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Thursday, May 9, 2013

Sex and Cancer

By Heather Millar

man in bed

In my experience, sex is the big elephant in the room for cancer patients. I’ve written about this before, here and here. But in the year since I wrote those posts, I’ve begun to realize what a huge problem this is for patients and survivors alike. I’ve heard about it in support groups, I see people complain about it on on-line bulletin boards, like those at breastcancer.org.

People feel angry, ripped off. Cancer maims parts of your body, they cry. It saps your energy. It makes you miserable. All this, and it takes one of life’s great pleasures as well?

Full disclosure: My husband and I have struggled with how to be intimate after cancer. Right after my surgeries, and during chemo and radiation, he was afraid to touch me. In the couple of years since then, we’ve fought against fatigue, and schedules, and the realization that after 23 happy years of marriage, we need to reinvent the most private part of our relationship. We’re making headway, but it’s a work in progress.

We’re feeling our way, ha, ha. Part of the problem is that there’s so little advice out there, so little data on what cancer patients should do to spice it up, and to remain connected physically.

This is not a trivial problem. When might a person most need to feel loved and supported? During cancer treatment and after! Marriages and relationships are a great source of that love and support. And, in my humble opinion, sex is the glue that holds most marriages and relationships together. It’s what makes me accept that my husband will never check his pockets before putting his pants in the hamper. It’s what makes him accept that I will never update my computer or phone software unless he does it for me.

Luckily, it seems that there’s a growing scientific interest in the problem of what scientists call “sexual dysfunction” in cancer patients and survivors. Yesterday, I talked with Dr. Shari Goldfarb, a medical oncologist at Memorial Sloan Kettering Cancer Center in Manhattan. Dr. Goldfarb is part of the growing Female Sexual Medicine and Women’s Health Program there. It will be the counterpoint to a similar program for men, who most commonly struggle with these problems after prostate cancer treatment.

“We are definitely causing sexual dysfunction in women,” Dr. Goldfarb, who specializes in breast cancer, told me. “We need to understand what we’re doing and how we can fix it.

“Sex is important across the life span. For most patients, the problems have many causes. It may be medications. It may have physical and psychological components. We need to address all these things.”

So far, Dr. Goldfarb and her team have conducted a survey of 500 women, asking them to list their sexual complaints during and after treatment. She’s also looking into treatments for vaginal dryness, which is a common side effect of hormonal treatments after breast cancer. They’re following patients for five years to see when the problems begin, and when and how clinicians might intervene to help. They’re starting to look at these problems in other cancers, too.

“We’re still sort of learning,” Dr. Goldfarb says. “But there’s a growing awareness in our field. Part of it, is that doctors didn’t know what to do about this problem, so they avoided it. That’s changing.”

Dr. Goldfarb says that other cancer centers are starting to consider, or to found, programs like Sloan-Kettering’s.

As a cancer patient, all I can say is one word, “Hallelujah.”

Expect to see more in this space, as Dr. Goldfarb’s team publishes findings, and as other research groups contribute to this important research.

Has sex been a challenge for you and your partner during or after treatment? What worked for you? What didn’t? What would you like to know?

Posted by: Heather Millar at 8:15 am

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