Cancer diagnosis doesn’t have to halt your sex life
Cancer, whether it’s ovarian, prostate or even lymphoma, can have negative effects on a person’s sex life, but there are ways to increase desire and aid performance, according to doctors with expertise in the field.
Dr. Mary Jane Minkin, co-director of the Sexuality, Intimacy and Menopause for Cancer Survivors program at the Smilow Cancer Center, said anyone who is having sexually based problems, such as early-onset menopause, can get help in her center.
“In our clinic, in the SIMS program, we take all comers,” she said. “We have people with all cancers. We can point out all the interesting things that can happen to folks” whose sexual dysfunction is not directly related to their cancer.
According to research, 60 percent of women and 40 percent of men with cancer suffer from sexual dysfunction, but, according to one paper, it isn’t brought up by oncologists 80 percent of the time, Minkin said.
Minkin specializes in menopause, which, in addition to aging, can be brought on by removal of the ovaries. The program for cancer survivors was begun by Dr. Elena Ratner, who was doing a gynecology oncology fellowship and saw how many menopause patients in Minkin’s office were cancer survivors.
“The program started off, was quite successful, but we were only seeing GYN oncology patients,” Minkin said. “And what happened is, news got out in cancer world, you know, from patients who unfortunately were suffering from other cancers that the gynecology patients had these needs attended to.”
Oncologists wanted to start a similar program for patients with non-gynecology cancers. “The problem is that medical people in general aren’t attuned to dealing with menopause or sexuality issues. So they finally said … ‘can you just see our patients’ and we said, ‘Sure, no problem,’” Minkin said. “So we acquired everybody. We acquired all the women who were survivors of any cancer.”
Most of those patients have had breast cancer, because it’s the most common, Minkin said, but women also can get bladder cancer, which often is treated with radiation.
“Radiation therapy to the pelvis can scar the vagina because it’s right in the way.
It sits right behind where the bladder lives,” Minkin said. “And so these people can suffer from sexual issues because of the radiation therapy to their pelvis. So we see people with rectal cancers, gastroenterological cancers who have radiation therapy, or chemotherapy.”
Ovarian cancer “is the nastiest in general,” because it is hard to detect early, before it spreads to other parts of the body. But it’s not the most common gynecological cancer. That is uterine or endometrial cancer. Cervical cancer is declining, Minkin said, because of the increase in people getting the human papilloma virus vaccine.
Women also may have their ovaries and breasts removed even though they don’t have cancer, because they have the BRCA gene, which makes them more susceptible to those cancers. They are known as “previvors.”
“And what’s really interesting is many women don’t realize that most previvors who do not have a cancer diagnosis can quite safely take estrogen therapy,” Minkin said. “And we have most of our patients who are previvors on estrogen.”
Her office sees people who have non-GYN cancers, too. “If somebody is premenopausal and they get chemotherapy, the ovaries are often knocked out,” Minkin said. “So these people will undergo menopause just from the chemotherapy that they’re getting, say for Hodgkin’s disease or something like that.”
Besides the gynecologists, the SIMS program has a team of psychologists to attend to patients’ emotional needs.
Besides early menopause, which can bring on night sweats and hot flashes, Minkin sees women with vaginal dryness. In all these cases, a common treatment is estrogen, such as a cream for the vagina.
She said while some oncologists worry that estrogen can stimulate certain breast cancers, “there really is almost no risk from that,” she said, because the amount of the hormone is small.
She also uses dilators, which can be viewed on her website Madame Ovary (madameovary.com), which “basically help stretch the vagina for people who were having pain with sex,” she said, such as those whose vagina was scarred by radiation therapy. The website has a large number of resources, including videos and her research.
Much of what Minkin treats is pain during sex or low libido. “And this is a controversial issue, but many people think that, particularly for postmenopausal women, that testosterone is involved in sex drive, so that sometimes we will actually give our patients testosterone,” she said.
Among the psychological issues, “as far as people being concerned about having pain with sex and just emotionally that their organs are gone,” Minkin said. “Can they have sex successfully with their organs gone? And the answer is, yes, they can. But we have to convince them that they can.”
Men: Prostate and bladder cancers
Prostate and bladder cancers often require surgery, Dr. Stanton Honig, professor of clinical urology at the Yale School of Medicine, said.
Prostate and bladder cancers often require surgery, Honig said. “So we have a pretty robust program where we get patients in actually before they have treatments, before they have radiation and before they have surgery,” Honig said. “And we can prepare them for the fact that things may decline during the time but that we have good treatments available … so they can be intimate with their partner.”
Erectile dysfunction is a common after-effect of surgery. Treatments may be as simple as Viagra or Cialis, Honig said.
“And if that doesn’t work there are second-line options that work exceedingly well, and it may sound squeamish, but there are injectable medicines that go into the side of the penis, with a tiny, tiny needle,” he said. Patients are taught how to inject the medicine, “and most patients respond very, very well,” he said.
Another is a vacuum erection device that draws blood into the penis. Finally, patients can have a penile implant surgically implanted, “where you can put a mechanical device inside the penis,” which works hydraulically to fill two rods inside the penis with fluid.
“In actuality, of all the satisfaction rates that we have with patients who have treatments for their erectile dysfunction, the penile implant actually has the highest satisfaction rate,” above 85 percent, “in patients who are having significant problems,” Honig said.
That’s because, “once it’s in, patients can be intimate whenever they want,” he said. “It allows for spontaneity, and infection rates are very low; malfunction rates are very low.”
For men with testicular cancer, the issue is mostly about fertility, Honig said, so patients are urged to freeze their sperm if they undergo surgery to remove the testicle. For those who undergo chemotherapy, “many times the sperm will return and, if not, there are procedures where we can actually extract sperm from the testes and use that in conjunction with in vitro fertilization,” he said.