Is There Sex After Cancer?

When a woman is diagnosed and treated for gynecological or reproductive cancer, it can change her physical and psychological experience of sexuality. Two experts — one a doctor, one a patient — explain and offer advice on how to cope. When a woman learns she has cancer, her first question probably won’t be: “So, what does this mean for my sex life?” Yet when women go through treatment for gynecologic or reproductive cancer (affecting the cervix, uterus, endometrium, ovaries, vulva, or breasts), the physical and psychological toll can lead to devastating problems in their intimate relationships.

A 2015 study of gynecologic cancer patients at the University of Colorado School of Medicine, presented at the annual meeting of the American Society of Clinical Oncology, found that subjects had a one in six chance of seeking couples therapy, a one in six chance of separating, and a one in six chance of getting divorced. In fact, patients were less likely to see their cancer come back than they were to see their romantic relationship die.

The lead researcher in that UC study, Saketh R. Guntupalli, MD, shares more findings and insights in his 2017 book Sex and Cancer: Intimacy, Romance, and Love After Diagnosis and Treatment. His co-author is Maryann Karinch, a patient of his who has written prolifically about health and human behavior.

In a phone interview with Everyday Health, the two talked about the effect of cancer treatment on sexual function; the couples who break up and the ones who become stronger; and the things any patient and her partner can do to find emotional closeness and physical pleasure.

Everyday Health: Do doctors typically tell female patients how cancer treatments might affect their sex life?

Saketh Guntupalli: No. We have reasonably good data that came out of Harvard a few years ago that asked the question: “What percentage of the physicians brought up a woman’s intimate life after a diagnosis of cancer?” What we found was that only about 10 to 14 percent of doctors brought it up. Very few patients bring it up, as well. I think one reason they don’t is that they’re embarrassed. Also, cancer patients tend to be really focused on treatment, treatment, treatment, and cure, cure, cure. It kind of takes over their lives. So they don’t ask about [sex and intimacy] even if they think it might be important, even if their partner thinks it might be important.

Maryann Karinch: I should mention that there is one type of treatment that necessitates discussing your intimate life at least a little bit with your doctor. That’s brachytherapy. [When used to treat cervical cancer, brachytherapy involves inserting a metal cylinder filled with irradiated material into the vagina]. If you go in for that kind of therapy, it’s necessary to discuss how you are going to address the issues that come along with it. [The vaginal opening can become narrow and inflexible as a result of treatment; to prevent this, patients need to have sex several times a week or use a device called a vaginal dilator.] Otherwise they’ll close up forever.

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