Case Presentation
Colleen is a 45-year-old woman who began chemotherapy for breast cancer recently. She has been married for 20 years and had a healthy sexual relationship with her husband prior to her diagnosis with breast cancer.
At her last visit, Colleen reported having hot flashes. Upon further discussion, she reluctantly admitted to experiencing other menopausal symptoms, including vaginal dryness and dyspareunia. She reported that it is difficult to be intimate with her husband due to the symptoms that she is experiencing. In addition to her premature menopausal symptoms, losing her hair and experiencing scarring on her breast has had an impact on her body image that carries over into her intimate interactions with her husband.
Discussion
First, you should emphasize to Colleen that sexual side effects are common in breast cancer survivors and that there are treatment options to diminish the impact of these symptoms. Colleen is experiencing premature menopausal symptoms induced by breast cancer treatment drugs that block estrogen. You should discuss the use of lubricants to help ease the vaginal dryness. The use of a low dose vaginal estrogen product may be helpful in easing painful sex.
Colleen is also experiencing body image issues due to changes in her appearance after her breast cancer treatment. You may recommend yoga or another exercise regimen to help her become reacquainted with her new body. In addition, mindfulness exercises, as part of the total treatment plan, have been shown to be effective in decreasing sexual distress. Colleen may benefit from participating in counseling sessions to address her body image issues and the impact they are having on intimacy in her relationship.
This case illustrates the impact of treatment on the sexual health of cancer survivors. The National Cancer Institute estimates that 40-100% of cancer survivors experience some form of sexual dysfunction. As a clinician, it is important to initiate conversations about sexual health with your patients who are cancer survivors in order to identify and treat any issues that they may be experiencing.
References
- World Health Organization, Department of Reproductive Health and Research. Developing sexual health programmes: a framework for action. Nov 2010. Available at http://www.who.int/reproductivehealth/publications/sexual_health/rhr_hrp_10_22/en/index.html
- Fisher L. Sex, romance, and relationships: AARP survey of midlife and older adults. April 2010. Available at: http://www.aarp.org/relationships/love-sex/info-05-2010/srr_09.html
- Laumann EO, Nicolosi A, Glasser DB, et al. Sexual problems among women and men aged 40-80 y: prevalence and correlates identified in the Global Study of Sexual Attitudes and Behaviors. Intl. J of Impotence Research 2005; 17:39-57.
- Nusbaum MRH, Hamilton C, Lenahan P. Chronic Illness and Sexual Functioning. Am Family Physician 2003;67:347-54.
- Marwick C. Survey says patients expect little physician help on sex. JAMA 1999;281:2173-74.
- Clayton AH. Assessment of female sexual dysfunction. Prim Psychiatry 2001;8:36-52.
- National Cancer Institute. The prevalence and types of sexual dysfunction in people with cancer. 2011. Available at http://www.cancer.gov/cancertopics/pdq/supportivecare/sexuality/HealthProfessional. Accessed on March 15, 2012.
- Mortimer JE, Boucher L, Baty J, et al. Effect of tamoxifen on sexual functioning in patients with breast cancer. J Clin Oncol 1999;17:1488-92.
- Ochsenkuhn R, Hermelink K, Clayton AH. Menopausal status in breast cancer patients with past chemotherapy determines long-term hypoactive sexual desire disorder. J Sex Med 2011;8:1486-94.
- Association of Reproductive Health Professionals. Handbook on Female Sexual Health and Wellness. September 2011. Available at http://www.arhp.org/Publications-and-Resources/Clinical-Practice-Tools/Handbook-On-Female-Sexual-Health-And-Wellness
Resources
The Impact of Cancer on Sexual Health
