DeeDee Stiepan: Coming up on Mayo Clinic Q&A,
Dr. Jennifer Vencill: We need to be really, really patient with
our physical and our mental health as we recover from an
ordeal that for many, many people is incredibly traumatic,
often rediscovering our optimal sexual health after a major
illness and traumatic process that comes with that requires a
lot of patience and exploration.
DeeDee Stiepan: Treatment for certain cancers can affect your
sexuality, causing a range of signs and symptoms that can make
sex with your partner more difficult. But that doesn't mean
you can't have a healthy sex life after cancer treatment.
Dr. Halena Gazelka: It's really important for folks to know and
for your audience to know that there's treatment available and
way more options out there than most people think. There's so
many more options than there ever used to be.
Welcome, everyone to the Mayo Clinic Q&A podcast, I'm your
host, Dr. Halena Gazelka. Treatment for some cancers can
affect sexuality, causing a range of signs and symptoms that
can make sex more difficult. Having cancer also affects
emotions, which can also affect one's attitude toward sex and
intimacy with a partner. Here to discuss how cancer and cancer
treatment can affect sexual health, is Dr. Jennifer Vencill,
a Mayo Clinic psychologist. Thanks for being here with us
again today, Jennifer.
Dr. Jennifer Vencill: Thanks for having me, Halena. It's great to
be back.
Dr. Halena Gazelka: Well, and I always learn something when we
have you on the podcast, so I'm delighted to have you here. What
are the most common sexual side-effects after cancer
treatment?
Dr. Jennifer Vencill: Well buckle up for maybe a long
answer, because there actually are a lot I think that we don't
tend to give much thought to unfortunately. So, you know,
I'll first preface that by saying sex and sexuality are
multifactorial. They're incredibly complex. But we
typically break sexual functioning into four general
domains when we're talking to patients about sexual concerns.
So, those domains are arousal, desire, orgasmic/ejaculatory
function, and pain, of course, with sex. There's overlap
between those four domains, but in general, we might see things
like for arousal, this is the physiological side of sexual
arousal. So, we might see changes during or after cancer
treatment in how one's body experiences sexual arousal in
that way. So, that could be difficulty with erections for
example, or thinning of the vulva vaginal tissues, or
dryness of those tissues. That could be a problem for sexual
activity. With desire, also known as libido, so this is kind
of a psychological interest in sexual activity, very commonly
lowered interest in sex, or loss of libido in sexual activity
during or following cancer care. And then the orgasmic or
ejaculatory domain, it is very common for patients to
experience changes in their sensitivity. So, this might be
numbness in parts of the body, neuropathy, tingling sensations
that can really disrupt their ability to reach sexual climax
or orgasm. Ejaculatory function in particular can be greatly
impacted by things like prostatectomy surgeries, or
treatment for prostate cancer in particular. And then the final
category of pain. So, sexual discomfort and pain in
particular can be directly related to cancer care. So, that
could be a surgery, perhaps in the pelvic area, or the genital
area or reproductive organs. But pain with sex can also be
indirectly related. There's a couple of ways that that could
happen. So, this might be chemotherapy or radiation in the
pelvic area leads to vulva vaginal dryness, which then in
turn creates pain with vaginal penetration, or a surgery
creates hormonal changes. So, something like an oophorectomy
where the ovaries are removed, and sex hormones change really
dramatically. That could lead to a similar outcome where there's
vulva vaginal dryness and pain or discomfort with penetrative
sexual activity. So, those are kind of the four big domains
that we start to see sexual side-effects from cancer
treatment. And then of course, we can't neglect the mental,
emotional, relational impact that treatment can have on both
the patient, and of course, their sexual and/or romantic
partners. For many partners who are also caretakers, navigating
sex amidst cancer treatment and kind of the cancer survivorship
period can really be a unique and challenging reality for a
lot of folks.
Dr. Halena Gazelka: So Jennifer, it sounds to me like from a
treatment viewpoint, that sometimes it's a surgical or
radiation perhaps, or even drug related like a chemotherapy or
something like that side-effects essentially.
Dr. Jennifer Vencill: Correct. Yeah. So, we can have this
direct sexual effect or impact, if you will. So, a surgical
procedure, especially to the pelvis, of course, can really
directly impact the nerve endings, the muscle groups, so,
the pelvic floor muscles, for example, that are directly
involved in our sexual response, and so that can be kind of these
very clear direct impacts from cancer treatment on sexual
health. But a lot of them are less direct, maybe more
indirect, or what we would consider kind of a cascade
effect of treatment. So, this commonly comes up with loss of
libido or decreased desire for sexual activity. So, that could
be indirectly related to anything from fatigue to nausea
because of chemotherapy, to body image concerns. That might be
about surgery, for example, mastectomy for breast cancer
patients comes up a lot. Loss of libido could also be related
to pain that has come from a surgery. So, we can see these
kind of cascade effects very clearly for patients.
Dr. Halena Gazelka: What should patients ask their physicians or
their treatment teams so that they're prepared for the sexual
side-effects that might come with their treatment for cancer?
That's such a great question. I really appreciate you asking it.
You know, I think the first thing I would be remiss not to
mention is that folks should be aware that unfortunately, there
are many medical providers who are reluctant, or they just feel
unprepared to counsel their patients about sexual
side-effects related to cancer treatment. And that's kind of on
the medical education side of things. That's work that we're
still trying to do. And so, it's really important to be your own
advocate here, even if it feels like a bit uncomfortable. It's a
topic that most of us are not taught to talk about openly,
really, with anyone, much less medical providers, but it's
really important to be your own advocate here and to ask
questions. So, what to ask about, ask about expected body
changes from treatment, ask about common effects on those
four sexual function domains that we just talked about. So,
arousal, desire, orgasm/ejaculation, any
discomfort or pain that might result from care. And then of
course, what care is available if you have difficulties. So,
it might not present right away. Many people initially after a
diagnosis can understandably be shell shocked, and they're
focused on simply surviving. Of course, of course they are, so
sometimes sexual health concerns come later down the line. But
it's important to know what support you have. So, ask about
resources, certainly websites, books, support groups in the
area or online, but also any sexual health specialists that
are in your area. So, sexual medicine providers, sex
therapists like me are often really well versed in helping
patients navigate sexual side-effects and sexual recovery
after cancer.
So, you mentioned sexual recovery. So, is it possible to
regain sexual function? And are there things that individuals
can actively be working on to help promote that for
themselves?
Dr. Jennifer Vencill: Absolutely, it's not always a return exactly
to what it was pre cancer diagnosis and treatment,
sometimes, but that's not always the case. You know, I think
three words come to my mind here when I think about regaining
sexual functioning and what we can do. And those words are
patience, exploration, and support, right. So, we need to
be really, really patient with our physical and our mental
health as we recover from an ordeal that for many, many
people is incredibly traumatic to go through this process. And
often rediscovering our optimal sexual health after a major
illness and traumatic process that comes with that requires a
lot of patience and exploration. This could be anything from
relearning our body sensations and our erogenous zones,
something that we refer to as body mapping in the sex therapy
world. Or it might be getting comfortable in a body that has
really drastically changed in how it looks or how it works.
This might be exploring sexual aids and things that you maybe
previously hadn't thought about incorporating into your sex
life, whether solo or with a partner. And oftentimes,
exploration on one's own is really beneficial to start to
understand your new normal, a phrase that I don't love in
these COVID times, because we overuse it, I think. The new
sexual health normal following cancer care, sometimes it's
helpful to really do that exploration on our own before we
kind of move into partner exploration just to kind of get
a sense of baseline, a sense of personal comfort, those sorts of
things. And then the support piece of course, as I mentioned
before, you know, you always want to ask your care team about
resources and sexual health specialists in the area. It's
really important for folks to know and for your audience to
know that there's treatment available, and way more options
out there than most people think. So, we have excellent
treatment options for folks that are struggling with vulva
vaginal dryness, with sexual pain, with erectile concerns,
and so on. There's so many more options than there ever used to
be. There are also amazing mental health providers who
specialize certainly in sexual health, sex therapy, but there
are also mental health providers out there that specialize in
oncology care, cancer care. So, they help folks work through the
process of cancer treatment and cancer survivorship as well. And
so, it's really important to be aware of those support systems
and to make use of them.
Dr. Halena Gazelka: I was interested in what you said
earlier about how people kind of get in a survival mode where
they are just trying to get through. I've been very open
about the fact that I was diagnosed with breast cancer
earlier this year, and went through surgery and radiation,
etc. And I was amazed. And I work in a healthcare setting.
So, you think I would know better how much energy and time
it takes just to go to appointments.
Dr. Jennifer Vencill: Oh, yeah.
Dr. Halena Gazelka: Just to wait in the waiting room into and of
this other stuff. And then there's an emotional impact that
comes after that. So, what is the best way for individuals to
recognize their own emotional needs and get them met during
and after cancer treatment?
Dr. Jennifer Vencill: I think for me, this is knowing that
Dr. Halena Gazelka: I was just going to ask you, you kind of
it's expected, right. And so, it's not a matter of, if it's
sort of a matter of when, or really just sort of when you
decide you're ready to seek support, right. So, you know, in
general psychological and emotional stresses, it's a
barrier to sexual health, of course, but it's also really
common, if not entirely predictable, in the face of a
major life stressor, like cancer and cancer treatment, and all
that you are going through physically, emotionally,
mentally, relationally, as you mentioned. And so, we know that
symptoms of stress, anxiety, depression, these are all
really, really common for cancer patients, and their families,
oftentimes, that are battling cancer right alongside with them
in their own ways and having their own experiences at the
same time. And so, this is something to really be kind of
keeping an eye on for yourself, and perhaps for your loved one
who's going through the process as well, if they are so tired
and so exhausted from treatment, that they're maybe not able to
advocate for themselves to help them find the support systems
that they need.
mentioned partners, but what can intimate partners do to better
understand what their partner is going through with cancer
treatment? And how can they help?
Dr. Jennifer Vencill: Yeah, partners have historically been
so overlooked and undervalued, I would argue, when it comes to
just kind of patient care in general, but particularly in my
field, when we talk about sexual health recovery after cancer.
Certainly, sexual health can happen on our own, but
oftentimes, it happens within relationships and with partners,
of course, and so, you know, just like cancer related
distress, that anxiety, that general stress can be buffered
with positive partner support. So too, can sexual health
concerns be impacted by positive partner and relational dynamics.
But it can really go either way, right. So, if those partner and
relational dynamics are hostile, if they're negative, if they're
unsupportive, that can really take a toll on everything from
kind of general mental health to physical well being, and
certainly sexual health as well. And so, what's really important
here is making sure that we're having the conversations right,
both around kind of mental and emotional well-being and then
sexual health as well, when that patient feels ready to do that,
because again, for many people, the focus is just surviving at
first, and of course, it is right.
Dr. Halena Gazelka: It is very physical.
Dr. Jennifer Vencill: Yes, absolutely. We go into quite
literally a stress response, a survivorship mode, and that is
okay, right. And so, the sexual health piece of things might not
come until later. What I have found is that partners abilities
and comfort levels really in discussing sex and sexual
health, sexual health education, general attitudes around sex,
that really can be really predictive of how well they do
here, right. And so, the better able you are to talk openly with
your partner about these topics, which again, we consider
culturally very sensitive, most of us are not encouraged or
certainly trained in the medical world to talk about sexual
health concerns in an open way. This can be really, really
tough. And so, it might get to a point where if these are hard
conversations to have, for whatever reason, that again,
seeking that support from a professional that can help you
through it can be really, really enormously helpful.
Dr. Halena Gazelka: Well, like you said Jennifer, medical
education is a little negligent in teaching about sexual health,
interviewing and advising, I think, in many areas. And so, I
think just us talking about this today and giving listeners an
invitation to ask their provider and to talk to their partner
about it and to explore the topic is really helpful. So,
thank you.
Dr. Jennifer Vencill: You're very welcome. I'm happy to be
here.
Dr. Halena Gazelka: Do you have any last words of wisdom for our
listeners today?
Dr. Jennifer Vencill: I think I would go back and reiterate
those key words right, patience, exploration, support. What the
new sexual normal looks like during and after cancer care
could be worlds different than what you expected it to be. But
that doesn't always mean bad. So, sometimes when I meet people
for the first time there's a grieving process that's
happening and understandably so. Again, they've been through a
trauma physically, emotionally, sometimes relationally. And
through that grieving process we need to recognize the other side
might not be a catastrophe. Right, it might not be as bad as
we think it's going to be. In fact, for some of the cancer
survivors I work with, they're having better sexual health and
better sex lives than they did before cancer treatment. So, I
think it's important to hear those messages of hope and
positivity here because this can be such a hard journey for folks
and their partners.
Dr. Halena Gazelka: Wonderful. Our thanks to Dr. Jennifer
Vencill for being here today to talk to us about sexual health
and how it relates to cancer care. I hope that you learned
something. I know that I did. And we wish each of you a
wonderful day.
Narrator: Mayo Clinic Q&A is a production of the Mayo Clinic
News Network and is available wherever you get and subscribe
to your favorite podcasts. To see a list of all Mayo Clinic
podcasts, visit newsnetwork.mayoclinic.org. Then
click on podcasts. Thanks for listening and be well. We hope
you'll offer a review of this and other episodes when the
option is available. Comments and questions can also be sent
to mayoclinicnewsnetwork@mayo.edu.