Oncosexology, the study of the intersection between cancer treatment and sexual health, addresses the profound impact of cancer diagnosis and treatment on patients’ sexual function and quality of life. This article explores the controversies, impacts, and management strategies related to sexual dysfunction in cancer survivors.
Cancer Diagnosis and Sexual Dysfunction
A cancer diagnosis often brings significant emotional and physical challenges, including the potential for sexual dysfunction. The disruption caused by the disease and its treatments can affect sexual desire, function, and intimacy, making it a critical aspect of cancer care that is sometimes overlooked.
Testosterone Therapy in Prostate Cancer
The use of testosterone therapy in prostate cancer is a controversial topic. Historically, testosterone was believed to stimulate prostate cancer growth, leading to the widespread use of androgen deprivation therapy (ADT) to lower testosterone levels and slow disease progression. Recent studies, however, challenge this paradigm, suggesting that controlled testosterone replacement therapy (TRT) might not exacerbate prostate cancer and could benefit quality of life in men with hypogonadism. The “saturation model” proposes that prostate cancer growth is driven by low levels of testosterone and that once these levels surpass a certain point, additional testosterone does not further stimulate cancer growth. While these findings are promising, the potential risks and benefits of TRT in prostate cancer patients need further research, requiring a delicate balance between mitigating cancer progression and improving quality of life.
Impact of Oncology Treatments on Sexual Function
Oncology treatments, including surgery, radiation, and hormone therapies, profoundly impact sexual function. Radical prostatectomy, a common surgical treatment for prostate cancer, often results in erectile dysfunction due to nerve damage. Radiation therapy can cause erectile tissue and vascular damage, leading to similar outcomes. Androgen deprivation therapy (ADT), where medication is used to lower testosterone levels to almost zero, can lead to alterations in libido, orgasm, and erectile function.
In breast and gynecological cancers, surgery can lead to changes in body image and physical function, affecting sexual health. Mastectomy, for example, may result in loss of erotically valuable nipple sensation as well as altered body perception and reduced sexual desire if cancer survivors feel less at home in their bodies after the procedure. Radiation therapy to the pelvic region can cause vaginal dryness and stenosis, making intercourse painful and changing arousal and orgasm. Hormone therapies, such as tamoxifen or aromatase inhibitors, decrease estrogen levels, further exacerbating these issues.
It is easy to understand that genital cancer treatments might cause sexual function changes, particularly when hormone suppression is an important treatment. However, treatments for a wide range of cancers, including colorectal, bladder, or head and neck cancer, may also cause sexual function concerns.
Challenges in Managing Sexual Dysfunction in Cancer Survivors
Managing sexual dysfunction in prostate cancer survivors presents significant challenges. Erectile dysfunction, a common side effect, can be addressed with phosphodiesterase type 5 inhibitors (PDE5i) like sildenafil. However, these can often be less effective post-prostatectomy, due to the involved nerve trauma. Penile rehabilitation programs, which may include PDE5i, vacuum erection devices, and penile injections, aim to restore function but require patient/partner commitment.
For breast and gynecological cancer survivors, the management of sexual dysfunction is equally complex. Vaginal dryness and dyspareunia can be treated with lubricants, non-hormonal moisturizers, and dilator therapy, while vaginal dryness in those with non-hormone dependent cancers or more severe cases might benefit from vaginal estrogen and other topical hormonal treatments. Psychological support and counseling play a crucial role, addressing a new or changed relationship with the body and fostering open communication between partners for those in relationships.
Treatment Strategies for Iatrogenic Sexual Dysfunction
Iatrogenic sexual dysfunction, caused by medical treatment, requires tailored strategies for effective management. For men with prostate cancer, penile rehabilitation might include PDE5i, vacuum devices, and intracavernosal injections, which can improve erectile function and penile tissue health. Psychological support and sexual counseling are vital, helping patients and partners navigate changes in sexual function and maintain intimacy.
For women, addressing estrogen deficiency with local estrogen therapy can alleviate vaginal symptoms, while non-hormonal options like lubricants and moisturizers are also effective. Pelvic floor physical therapy can improve sexual function and reduce pain during intercourse. Cognitive-behavioral therapy (CBT) and sex therapy can address psychological barriers and enhance sexual satisfaction.
The Impact on the Partner
The sexual dysfunction resulting from cancer treatment doesn’t just affect the patient; it also profoundly impacts their partner. Partners may experience feelings of loss, frustration, and anxiety as they navigate changes in their sexual relationship and intimacy. Open communication and involvement in the treatment process can help both partners adjust and find new ways to connect emotionally and physically. Addressing the needs of the partner is essential in providing comprehensive care and fostering mutual support in the relationship.
Conclusion
The relatively new area on oncosexology, the intersection of oncology and sexual health, highlights the profound impact of cancer treatments on sexual function. Effective management of sexual dysfunction in cancer survivors, whether male or female, requires a multifaceted strategy encompassing medical, psychological, and supportive interventions. As research progresses, integrating sexual health into cancer care will continue to improve the quality of life for survivors.
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