Female Cancer Survivors’ Sexual Concerns

It has been estimated that as many as 70% of female cancer survivors—regardless of age, treatment, or specific diagnosis—experience difficulties with sexuality and intimacy. Since this topic is often not discussed with our providers, it may well be that the real numbers are even higher. It is impossible to tease out exactly what any statistics in this area mean. Are we thinking about diminished libido, changed responsiveness, poor self-image, or stresses in relationships?

It has been estimated that as many as 70% of female cancer survivors...experience difficulties with sexuality and intimacy.

Since most of the factors are tough to measure, we are left with subjective experiences and self-reports. Here are a few stories that I have heard that reflect the variability and scope of the problems. I am remembering a woman in her 50s who described a long history of a very satisfying sex life with her husband. After having bilateral mastectomies, she never again allowed him to see her without a camisole and absolutely forbade him from touching her chest. I am remembering a woman in her 40s whose chemotherapy threw her into early menopause; she experienced vaginal dryness and such pain with intercourse that she once screamed. I am remembering countless women listing anything they would prefer to do on a rainy afternoon rather than have sex; their lists included cleaning closets and going to the dentist.

Common sexual concerns include low or absent libido, difficulties with arousal, vaginal dryness, inability to achieve orgasm, and pain with intercourse. Obviously, any of these problems are going to affect the relationship with a partner. Loving partners often worry that sex is no longer a mutual pleasure and refrain from initiating lovemaking for fear of emotionally or physically hurting their loved one. Women often worry about the absence of sex in their primary relationship and understand that their partner may be quite sad, disappointed, or even angry. These are hard themes to discuss and, all too often, the problems persist and contribute to a less close connection.

There has been a lot of interest in the possibility that bupropion, a drug that is often prescribed and effective for major depression, smoking cessation, and seasonal affective disorder, might increase libido. However, a study recently published in The Journal of Clinical Oncology found no difference or improvement among female survivors of breast and gynecological cancers who were given either 150 mg or 300 mg of bupropion or a placebo. The question examined was whether nine weeks of the drug would improve libido, arousal, lubrication, or ease of orgasm. It did not.

The study authors concluded that this is a tough problem and requires an integrative biopsychosocial approach to treatment. Such a strategy would include consideration of biologic (such as diminished hormones), psychological, and relationship issues. They go on to recommend the involvement of a team of specialists, including appropriate physicians, psycho-oncology therapists, and physical therapists who are skilled in pelvic floor rehabilitation. This is a tall order and not one that can be easily delivered.

For most women and their partners, we are left with the simple and not always adequate recommendation of understanding that there have been physical changes, having honest and loving communication about reactions and feelings, and making a commitment to loving one another.

What I have learned over the years of my clinical practice is that sex may never be what it was before cancer, but it absolutely can be a tender, respectful, and joyful expression of a loving relationship.