Psychosexual health and cancer

A study on psychosexual health in FIGO’s Updated Cancer Report 2018 shows how vital it is to treat every aspect of gynecologic cancer, not just the physical disease itself.

A team led by the University of Cape Town examined data relating to sexual health after gynecologic cancers and treatment, and found that many women experience serious issues surrounding their sexual identity, sexual functioning and relationships.

Ensuring that the sexual health of women who have survived gynecologic cancer is maintained should be a key part of treatment and rehabilitation, their research round-up has concluded.

According to the World Health Organization (WHO), more than three million women were living with gynecologic cancers worldwide in 2012. These include cervical cancer and ovarian cancer. Although many more patients can expect to survive these diseases today than in earlier generations, the long-term effects and associated negative impact on health and wellbeing can be severe.

Sexual dysfunction after treatment

Among gynecologic oncology patients, sexual dysfunction can be as high as 90 per cent.

In some cases, dysfunction can be physiological and may result from surgery required to remove the cancer. The more radical the surgery, the greater the likelihood of sexual issues afterwards, potentially including the complete prohibition of penetration.

The negative impact on sexual health can also be psychological. For example, chemotherapy may cause weight gain, nausea and hair loss, all of which are likely to affect sexual identity and could make women less likely to feel like having intercourse.

Despite this widespread knowledge, a study published in the Journal of Psychosocial Oncology (2007; 25, 61-70) found that fewer than 50 per cent of gynecologic oncologists routinely ask patients about sexual health.

Collusion of silence

Some suggested this was due to constraints on their time; others reported not feeling they had the training, or expressed concerns about embarrassing themselves or their patients.

At the same time, most of the patients questioned for a study in the journal Gynecologic Oncology (2007; 106, 413-418) reported that they would like to have the opportunity to discuss sexual health issues with their therapeutic team.

According to WHO, sexual health is defined as "a state of physical, emotional, mental and social well-being in relation to sexuality; it is not merely the absence of disease, dysfunction or infirmity".

The report published in IJGO therefore highlights how vital it is to treat sexual health issues and dysfunction as part of a comprehensive approach to cancer care, through careful understanding and evaluation.

It recommends avoiding the "collusion of silence" identified above, and instead advises that oncology experts should explain the potential impact on sexual function of any cancer and its treatment prior to going ahead.

The authors also suggest that regular follow-ups should take place to record post-treatment adjustment using the Brief Sexual Symptom Checklist for Women, since many sexual health issues can continue long after cancer survival.

A relationship disease

To conclude, the report quotes from the book Cancer, Intimacy and Sexuality: A Practical Approach: "For effective treatment of sexual difficulties in cancer patients, coordinated provision of information, support, and symptom management should preferably be provided, which may require a multidisciplinary approach with the focus on the physical and psychosexual aspects of sexuality."

As this study reiterates, cancer is "a relationship disease" and should be treated as such, particularly concerning gynecologic cancers that can have lasting effects on both patients and their partners' sexual health.