Women’s Perceptions and Experiences of Sexual Health After Radical Cystectomy
Bladder cancer is more common in men, but women often have more advanced disease and worse health outcomes after treatment. Women with high-risk bladder cancer may undergo radical cystectomy, which involves the removal of the bladder and often the uterus, fallopian tubes, ovaries, and anterior vaginal wall. This can significantly impact sexual function.
Female sexual dysfunction (FSD) after this surgery includes symptoms like pain during intercourse and difficulty with arousal and orgasm. Few studies focus on FSD in women post-radical cystectomy, and those that do highlight issues like changes in body image and inadequate sexual health counseling. Therefore, the authors of a new study aimed to fill gaps in understanding by using in-depth interviews with women to explore their sexual function and quality of life after this type of surgery. Their ultimate goal is to improve surgical techniques and support services for these patients.
The researchers recruited 40 women who had undergone bladder cancer surgery within the past 6 months to 5 years. Participants completed quality of life and sexual function questionnaires and participated in 45-minute, one-on-one telephone interviews. These interviews, conducted by non-treating physicians, explored experiences and perspectives on sexual function post-surgery. The interviews were transcribed and analyzed to identify common themes.
The data revealed significant issues related to sexual dysfunction and lack of guidance, highlighting areas for improvement in patient care and support. In the end, the authors found four main themes:
- Limited Provider Guidance: Many women felt they received little information from their doctors about how radical cystectomy would affect their sexual function. Some were left unsure about their ability to engage in sexual activity post-surgery.
- Barriers to Sexual Activity: Women faced both physical and mental challenges to resuming sex, including feelings of uncleanliness due to incontinence and vaginal discharge, as well as emotional strain.
- Lack of Arousal and Climax: Patients experienced difficulty in achieving sexual arousal and climax. Some reported a complete loss of sexual sensation, while others found the effort required to reach climax was not worth it.
- Helpful Strategies: Physical therapy and the use of vaginal dilators helped some women regain sexual function. Specialized exercises and therapies played a crucial role in their physical and mental recovery, enabling them to resume sexual activity.
Ultimately, through examining the experiences of female bladder cancer survivors after radical cystectomy, the researchers shed light on their sexual health outcomes. Despite the patients’ interest in maintaining sexual activity post-surgery, they often received little guidance from providers. Removing other organs during surgery, like the uterus and ovaries, negatively impacted sexual function. What’s more, physical and mental barriers, such as changes in arousal and climax, body image issues, and uncertainty about safety all hindered their ability to engage in sex.
The results of this study emphasize the need for healthcare providers to openly discuss sexual health with female patients, offering strategies like self-pleasure and referrals to specialized therapists to help them with these challenges. This dialogue should occur throughout the patient’s care journey.
Still, sexual dysfunction post-cystectomy remains very complex, suggesting the need for further research into its various contributing factors. Though this study had limitations, like relying on telephone interviews and a predominantly English-speaking sample, it shed light on crucial issues that must be addressed to improve the quality of life for bladder cancer survivors.
For more information on this topic, please read these publications from the ISSM Journals: The Journal of Sexual Medicine, Sexual Medicine Reviews, and Sexual Medicine Open Access:
References:
Ceasar, R. C., Ladi-Seyedian, S., Escobar, D., Han, J., Koh, K., Porten, S., Chu, C., Gould, E. E., & Bhanvadia, S. (2024). “I think my vagina is still there?”: Women’s perspectives on sexual function and dysfunction following radical cystectomy for bladder cancer, a qualitative study. The Journal of Sexual Medicine, 21(5), 464–470. https://doi.org/10.1093/jsxmed/qdae025
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