Cancer - Sexuality And Health Problems: Womens Sexual Health

Content provided by the Faculty of the Harvard Medical School

Cancer

The physical and psychological ramifications of cancer can deal a serious blow to sexual functioning. Cancer's effects are both direct and indirect. The disease itself can cause fatigue and pain, and the diagnosis may also engender fear, depression, guilt, stress, and poor self-image.

Cancer treatments often produce another set of problems. Nearly half of the women who undergo treatment for breast or gynecologic cancer have long-term sexual problems. For men, prostate cancer treatment causes erectile dysfunction about 85% of the time; however, these effects vary based upon the type of treatment the man chooses. His chances of returning to sexual functioning also depend heavily on his age, his health habits, and the priority he places on sexual activity. A closer look at the impact of common cancer treatments follows.

Surgery

In women, surgery that involves the pelvic organs can damage nerves, diminishing sexual sensation during intercourse. If a woman's ovaries are removed before she has reached menopause, she is likely to experience sexual problems because of the sudden absence of estrogen as well as testosterone. Breast removal denies women the pleasure of being caressed in this area, and it can have a psychological effect as well. After a mastectomy, many women struggle with body image issues and feel less sexually attractive.

For men, surgery for prostate cancer can cut nerves or arteries that are necessary for an erection. Even "nerve-sparing" operations lead to erectile dysfunction at least 20%–50% of the time. Regardless of the type of surgery used, most men do not regain potency for 6–12 months.

Radiation

Radiation treatment for prostate cancer can damage the nerves and vessels that serve the penis. It may also affect testosterone levels, leading to low libido and erection difficulties. Men who've had this therapy may have problems getting or keeping an erection. Women who have had radiation to the pelvic area can develop scar tissue in the lining of the vagina that can cause pain during intercourse. Side effects of radiation treatment — such as fatigue, nausea, vomiting, and diarrhea — are also deterrents to sexual activity.

Chemotherapy

Many of the side effects of chemotherapy, such as nausea, hair loss, weight changes, and diarrhea, can squelch desire, damage a person's self-image, and prompt depression. Women may also notice vaginal dryness and pain. In addition, estrogen levels can drop radically during treatment, causing menopause-like symptoms. Erectile dysfunction is sometimes a side effect in men, but diminished testosterone levels and ejaculation problems are more common. Both sexes report lower sex drive and less frequent intercourse.

Other treatments

Hormone therapy for prostate cancer is aimed at reducing testosterone levels. As a result, approximately 80% of men undergoing this therapy experience low desire, erectile problems, and lack of orgasm.

The sexual effects of tamoxifen, a drug used by women to prevent breast cancer or its recurrence, are not clear. Some studies have shown that it can cause vaginal dryness or tightness, especially in postmenopausal women.

Last updated:	January 23, 2007