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Sexual Health and Survivorship

Posted 1/22/2014

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  This is an important issue for growing numbers of women. As I have written before, sex and intimacy are usually not the first worry for women diagnosed with breast cancer (although they can be; I have known a few women for whom maintaining an active sex life was their biggest concern). In the beginning, most of us are worried about survival, and, during treatment, most of us are focused on just getting through. It is later that concerns about intimacy tend to become increasingly important.

  Most oncologists are not experts in this area and the topic is often not addressed. If a woman brings it up, most doctors are able to make a few recommendations, but, at least here, the primary suggestion is often that the woman/couple meet with me or one of my colleagues. That's fine as we are well informed and prepared for these discussions, but it feels very important that the subject is part of every cancer patient's care. Not everyone wants or needs to talk about it, but doctors surely should ask. Along with the routine questions about energy and appetite and any new aches or pains, there should be a question like: "Have there been changes to your intimate relationships related to cancer and treatment?".

  This article from The Oncologist confirms that this is an important topic that is too often overlooked. Here is the abstract and the introduction. I am not able to post a working link, but, if you want the whole article, please email me (hhill@bidmc.harvard.edu), and I am happy to send it to you.

Sexual Health as a Survivorship Issue for Female Cancer Survivors
DON S. DIZON,a,b DAPHNE SUZIN,a SUSANNEMCILVENNAa
aGillette Center for Gynecologic Oncology and bOncology Sexual Health Clinic, Massachusetts General Hospital, Boston, Massachusetts,
 

ABSTRACT
As more and more people are successfully treated for and live
longer with cancer, greater attention is being directed toward
the survivorship needs of this population.Women treated for
cancer often experience issues related to sexual health and
intimacy, which are frequently cited as areas of concern, even
among long-term survivors. Unfortunately, data suggest that
providers infrequently discuss these issues. We reviewed a
contemporary understanding of sexual health of women and
the impact of treatment on both sexual function and intimacy.
We also provide a review of the diagnosis using the newest
classification put forth by the American Psychiatric Association
in the Diagnostic and Statistical Manual of Mental Disorders,
fifthedition,andpotential treatments, includingbothendocrine
and nonendocrine treatments that the general oncologist may
be asked about when discussing sexual health with his or her patients.

INTRODUCTION
For patients diagnosed with cancer, survivorship starts at the
time of diagnosis [1]. Fortunately, most patients can be expected
to do quite well following diagnosis, with a 5-year
survival rate of approximately 70% across all tumor types [2].
Current estimates in theU.S. alone indicate that 64%, 40%, and
15% of cancer survivors are alive 5 years, 10 years, and 20 years
or more, respectively, following diagnosis [3]. As a result,
almost 13 million people in the U.S. and 30 million people
globally are living beyond cancer [4].
Despite the data showing that most survivors have a good
prognosis, current treatments can result in problems, which
can extend for years after treatment. Of those most commonly
cited by survivors are issues pertaining to sexual health [5]. In
this review,wewill discuss sexual health following the diagnosis
and treatment of cancer. We will specifically concentrate on
these issues as they relate to female cancer survivors; the
approach tomale sexual health after cancer differs substantially
and is beyond the scope of this paper.

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