Sexual pain is a common, but unspoken, aftermath of women’s cancer treatment. Doctors can be reluctant and patients too embarrassed to discuss it.
But it’s an all-too-real aspect of cancer treatment for women, according to Dr. Vanessa Kennedy, a gynecological oncologist for the UC Davis Health System.
“Some patients are two to three years out of treatment and they’re dealing with sexual pain and no one’s talked about it. Patients hesitate to bring it up because it’s a sensitive issue,” said Kennedy, who recently discussed the problem in the journal Obstetrics & Gynecology. Her co-author, Dr. Deborah Coady of New York University Langone Medical Center in New York, is author of the book “Healing Painful Sex: A Woman’s Guide to Confronting, Diagnosing and Treating Sexual Pain.”
Kennedy estimates that about 50 percent of female patients with cancer – of any type – experience some form of sexual pain, due to physical changes caused by surgery, chemotherapy and radiation. It can range from vaginal dryness caused by early menopause to anatomical changes that can make sex uncomfortable.
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Some women feel guilty they’re even concerned about their sex lives, given what they’ve been through battling cancer. “There’s some guilt that they should just feel lucky to be alive and shouldn’t ask about these other things,” she said. But when sexual health is addressed, “They’re actually relieved to know they’re not alone.”
Twice a month on Fridays, Kennedy holds a regular clinic, seeing UC Davis patients who’ve been referred for post-cancer problems with sex. She works with patients on a number of interventions, including physical therapy, lubricants (even coconut or olive oil), vaginal dilators and couples counseling to re-establish intimacy.
Kennedy said doctors and medical students need to learn to be comfortable broaching the topic. “A lot of students and providers are still a little bit nervous asking about sex,” she said. “How do you get comfortable talking about these things? You just do it. It’s just like asking a patient about changes in appetite or changes in sleep. Sex is another thing (on the list). Get over it and ask about it.”
There’s a difference in how men and women cancer patients deal with sexual health, Kennedy contends. For men who’ve undergone prostate cancer treatment, there’s an emphasis on restoring their sexual function. For women, there’s often physical pain and a loss of intimacy, along with the added fear by some that their partners view them as less desirable. In some cases, where sex has become nonexistent, patients confide that their partners have threatened to leave or cheat on them.
Kennedy, who did fellowship training at the University of Chicago, which has a sexual health program for women cancer patients, says research on women’s sexual health issues is lagging, compared with that for men with prostate cancer. Next April, she’s hosting a national gathering of the Scientific Network on Female Sexual Health and Cancer, which promotes research and information for women patients and their providers.
“Sex is a quality-of-life issue and a core of our well-being,” Kennedy concludes. “We have to bring back the intimacy and make this a part of the body that’s associated with pleasure, rather than an uncomfortable, negative place.”