Recovering from sexual dysfunction after cancer

For most of us, the doctor’s office is not the most comfortable locale to talk about that most private activity: sex. No doubt, many of us have questions, but that is what friends, advice columns and phone-in shows are for.
There are, however, situations when typical sex advice may not be sufficient. Consider, for example, sexual dysfunction resulting from cancer treatment.

A recent report by Sharon L. Bober and Elyse R. Park in the Boston Globe raises new and troubling questions regarding the sexual rehabilitation of cancer survivors in a medical climate where confronting the sex lives of patients is still relatively taboo.
This particular cohort of patients is growing, and the medical and therapeutic experts upon which they depend are struggling to catch up.

As Bober and Park report, December 2007 saw the Institute of Medicine publish a landmark report calling for “a new standard of cancer care that tackles a broad range of often unaddressed psychosocial issues.” Yet, tellingly, “sexual functioning is barely mentioned.”

This report, while progressive in its assessment of the needs of cancer survivors, is also a testament to the strides made in the field of oncology, as well as an indicator of how little we understand the post-cancer human experience.
More than ever before, people are successfully overcoming the hazards associated with cancer treatment and looking for continued guidance once the initial threat is contained.
After the tribulations of diagnosis, radiation and medication are overcome, patients must strive to reclaim the lives to which they were accustomed before battling the disease. An integral part of this transition is the re-establishing of sexual practices – an adjustment which, in many cases, falls well outside of the patient-doctor comfort zone.
Leslie Schover from the University of Texas M.D. Anderson Cancer Centre claims that altered “body image, erectile dysfunction, pain and loss of desire” are common to “at least half of breast, prostate, colorectal [and] gynecological cancer survivors.”

A report issued by the department of urology at the Cleveland Clinic Foundation states, “Men with prostate cancer often have sexual dysfunction before the cancer diagnosis is made.”
Other medical researchers definitely appear to be in agreement regarding the importance of sexual rehabilitation. The point of contention seems to be a decision regarding just what must comprise that rehabilitation.
Les Gallo-Silver, senior social worker at New York University, stresses the importance of “phases of sexual functioning and the impact of treatment, giving patients permission to explore their ability to respond to sexual stimulation by using self-pleasuring exercises, teaching sensate focus exercises that structure non-coital foreplay and suggesting changes in coital positions.”
In reference to the doctor’s participation in rehabilitation, Valgntina Clark Donahue of the department of gynecology and obstetrics at Beth Israel Hospital and Robert C. Knapp of the Harvard Medical School states the “sexual rehabilitation of […] patients is vital and must be done sensitively lest one’s own concepts of ‘adequate sexuality’ be imposed.”
Indeed, what is the ideal level of sexual function, and how does one know if one is adequately functional? These are vague terms, doubtlessly difficult to achieve thanks to their lack of clarity.

Whether because of embarrassment on the part of the patient or a lack of training for doctors, discussions about sex can be challenging, and, to the detriment of cancer survivors, sometimes avoided all together. But, as Bober and Park remind us, “Somebody has to start talking about sex.” Certainly. The question is: how?

Written by Jayson Young, Staff Writer
Restablishment of sexual practices can fall outside comfort zone

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February 21, 2008 | Filed Under Erectile Dysfunction

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Recovering from sexual dysfunction after cancer

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