Factors Affecting Sexual Function in People With Cancer
Surgery-Related Factors
Breast Cancer
Colorectal Cancer
Prostate Cancer
Other Pelvic Tumors
Chemotherapy-Related Factors
Radiation Therapy-Related Factors
Hormone Therapy-Related Factors
Psychological Factors
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.
In a large study of women with breast cancer who were treated with adjuvant hormone therapy, patients who took exemestane, a type of aromatase inhibitor, had fewer hot flashes and less vaginal discharge than those who took tamoxifen. However, patients who took exemestane had more vaginal dryness, bone pain, and sleep disorders than patients who took tamoxifen.
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.
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