Sexual health in cancer survivorship complex, often unaddressed
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Survivors of cancer may face long-term sexual side effects, not only in terms of physical function but also in confidence, body image and the ability to connect emotionally with a partner.
Additionally, ongoing sexual problems in survivorship are all too often left unaddressed due to discomfort at both the patient and provider levels in discussing this sensitive topic, according to a presenter at Cancer Center Survivorship Research Forum.
“I want to normalize that sexual problems after cancer are very common,” Catherine Benedict, PhD, clinical associate professor of psychology and behavioral sciences at Stanford Medicine, told Healio. “So many people feel alone and isolated, and they don’t know who to talk to about these problems. It’s something that gets hidden in the bedroom.”
Pain, disconnectedness and body image
Benedict said, if neglected, sexual problems in survivorship generally do not resolve on their own.
“They will either stay the same or worsen with time,” she said. “This is really something we want to keep discussing and addressing.”
Treatment exposure is the cause of many of the most common sexual issues seen in survivorship, which can include vaginal dryness, irritation or pain with sex, Benedict said. Other issues may have both physical and psychological origins, such as low libido, erectile dysfunction, and anxiety around sex. She said these physical and psychological issues often interact and serve to perpetuate each other, leading to a confusing psychosomatic pattern.
“You can see how that cycle starts to form. If you have pain with sex or erectile dysfunction, sex can all of a sudden become anxiety-provoking or scary,” Benedict said. “It’s very likely that’s going to reduce your desire.”
Body image is another common problem with sexual health in survivorship for both men and women. Benedict clarified that body image issues around sex are not necessarily limited to physical appearance.
“I define body image in terms of the look, feel and function of the body, and all the ways cancer treatment can impact your body and change those things,” she said. “The experience of going to the hospital and getting poked and prodded by strangers is difficult, and so it can be adaptive for people to separate from the body, psychologically. The body isn’t a pleasant place to be.”
Although this adaptation may serve its purpose while a person is undergoing treatment, it is generally the opposite of what is desirable in terms of a sexual encounter.
“During sex, we want to be embodied, we want to be connected to our bodies,” Benedict said. “I work with my patients on how they’re feeling about their bodies and how connected they’re feeling.”
‘Protective buffering’: a misguided act of love
Benedict added that in partnered sex, the wish to please one’s partner can lead to additional frustration, miscommunication and confusion.
“Sometimes a person can feel comfortable being alone in finding sexual pleasure, but as soon as you have that dynamic of another person, there’s pressure,” she said. “I work with women, and women often rush through because they’re worried about their partner having pleasure. They’ll just rush through so it’s done and over with, and they can check that box for the week. That’s not good.”
Benedict said this kind of situation often goes undiscussed, even between couples in a loving, trusting relationship — perhaps especially in those situations. She attributes this to a phenomenon known as “protective buffering,” in which individuals in a relationship avoid bringing up topics that they think will upset their partner.
“This is often done out of love,” Benedict said. “They’re trying to protect the other person, but then nothing gets talked about and it’s hard to move on. Meanwhile, their partners want to be supportive in any way they can, but without communication, they’re just lost.”
‘Please bring this up’
In discussing how oncologists can help cancer survivors with sexual health, Benedict emphasized the importance of simply broaching the topic with patients.
“My message to cancer care teams — whether it’s oncologists, nurses or advanced practice providers — is to please bring this up,” she told Healio. “The same way that you ask about any other side effects of treatment, please bring it up. I don’t need you to spend the entire appointment talking about sexual health, but I do need you to bring it up and ask your patient if it’s a problem.”
Benedict acknowledged that cancer survivors often have a variety of concerns to discuss with their oncologists, adding that in many cases, clinicians can simply refer patients to the sexual health services they may need.
“When it comes to sexual health, I work closely with gynecologists, pelvic floor physical therapists and other specialists,” she said. “I need those front-line cancer care providers to screen for any sexual problems and then pass them off to us, so that we can take the time to dive in and do a careful assessment and treatment plan.”
Benedict said research has shown that survivors and patients want their providers to check in with them about sexual health. However, she added that patients should also feel empowered to bring up the issue with their clinicians.
“If a patient’s provider is not bringing up the issue, patients should know that this is an absolutely common issue that is to be expected from many cancer treatments, and therefore should be talked about,” she said. “If it is something you’re worried about or is affecting your relationship, know that there are treatments out there, and that your oncologist can connect you to those. I urge you to advocate for yourself as a patient if it’s not being brought up.”
For more information:
Catherine Benedict, PhD, can be reached at Clinical Behavioral Analysis Clinic, 401 Quarry Road, Department of Psychiatry, Stanford, CA 94305-5795; email: cbenedict@stanford.edu.
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Benedict C. Sexual health/intimacy. Presented at: Cancer Center Survivorship Research Forum; Sept. 11-12, 2023, Stanford, California.
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