Sexuality

Definition

Sexuality can be defined as the quality or state of being sexual. Quite often it is an aspect of one's need for closeness, caring, and touch.

Cancer and sexuality

Faced with a disease such as cancer most people initially lose interest in sex. Sexual desire is overshadowed by concern for one's health. Certain cancers directly affect sexual organs making sexual activity impossible or painful. Chemotherapy, radiation and surgical treatments of cancer can affect sexual activity making it difficult or undesirable. The side effects of cancer treatments such as nausea and pain can lessen sexual desire. Cancer treatments that disturb the normal hormone balance can also lessen desire. Many cancer patients are also worried that their partner may feel negatively about them because of the changes in their body and the fact that they have cancer.

Sexuality can be expressed in many different ways. It is possible to continue a healthy and satisfying relationship and maintain a healthy sexual image even after any changes brought about by cancer. Sexual intimacy can be a source of comfort during treatment and recovery from cancer. This may require some adaptation and change of the patient's current sexual patterns but with the right support groups and encouragement from the partner it should be possible to maintain healthy sexual activity.

Cancer and female sexuality

Women undergoing chemotherapy, radiation therapy, or pelvic surgery may experience pain during inter-couse. This could be caused by changes in the size and moistness of the vagina, or infection of the bladder or vagina. Sometimes the pain is so severe that it sets off an involuntary contraction of the vagina called vaginismus. This contraction makes intercourse impossible. Extra lubrication is necessary to make intercourse comfortable. Vaginisimus can be treated by counseling and special relaxation training.

Radical surgery that will drastically change the physical aspects of the vagina and vulva pose an additional challenge for the affected woman and her partner. The woman may be affected psychologically by the change in appearance and also by the fear of pain or bleeding. The genitals may be physically altered so that sexual intercourse is difficult or impossible. Sex therapy, reconstructive surgery, or altering habits so that sexual needs are met without intercourse all may be options after surgery that radically affects the genitals.

Another common effect of cancer treatment is premature menopause. This may follow removal of ovaries by surgery, suppression of ovaries by chemotherapy or radiation therapy of the pelvis. The symptoms are much more severe than normal menopause causing vaginal dryness and tightness, hot flashes and sometimes low androgen levels which can also reduce sexual desire. Women who do not have hormone-sensitive tumors may want to consider hormone replacement therapy, after consultation with their doctor. Radiation treatment of the pelvis, cervix or vagina may cause scarring of the vagina. This makes it tighter and difficult to penetrate. Series of vaginal dilators of different sizes can help to relieve this problem. It is important to use these early to prevent vaginal shrinkage. Counseling may also be beneficial for the affected woman and her partner.

Cancer and male sexuality

Radiation therapy of the pelvis can impair sexual function. Circulating testosterone levels may come down temporarily and during this time men may have a loss of sexual desire. But this does not seem to be a permanent effect in all cases. It may be possible to get aroused by taking more time and experimenting with different kinds of caressing and love making. If erection does not occur after a significant period of time the doctor may suggest tests to check for sleep erections. Some are take-home tests and if they suggest that erection occurs normally during sleep, it is clear the physiological mechanism is intact and sexual counseling may relieve the problem. Sexual counseling may also be helpful to allow enjoyment with sexual caressing in the absence of erections. Men with medical impotence may also be helped by the use of Viagra. Men need replacement with hormones in only very rare cases. In fact, extra testosterone can cause undetected prostate cancer to grow.

Surgery for various cancers can cause sexual problems. Surgery for bladder cancer can lead to decreased sexual desire, lowered ability to obtain an erection, and less frequent or less intense orgasms. Surgery for penile cancer and testicular cancer can result in decreased fertility and desire, difficulties with erections and orgasms, and decreased volume of semen. In treating prostate cancer, the biopsy obtained to confirm diagnosis may decrease semen levels, and, after a man has had his prostate gland removed (prostatectomy), he may be unable to obtain an erection. However, new surgical advances and new chemotherapy options may help reduce these effects.

If, during surgery, the blood supply to the penis is affected, the surgeon may take an abdominal artery and try to connect it the penis. This operation is only successful in a quarter of the patients. Penile injection therapy and vacuum devices have been used to produce erections in the absence of sufficient blood flow. Medications that produce erections are risky and may lead to the formation of scar tissue. Vacuum erection devices are safer but intrude in the lovemaking. Medical erection problems may also be treated by penile prosthesis. This is one of the best ways to treat a permanent erection problem.

Sexual problems of specific cancer treatments

Urostomy or colostomy

Before sexual activity one must ensure that the urostomy fits correctly. The appliance should be emptied to reduce the chance of a leak. A patterned pouch can be worn over it to cover it. Sexual activity with a colostomy can be performed with the same precautions. One can plan sexual activity at a time when the colostomy is not active and avoid gas-producing foods that day. Direct communication and reassurances from a loving partner can be extremely helpful.

Mastectomy

The breast symbolizes sexuality and when the treatment of breast cancer involves mastectomy, psychological counseling is helpful to regain desire and sexual enjoyment. There may be fewer problems when a lumpectomy is done. Women who feel awkward about the change after surgery may consider using a prosthesis covered with a nightgown or bra, or they may consider reconstruction either with or without implantation.

Limb amputation

Treatment mainly of primary tumors of bone often includes amputating a limb. If the partners can openly communicate they can decide whether the prosthesis needs to be worn during lovemaking. Prosthesis can help with movement and balance but the straps that attach it can get in the way. If the prosthesis is not used, pillows could be used instead for balance.

Treatment of facial cancer

Some cancers of the head and neck may be treated by partial removal of the facial bony structure. This can be psychologically very damaging as the scar is so public and affects the face, a vital part of the human personality. Following such surgery, speech may also be affected. Recent advances in facial prosthesis and plastic surgery may help regain a more natural appearance and speech.

Professional help for sexual problems

The first step is to discuss sexual problems with one's doctor. Sometimes doctors themselves may not be at ease discussing sexual issues. Cancer centers may have sexual rehabilitation centers with experts on staff comfortable dealing with these issues. Medical schools and some private practice groups run sexual dysfunction clinics that provide comprehensive care to treat sexual problems. Sex therapists can provide sexual counseling. It is important that the sex therapist be a psychiatrist, social worker or psychologist with special training in treating sexual problems. Professional societies such as American Association for Marriage and Family Therapy can give information about these specialists. It is important to avoid untrained people who provide useless and sometimes harmful therapy.

Resources

BOOKS

Bullard, David G. et al. "Becoming Sexually Active Again." Cancer Therapy, edited by Malin Dollinger M.D., Ernest H. Rosenbaum M.D., and Greg Cable. Kansas City, Missouri: Somerville House, 1994.

DeVita, Vincent T., Samuel Hellman and Steven A. Rosenberg, ed. Cancer, Principles and Practice of Oncology. Philadelphia: J.B. Lippincott Company, 1998 .