N, Hoffman L. Psychological risk factors and early complications after bone marrow transplantation on adults. Bone Marrow Transplant. 1999; 24(10): 1109-20.
- Cassileth BR, Lusk EJ, Tenaglia AN. Patients’ perceptions of the cosmetic impact of melanoma resection. Plast Reconstr Surg. 1983; 71(1): 73-5.
- Ginsburg ML, Quirt C, Ginsburg AD, MacKillop WJ. Psychiatric illness and psychosocial concerns of patients with newly diagnosed lung cancer. CMAJ. 1995; 152(5): 701-8.
- Marks DI, Friedman SH, Delli Carpini L, Nezu CM, Nezu AM. A prospective study of the effects of high-dose chemotherapy and bone marrow transplantation on sexual function in the first year after transplant. Bone Marrow Transplant. 1997; 19(8): 819-22.
- Rose DP, Davis TE. Effects of adjuvant chemohormonal therapy on the ovarian and adrenal function of breast cancer patients. Cancer Res. 1980; 40(11): 4043-7.
- Ganz PA, Rowland JH, Desmond K, Meyerowitz BE, Wyatt GE. Life after breast cancer: Understanding women’s health-related quality of life and sexual functioning. J Clin Oncol. 1998; 16(2): 501-14.
- Kaplan HS. A neglected issue: The sexual side effects of current treatments for breast cancer. J Sex Marital Ther. 1992; 18(1): 3-19.
- Makar K, Cumming CE, Lees AW, Hundleby M, Nabholtz JM, Kieren DK, et al. Sexuality, body image and quality of life after high dose or conventional chemotherapy for metastatic breast cancer. Can J Hum Sex. 1997; 6: 1-8.
- Maguire GP, Lee EG, Bevington DJ, Küchemann CS, Crabtree RJ, Cornell CE. Psychiatric problems in the first year after mastectomy. Br Med J. 1978; 1: 963-5.
- Schover LR, Fife M, Gershenson DM. Sexual dysfunction and treatment for early stage cervical cancer. Cancer. 1989; 63(1): 204-12.
- Flay LD, Matthews JH.The effects of radiotherapy and surgery on the sexual function of women treated for cervical cancer. Int J Radiat Oncol Biol Phys. 1995; 31(2): 399-404.
- Cain EN, Kohorn EI, Quinlan DM, Schwartz PE, Latimer K, Rogers L. Psychosocial reactions to the diagnosis of gynecologic cancer. Obstet Gynecol. 1983; 62(5): 635-41.
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