Table of Contents Introduction The Prevalence and Types of Sexual Dysfunction in People With Cancer Factors Affecting Sexual Function in People With Cancer
Assessment of Sexual Function in People with Cancer Effects of Medicines on Sexual Function Treatment of Sexual Problems in People With Cancer Fertility Issues Get More Information From NCI Changes to This Summary (07/18/2006) Questions or Comments About This Summary About PDQ
Introduction
This patient summary on the sexual side effects from cancer and cancer
treatment is adapted from the summary written for health professionals by
cancer experts. This and other credible information about cancer treatment, screening, prevention, supportive care, and ongoing clinical trials, is
available from the National Cancer Institute. Better treatment of many cancers
has resulted in more patients experiencing longer periods of disease-free
survival. In addition, the side effects associated with cancer and cancer
treatments have also become more prevalent.
This patient summary addresses the impact cancer and cancer treatment can have
on all aspects of an individual's sexuality, including sexual desire and
physical and psychological sexual dysfunction.
Back to Top The Prevalence and Types of Sexual Dysfunction in People With Cancer
Sexuality is a complex characteristic that involves the physical,
psychological, interpersonal, and behavioral aspects of a person. Recognizing
that "normal" sexual functioning covers a wide range is important. Ultimately,
sexuality is defined by each patient and his/her partner according to sex, age,
personal attitudes, and religious and cultural values.
Many types of cancer and cancer therapies can cause sexual dysfunction. Research shows that approximately one-half of women who have been treated for breast and gynecologic cancers experience long-term sexual dysfunction. Men who have been treated for prostate cancer report problems with erectile dysfunction that varies depending on the type of treatment.
An individual's sexual response can be affected in many ways. The causes of
sexual dysfunction are often both physical and psychological. The most common
sexual problems for people who have cancer are loss of desire for sexual
activity in both men and women, problems achieving and maintaining an erection in men, and pain with intercourse in women. Men may also experience inability
to ejaculate, ejaculation going backward into the bladder, or the inability to
reach orgasm. Women may experience a change in genital sensations due to pain,
loss of sensation and numbness, or decreased ability to reach orgasm. Most
often, both men and women are still able to reach orgasm, however, it may be
delayed due to medications and/or anxiety.
Unlike many other physical side effects of cancer treatment, sexual problems
may not resolve within the first year or two of disease-free survival and can
interfere with the return to a normal life. Patients recovering from cancer
should discuss their concerns about sexual problems with a health care
professional.
Back to Top Factors Affecting Sexual Function in People With Cancer
Both physical and psychological factors contribute to the development of sexual dysfunction. Physical factors include loss of function due to the effects of cancer therapies, fatigue, and pain. Surgery, chemotherapy, and radiation
therapy may have a direct physical impact on sexual function. Other factors
that may contribute to sexual dysfunction include pain medications, depression,
feelings of guilt from misbeliefs about the origin of the cancer, changes in
body image after surgery, and stresses due to personal relationships. Getting
older is often associated with a decrease in sexual desire and performance,
however, sex may be important to the older person's quality of life and the
loss of sexual function can be distressing.
Surgery-Related Factors
Surgery can directly affect sexual function. Factors that help predict a
patient's sexual function after surgery include age, sexual and bladder function before surgery, tumor location and size, and how much tissue was
removed during surgery. Surgeries that affect sexual function include breast cancer, colorectal cancer, prostate cancer, and other pelvic tumors.
Breast Cancer
Sexual function after breast cancer surgery has been the subject of much
research. Surgery to save or reconstruct the breast appears to have little
effect on sexual function compared with surgery to remove the whole breast.
Women who have surgery to save the breast are more likely to continue to enjoy
breast caressing, but there is no difference in areas such as how often women
have sex, the ease of reaching orgasm, or overall sexual satisfaction.
Having a mastectomy, however, has been linked to a loss of interest in sex. Chemotherapy has been linked to problems with sexual function.
Colorectal Cancer
Sexual and bladder dysfunctions are common complications of surgery for rectal cancer. The main cause of problems with erection, ejaculation, and orgasm is
injury to nerves in the pelvic cavity. Nerves can be damaged when their blood supply is disrupted or when the nerves are cut.
Prostate Cancer
Newer nerve-sparing techniques for radical prostatectomy are being debated as a
more successful approach for preserving erectile function than radiation therapy for prostate cancer. Long-term follow-up is needed to compare the
effects of surgery with the effects of radiation therapy. Recovery of erectile
function usually occurs within a year after having a radical prostatectomy.
The effects of radiation therapy on erectile function are very slow and gradual
occurring for two or three years after treatment. The cause of loss of
erectile function differs between surgery and radiation therapy. Radical
prostatectomy damages nerves that make blood vessels open wider to allow more
blood into the penis. Eventually the tissue does not get enough oxygen, cells die, and scar tissue forms that interferes with erectile function. Radiation
therapy appears to damage the arteries that bring blood to the penis.
Brachytherapy (internal radiation therapy using radioactive implants) is being used more often to treat prostate cancer. With brachytherapy alone, ejaculation and erectile function are better preserved than when external radiation and/or hormone therapy are added. Radiation damage to nerves and blood vessels may occur with brachytherapy, and higher doses of radiation may cause more damage.
Other Pelvic Tumors
Men who have surgery to remove the bladder, colon, and/or rectum may improve
recovery of erectile function if nerve-sparing surgical techniques are used.
The sexual side effects of radiation therapy for pelvic tumors are similar to
those after prostate cancer treatment.
Women who have surgery to remove the uterus, ovaries, bladder, or other organs in the abdomen or pelvis may experience pain and loss of sexual function
depending on the amount of tissue/organ removed. With counseling and other
medical treatments, these patients may regain normal sensation in the vagina and genital areas and be able to have pain-free intercourse and reach orgasm.
Chemotherapy-Related Factors
Chemotherapy is associated with a loss of desire and decreased frequency of
intercourse for both men and women. The common side effects of chemotherapy
such as nausea, vomiting, diarrhea, constipation, mucositis, weight loss or
gain, and loss of hair can affect an individual's sexual self-image and make
him or her feel unattractive.
For women, chemotherapy may cause vaginal dryness, pain with intercourse, and
decreased ability to reach orgasm. In older women, chemotherapy may increase
the risk of ovarian cancer. Chemotherapy may also cause a sudden loss of estrogen production from the ovaries. The loss of estrogen can cause
shrinking, thinning, and loss of elasticity of the vagina, vaginal dryness, hot
flashes, urinary tract infections, mood swings, fatigue, and irritability.
Young women who have breast cancer and have had surgeries such as removal of
one or both ovaries, may experience symptoms related to loss of estrogen.
These women experience high rates of sexual problems since there is a concern
that estrogen replacement therapy, which may decrease these symptoms, could
cause the breast cancer to return. For women with other types of cancer,
however, estrogen replacement therapy can usually resolve many sexual problems.
Also, women who have graft-versus-host disease (a reaction of donated bone
marrow or peripheral stem cells against a person's tissue) following bone
marrow transplantation may develop scar tissue and narrowing of the vagina that
can interfere with intercourse.
For men, sexual problems such as loss of desire and erectile dysfunction are
more common after a bone marrow transplant because of graft-versus-host disease
or nerve damage. Occasionally chemotherapy may interfere with testosterone production in the testicles. Testosterone replacement may be necessary to
regain sexual function.
Radiation Therapy-Related Factors
Like chemotherapy, radiation therapy can cause side effects such as fatigue,
nausea and vomiting, diarrhea, and other symptoms that can decrease feelings of
sexuality. In women, radiation therapy to the pelvis can cause changes in the
lining of the vagina. These changes eventually cause a narrowing of the vagina
and formation of scar tissue that results in pain with intercourse, infertility and other long term sexual problems. Women should discuss concerns about these
side effects with their doctor and ask about the use of a vaginal dilator.
For men, radiation therapy can cause problems with getting and keeping an
erection. The exact cause of sexual problems after radiation therapy is
unknown. Possible causes are nerve injury, a blockage of blood supply to the
penis, or decreased levels of testosterone. Sexual changes occur very slowly
over a period of six months to one year after radiation therapy. Men who had
problems with erectile dysfunction before getting cancer have a greater risk of
developing sexual problems after cancer diagnosis and treatment. Other risk
factors that can contribute to a greater risk of sexual problems in men are
cigarette smoking, history of heart disease, high blood pressure, and diabetes.
Hormone Therapy-Related Factors
Hormone therapy for prostate cancer can decrease normal hormone levels and
cause a decrease in sexual desire, erectile dysfunction, and problems reaching
orgasm. Younger men do not always experience the same degree of sexual
dysfunction. Some treatment centers are experimenting with delayed or
intermittent hormone therapy to prevent sexual problems. It is not yet known
if these modified treatments affect the long-term survival of younger men.
The effects of tamoxifen on the sexuality and mood of women who have breast
cancer are not clearly understood.
Psychological Factors
Patients recovering from cancer often have anxiety or guilt that previous
sexual activities may have caused their cancer. Some patients believe that
sexual activity may cause the cancer to return or pass the cancer to their
partner. Discussing their feelings and concerns with a health care
professional is important for patients. Misbeliefs can be corrected and
patients can be reassured that cancer is not passed on through sexual contact.
Loss of sexual desire and a decrease in sexual pleasure are common symptoms of
depression. Depression is more common in patients with cancer than in the
general healthy population. It is important that patients discuss their
feelings with their doctor. Getting treatment for depression may be helpful in
relieving sexual problems. (Refer to the PDQ summary on Depression for more
information.)
Cancer treatments may cause physical changes that affect how an individual sees
his or her physical appearance. This view can make a man or woman feel
sexually unattractive. It is important that patients discuss these feelings
and concerns with a health care professional. Patients can learn how to deal
effectively with these problems.
The stress of being diagnosed with cancer and undergoing treatment for cancer
can make existing problems in relationships even worse. The sexual
relationship can also be affected. Patients who do not have a committed
relationship may stop dating because they fear being rejected by a potential
new partner who learns about their history of cancer. One of the most
important factors in adjusting after cancer treatment is the patient's feeling
about his or her sexuality before being diagnosed with cancer. If patients had
positive feelings about sexuality, they may be more likely to resume sexual
activity after treatment for cancer.
Back to Top Assessment of Sexual Function in People with Cancer
Sexual function is an important factor that adds to quality of life. Patients
should discuss their problems and concerns about sexual function with their
doctor. Some doctors may not have the appropriate training to discuss sexual
problems. Patients should ask for other information resources or for a
referral to a health care professional who is comfortable with discussing
sexuality issues.
General Factors Affecting Sexual Functioning
When a possible sexual problem is identified, the health care professional will
do a detailed interview either with the patient alone or with the patient and
his or her partner. The patient may be asked any of the following questions
about his or her current and past sexual functioning:
- How often do you feel a spontaneous desire to have sex?
- Do you enjoy sex?
- Do you become sexually aroused (for men, are you able to get and keep an erection, or for women, does your vagina expand and become lubricated)?
- Are you able to reach orgasm during sex? What types of stimulation can
trigger an orgasm (for example, self-touch, use of a vibrator, shower
massage, partner caressing, oral stimulation, or intercourse)?
- Do you have any pain during sex? Where do you feel the pain? What does
the pain feel like? What kinds of sexual activity trigger the pain?
Does this cause pain every time? How long does the pain last?
- When did your sexual problems begin? Was it around the same time that
you were diagnosed with cancer or received treatment for cancer?
- Are you taking any medications? Did you start taking any new
medications or did the doctor change the dose of any medications around
the time that these sexual problems began?
- What was your sexual functioning like before you were diagnosed with
cancer? Did you have any sexual problems before you were diagnosed with
cancer?
Psychosocial Aspects of Sexuality
Patients may also be asked about the significance of sexuality and
relationships whether or not they have a partner. Patients who have a partner
may be asked about the length and stability of the relationship before being
diagnosed with cancer. They may also be asked about their partner's response
to the diagnosis of cancer and if they have any concerns about how their
partner may be affected by their treatment. It is important that patients and
their partners discuss their sexual problems and concerns and fears about their
relationship with a health care professional with whom they feel comfortable.
Medical Aspects of Sexuality
Patients may be asked about current and past medical history since many medical
illnesses can affect sexual function. Lifestyle risk factors such as smoking
and high alcohol intake can also affect sexual function as well as prescribed and over-the-counter medications. Patients may be asked to fill out
questionnaires to help identify sexual problems and may undergo a variety of physical examinations, blood tests, ultrasound studies, measurement of
nighttime erections, and hormone tests.
Back to Top Effects of Medicines on Sexual Function
The side effects of medicines can add to the sexual side effects of surgery, radiation therapy, and chemotherapy. Cancer patients may receive drug therapy that can affect nerves, blood vessels, and hormones that control normal sexual function. Mental alertness and moods may also be affected. These side effects may occur in cancer patients who take opioids for pain and drugs to treat depression, for example.
Back to Top Treatment of Sexual Problems in People With Cancer
Many patients are fearful or anxious about their first sexual experience after cancer treatment. Fear and anxiety can cause patients to avoid intimacy,
touch, and sexual activity. The partner may also feel fearful or anxious about
initiating any activity that might be thought of as pressuring to be intimate
or that might cause physical discomfort. Patients and their partners should
discuss concerns with their doctor or other qualified health professional.
Honest communication of feelings, concerns, and preferences is important.
In general, a wide variety of treatment modalities are available for patients
with sexual dysfunction after cancer. Patients can learn to adapt to changes
in sexual function through reading books, pamphlets, and internet resources or
listening to and watching videos and CD-ROMs. Health professionals who
specialize in sexual dysfunction can provide patients with these resources as
well as information on national organizations that may provide support. Some
patients may need medical intervention such as hormone replacement,
medications, medical devices, or surgery. Patients who have more serious problems may need
sexual counseling on an individual basis, with his or her partner, or in a
group. Further testing and research is needed to compare the effectiveness of
various treatment programs that combine medical and psychological approaches
for people who have had cancer.
Back to Top Fertility Issues
Radiation therapy and chemotherapy treatments may cause temporary or permanent infertility. These side effects are related to a number of factors including
the patient's sex, age at time of treatment, the specific type and dose of
radiation therapy and/or chemotherapy, the use of single therapy or many
therapies, and length of time since treatment.
When cancer or its treatment may cause infertility or sexual dysfunction, every effort should be made to inform and educate the patient about this possibility. When the patient is a child, this can be difficult. The child may be too young to understand issues involving infertility or sexuality, or parents may choose to shield the child from these issues.
Chemotherapy
For patients receiving chemotherapy, age is an important factor and recovery
improves the longer the patient is off chemotherapy. Chemotherapy drugs that
have been shown to affect fertility include: busulfan, melphalan, cyclophosphamide, cisplatin, chlorambucil, mustine, carmustine, lomustine, vinblastine, cytarabine, and procarbazine.
Radiation
For men and women receiving radiation therapy to the abdomen or pelvis, the
amount of radiation directly to the testes or ovaries is an important factor.
In women older than 40 years, infertility may occur at lower doses of radiation. Fertility may be preserved by the use of modern radiation therapy techniques
and the use of lead shields to protect the testes. Women may undergo surgery to protect the ovaries by moving them out of the field of radiation.
Procreative Alternatives
Patients who are concerned about the effects of cancer treatment on their
ability to have children should discuss this with their doctor before
treatment. The doctor can recommend a counselor or fertility specialist who
can discuss available options and help patients and their partners through the
decision-making process. Options may include freezing sperm, eggs, or ovarian tissue before cancer treatment.
Back to Top Get More Information From NCI
Call 1-800-4-CANCER
For more information, U.S. residents may call the National Cancer Institute's (NCI's) Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237) Monday through Friday from 9:00 a.m. to 4:30 p.m. Deaf and hard-of-hearing callers with TTY equipment may call 1-800-332-8615. The call is free and a trained Cancer Information Specialist is available to answer your questions.
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The NCI's LiveHelp® online chat service provides Internet users with the ability to chat online with an Information Specialist. The service is available from 9:00 a.m. to 11:00 p.m. Eastern time, Monday through Friday. Information Specialists can help Internet users find information on NCI Web sites and answer questions about cancer.
Write to us
For more information from the NCI, please write to this address:
- NCI Public Inquiries Office
- Suite 3036A
- 6116 Executive Boulevard, MSC8322
- Bethesda, MD 20892-8322
Search the NCI Web site
The NCI Web site provides online access to information on cancer, clinical trials, and other Web sites and organizations that offer support and resources for cancer patients and their families. For a quick search, use our “Best Bets” search box in the upper right hand corner of each Web page. The results that are most closely related to your search term will be listed as Best Bets at the top of the list of search results.
There are also many other places to get materials and information about cancer treatment and services. Hospitals in your area may have information about local and regional agencies that have information on finances, getting to and from treatment, receiving care at home, and dealing with problems related to cancer treatment.
Find Publications
The NCI has booklets and other materials for patients, health professionals, and the public. These publications discuss types of cancer, methods of cancer treatment, coping with cancer, and clinical trials. Some publications provide information on tests for cancer, cancer causes and prevention, cancer statistics, and NCI research activities. NCI materials on these and other topics may be ordered online or printed directly from the NCI Publications Locator. These materials can also be ordered by telephone from the Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237), TTY at 1-800-332-8615.
Back to Top Changes to This Summary (07/18/2006)
The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.
Changes were made to this summary to match those made to the health professional version.
Back to Top Questions or Comments About This Summary
If you have questions or comments about this summary, please send them to Cancer.gov through the Web site’s Contact Form. We can respond only to email messages written in English.
Back to Top About PDQ
PDQ is a comprehensive cancer database available on NCI's Web site.
PDQ is the National Cancer Institute's (NCI's) comprehensive cancer information database. Most of the information contained in PDQ is available online at NCI's Web site. PDQ is provided as a service of the NCI. The NCI is part of the National Institutes of Health, the federal government's focal point for biomedical research.
PDQ contains cancer information summaries.
The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries are available in two versions. The health professional versions provide detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language. Both versions provide current and accurate cancer information.
The PDQ cancer information summaries are developed by cancer experts and reviewed regularly.
Editorial Boards made up of experts in oncology and related specialties are responsible for writing and maintaining the cancer information summaries. The summaries are reviewed regularly and changes are made as new information becomes available. The date on each summary ("Date Last Modified") indicates the time of the most recent change.
PDQ also contains information on clinical trials.
A clinical trial is a study to answer a scientific question, such as whether one method of treating symptoms is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. Some patients have symptoms caused by cancer treatment or by the cancer itself. During supportive care clinical trials, information is collected about how well new ways to treat symptoms of cancer work. The trials also study side effects of treatment and problems that come up during or after treatment. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become "standard." Patients who have symptoms related to cancer treatment may want to think about taking part in a clinical trial.
Listings of clinical trials are included in PDQ and are available online at NCI's Web site. Descriptions of the trials are available in health professional and patient versions. Many cancer doctors who take part in clinical trials are also listed in PDQ. For more information, call the Cancer Information Service 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615.
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