The time between when a woman receives a cancer diagnosis and when she first begins treatment varies. While very little cancer research focuses on exactly what happens for women in that critical span of time, we do know that one topic, the effect of cancer and cancer treatment on a woman’s sexual function, is rarely addressed.
Important professional organizations recommend that doctors raise the issue of sexual function in the context of a woman’s cancer care.
- National Comprehensive Cancer Network
- National Cancer Institute
- The American Congress of Obstetricians and Gynecologists
- Society of Gynecology Oncology
Studies show that women of all ages, even women who don’t have a current partner or who haven’t had sex in a while, value their sexuality and regard this topic as appropriate for discussion with a physician. The best available studies indicate that 40-75% of women with cancer experience sexual difficulties after cancer treatment. Still, cancer doctors (like most other doctors) tend to avoid this topic unless a woman herself brings it up.
The Program in Integrative Sexual Medicine for Women and Girls with Cancer at the University of Chicago sees women with all cancer types – since 2010, we’ve seen more than 500 women with cancers such as breast, uterine, colorectal, lymphoma, leukemia, head and neck cancers, ovarian cancer, vulvar and vaginal cancers and others. Here is a list of questions, pertinent to women with many different cancer types, to give you and the people who love you some ideas about what you can and should ask your cancer care team. Many of these questions are ideally asked BEFORE you make decisions about your cancer treatment plan. Asking these questions after your cancer treatment has been completed may, in some cases, mean an unnecessary loss of function or more difficulty recovering your function.
If you do not have cancer, you can use these questions to help someone who does or you can easily adapt them to inform decision-making about other health conditions and procedures.
Sexual problems after cancer are common among women. You are not alone. If we start routinely asking these questions, doctors will be motivated to learn and communicate the answers.
Here are 3 questions about sex that a woman should ask her doctor before starting cancer treatment.
1. Among my cancer treatment options, are there any that would likely give me both a good cancer outcome and a good chance at preserving my sexual function?
2. Is there anything I can do or know before treatment starts that will help me preserve as much of my sexual function as possible?
3. Do I need to stop having sex and, if so, how will I know when it’s ok to start having sex again?
Here are other totally legitimate questions, some of which are specific to certain cancer types or treatments:
How might chemotherapy affect my sexual function? I know that chemotherapy can put me into menopause or shut down the normal function of my ovaries. Will this chemotherapy affect my sexual function? Are there other options? Can the chemotherapy hurt my partner if we have sex? Do I need to use contraception to prevent pregnancy?
What information can you tell me about how these different surgical options will affect my ability to have normal sexual arousal and pleasure?Men who have prostate cancer get information how different treatments might affect their ability to have erection and orgasm. Do you have similar information you can share with me so I can make an informed choice about surgery?
How will shutting down my ovaries or blocking all the estrogen in my body affect my sexual function? Are there any alternatives? Is there anyone who can help me if I start to have problems?
I hear that using some estrogen in my vagina, like a cream, a ring or a tablet, might make sex easier or less painful after this treatment. Could I try something like that? Is there any evidence that using some estrogen in the vagina increases the risk of a cancer recurrence or cancer spread? Are there any alternatives to estrogen for vaginal dryness that I could try?
What will radiation in or near my vagina do to the normal functioning of my vagina? You are putting radiation in my vagina (or my rectum or in my pelvic area) to treat this cancer. Will I be able to have satisfying sex again? Is there anything I can do to prevent my vagina from scarring up? Will the radiation hurt my partner?
My breasts are very important for my sexual function. How will my breasts be different after this treatment? I know you are very skilled at restoring the appearance of breasts after a woman has a mastectomy. Will I have any sensation in my breasts? Will my nipples still respond to stimulation? Will my breasts feel different to my partner? What if I don’t have reconstruction after my mastectomy? Will my sensation be better with or without reconstruction? How will radiation affect the appearance and sensation of my breast? Will a lumpectomy affect my breast sensation or function during sex?
Could I spread cancer to my partner if we have sex? Are there certain kinds of sex we should avoid like oral sex or anal sex? If so, for how long? Does my partner need any kind of cancer check?
When are my white blood cell counts or my platelet counts too low for me to have sex? Can I have sex even if these numbers are really low? If I have vaginal bleeding after sex, does that mean my platelets are too low? What should I do?
Is there a gynecologist or someone you can refer me to who has expertise in helping women with cancer recover their sexual function? Ever since chemotherapy, sex is really painful. I hear that many women have this problem. Is there anything I can do?
Could graft versus host disease (GVHD) be affecting me in the genital area? My partner thinks the difficulties I’m having with sex since the bone marrow transplant are in my head. But the problems really started when I developed GVHD. Is there anything you can do to help me with these symptoms so I can have sex again? Could you help explain this problem to my partner?
A woman diagnosed with cancer or considering treatments to reduce her future risk of cancer should also ask her doctor: “How will this treatment affect my future ability to become pregnant?” “If I can’t have vaginal intercourse, how can I become pregnant and give birth?” “What can be done to preserve my fertility?” “When is the right time to consult with a fertility specialist?”
If you are a woman with cancer and concerns about your sexual function, you are not alone. Your partner and your doctor are not alone either. WomanLab is here to support you.
Are you a girl or woman with cancer with questions about sex that need answers? Or do you have insights from your own experience that can help doctors do better in this area?
Are you an oncologist or other cancer care professional? Tell us how you answer these questions. What resources do you use? What questions about sex have been difficult for you to answer?
We’d love to hear from you. Email us at firstname.lastname@example.org.
Click here to download a list of questions about sex and cancer that you can share with your providers to start this conversation.