Why it’s Important to Talk About Sex After Cancer

Holistic conversations between you and your doctor about sex after cancer should be a priority. Here’s how to make it happen, from experts at UChicago Medicine.

Following treatment for breast, ovarian or cervical cancer, women may struggle to feel whole again, especially in their intimate relationships. For those who have entered a new and possibly unwelcome phase of sexual functioning — or find they are no longer on the same page as their partners — there is hope.

When women and their health care providers can engage in holistic conversations from diagnosis to treatment and recovery, they may be able to better explore how cancer impacts the most intimate aspects of their lives, say experts at the University of Chicago Medicine.

talking-about-sex-after-cancer-dr-stacy-tessler-lindau
Stacy Tessler Lindau, MD, MA, tenured professor of obstetrics and gynecology and medicine-geriatrics at the University of Chicago Medicine. Photo credit: UChicago Medicine

“Especially when a cancer diagnosis involves a person’s sexual and reproductive organs, common concerns include what cancer means for having children, having sex, forming or keeping their intimate relationships and even being loved,” explains Stacy Tessler Lindau, M.D., M.A.P.P., Obstetrician and Gynecologist with UChicago Medicine and specialist in gynecologic cancers and female sexual dysfunction. “Oftentimes people have these concerns but don’t raise them to their doctors. When doctors do ask, most patients feel their doctor cares for them as a whole person.”

Understandably, these conversations can be an afterthought.

“Early on, both patients and their health care providers are focused on the cancer, even if caught at an early stage,” says Monica Christmas, M.D., Obstetrician and Gynecologist and Director of the Center for Women’s Integrated Health at UChicago Medicine. With the overriding goal of getting rid of their cancer, many women aren’t yet able to focus on the potential impact on sexual function, she says.

Talking openly about sex after cancer

A doctor may follow a patient’s lead on what topics to prioritize, but cancer care visits focus primarily on diagnosis and treatment, says Dr. Lindau. “We know that cancer and its treatment commonly interfere with sexual functioning, but we rarely raise the issue with women. We also tend to avoid talking about palliative and end-of-life care,” Dr. Lindau admits, adding that professional medical and cancer organizations agree these topics should be addressed by physicians. Ideally, a physician will start a conversation about what the treatment plan looks like, including potential impacts and side effects.

“The best approach for patients and health care providers is to proactively discuss how their cancer diagnosis and treatment may impact their mental and physical wellbeing including how sexual function may be impacted,” says Dr. Christmas, offering examples of how radiation treatment for cervical cancer can cause the vaginal walls to tighten and shrink and how chemotherapy medications can cause hot flashes, night sweats and vaginal dryness. While surgery for breast cancer might not affect sexual function for everyone, it can influence body image, cause pain and affect sexual arousal and sensation.

talking-about-sex-after-cancer-with-dr-monica-christmas
Monica Christmas, MD, gynecologist and director of the Center for Women’s Integrated Health at the University of Chicago Medicine. Photo credit: UChicago Medicine

“These side effects affect people differently, so it is important that healthcare professionals allow patients space to articulate their fears and frustrations without making assumptions,” says Dr. Christmas.

The focus of conversations with the physician depends on a woman’s values and priorities — even on the type of cancer and treatment required, says Dr. Lindau. And women can set their expectations about recovery through these discussions.

If the physician does not open the door for topics about sexual function, Dr. Lindau recommends asking the following questions:

 

  • What is known about the effects of my cancer and its treatment on female sexual function?
  • What can I expect in terms of my sexual function if I choose this treatment or the alternatives you are offering?
  • Do I have to stop having intercourse or other kinds of sexual activity? If so, how do I know when I can safely start having sex again?
  • Is there anything I can do or anyone who can help me preserve and recover my sexual function?

On womanlab.org, Dr. Lindau shares information about what doctors and patients talk about with regard to sex and things about sex a doctor shouldn’t say to a woman. Both are highly informative articles that shed light on the doctor-patient relationship.

Your sexual function is ‘integral to well-being’

Women should never feel guilt or hesitation about speaking up about their sexual function after cancer, says Dr. Christmas. At UChicago Medicine’s Center for Women’s Integrated Health, patients can expect a full range of resources to help them recover holistically in an environment of open, patient-focused care.

Patients should never minimize telling their doctor that it’s harder to have an orgasm or that sex hurts because they believe these issues are inconsequential to a doctor who saved them from  cancer, she says. “We’re setting the tone that sexual function is integral to well-being, not a small thing,” she explains. “Even if your provider can’t help you, they should provide resources.”

And that includes a recommendation to see a sex therapist, if needed, to help learn new ways of achieving sexual function and coping strategies, rather than focus on what sex was like before cancer.

Finally, when preparing to talk with your physician, make it a priority at the top of your visit, rather than waiting until your doctor is getting ready to walk out of the room. “You do need to come to the visit prepared,” says Dr. Christmas. “If you’re having a personal conversation with your health care provider and don’t want certain people to hear, don’t bring them into the room with you. Have the family member wait in the waiting room.”

Another tip: when you make your appointment, let your provider know your priorities for the visit. By giving your doctor a heads-up, you’re giving them time to prepare — and to prioritize your needs during the visit.

Expertise provided by UChicago Medicine. Learn more at UChicagoMedicine.org.

Claire Charlton
Claire Charlton
An enthusiastic storyteller, Claire Charlton focuses on delivering top client service as a content editor for Chicago Parent. In her 20+ years of experience, she has written extensively on a variety of topics and is keen on new tech and podcast hosting. Claire has two grown kids and loves to read, run, camp, cycle and travel.

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