Maintaining sexual function is often low on the list of priorities for a woman recently diagnosed with a gynecologic cancer, but raising the subject early in her treatment course may make the patient more willing to engage in a discussion as her care progresses, according to Don S. Dizon, MD, who specializes in survivorship issues.
Patients and their partners will remember that the physician initiated the conversation, Dizon said in an interview with OncologyLive®. He added that discussing sexual function is important so that a patient knows there are no limits to what she can talk about with her physician. The physician, he said, leaves the door open until the patient is ready to walk through it.
“It may not be the case that a woman whom you’re asking, ‘Would you like to discuss sexual health at this time?’ is going to go into the extreme details of her intimate sex life, but it might be [the case] months down the road,” said Dizon, director of women’s cancers at Lifespan Cancer Institute, and clinical director of gynecologic medical oncology and director of medical oncology for Rhode Island Hospital, both in Providence.
“When the smog clears from a cancer diagnosis, they may be able to say, ‘You know what? I don’t know how to be intimate with my partner now.’ It’s really important that they understand and recognize that this is a legitimate cause for their concern and that we are here to give them hope,” he said.
Dizon said it can be difficult to discuss this topic with patients, as oncologists often have little or no training in discussing sex and sexual health. Furthermore, physicians may have biases that lead them to assume, for instance, that a woman over 60 years may no longer be interested in sex, or that a lesbian might not be interested in penetrative sex. Dizon added that sex is a “delicate topic,” and the patient may be as unwilling to discuss what she does in the bedroom as the physician is uncomfortable to hear it.
He pointed out, however, that physicians have no trouble discussing with patients the nausea, diarrhea, and vomiting that may result from cancer therapy. “Those are not exactly delicate topics that you’re going to want to bring up in regular conversations,” Dizon said. “And I think, for the same way, we need to start being frank about sexual health and how our treatments would [affect] them. Most of our patients will get better once they have the conversation.”
Finding Available Resources
Dizon advised physicians to develop skills for talking with patients about sexual function and to embrace the topic as a part of routine medical practice. He also encouraged physicians to seek out resources and experts, both externally and within their own institutions, who can help guide patients.
“You need to give patients permission to bring it up,” he said. “We do know from the data that most patients are going to look for cues from their providers that this is a safe area to bring up. They’re not just going to randomly, spontaneously, talk about their sex lives.”
Most advocacy organizations, particularly those that focus on breast cancer, have information available for patients and their loved ones about sexual function issues and restarting their sexual lives after cancer therapy, Dizon said. For adolescent and young adult survivors, the Young Survival Coalition’s Living Beyond Breast Cancer program and Stupid Cancer, in particular, provide information on intimacy and dating.
He also mentioned Will2Love.com, a website for men and women developed by Leslie R. Schover, PhD, whom he described as “one of my mentors” in the field. “It is a self-exploratory website filled with anecdotes and case scenarios, and also information that can empower people to recover, but at their own pace,” Dizon said.
Schover is a clinical psychologist and internationally recognized expert on sexual problems and infertility related to cancer treatment. Dizon serves as a scientific advisor to Will2Love, which works with patients and health care providers to address sexual health concerns and chronic illness.
At Lifespan Cancer Institute, Dizon started the Sexual Health First Responders Clinic to provide personalized, multidisciplinary consultation and treatment for sexual health issues that patients with cancer encounter. The “first responder” aspect of the clinic gives other physicians a place to refer patients who need help.
Dizon also worked with Areej El-Jawahri, MD, a specialist in hematologic malignancies, to develop a sexual health program at Massachusetts General Hospital in Boston for patients who had undergone hematopoietic stem cell transplant. El-Jawahri and colleagues demonstrated that if a pilot program in which patients’ needs were assessed, education was provided, and therapeutic intervention, if appropriate, was offered, this would result in improvements to sexual function, quality of life, and mood.1
Nevertheless, Dizon said patients and physicians should not have to depend on having access to in-house expertise for information. Valid information should be available, both online and in the literature, so that people can access the latest data wherever they are, he said.
“Education is exceptionally valuable for anyone who’s having issues related to sexual dysfunction after cancer,” he said. “Having people understand that this is not something they’re going through alone, that a lot of people have issues with sexual health and intimacy and body image after treatment of cancer, makes it feel less isolating as an issue. When people finally get to understand what’s happened and what’s happening, that’s another way to gain control of the situation.”
1. El-Jawahri A, Fishman SR, Vanderklish J, et al. Pilot study of a multimodal intervention to enhance sexual function in hematopoietic stem cell transplantation. Cancer. 2018;124(11):2438-2446. doi:10.1002/cncr.31333