Sexual Dysfunction in Female Cancer Survivors

Introduction

Sexual dysfunction in women after cancer survival is one of cancer treatment's most common and distressing side effects. Multiple studies' data suggest the incidence of sexual dysfunction from 30 to 100 % in female cancer survivors. Sexual dysfunction related to cancer treatment affects all aspects of women's sexuality, including sexual desire, arousal, and orgasm, and can cause pain during sexual intercourse. Additionally, sexual dysfunction may impair body image, self-esteem, and sexual satisfaction resulting in psychological distress and diminished quality of life in women.

What Are the Sexual Dysfunctions in Female Cancer Survivors?

Sexual dysfunction is categorized into four classifications containing problems related to

1. Sexual arousal.

2. Sexual desire.

3. Orgasm.

4. Pain during sexual intercourse.

What Are the Factors Related to Cancer That Affects Female Sexual Functions?

Female sexual dysfunction in cancer patients is multidimensional and incorporates psychological, physiological, and social factors. The type of cancer and its treatment strategies, such as chemotherapy, radiotherapy, and surgery, play an essential role in sexual dysfunction. One study revealed that females who went through post-treatment chemotherapy had a more heightened risk of sexual dysfunction in comparison with patients receiving no chemotherapy. Hence, cancer-related sexual dysfunction in women is distinct from other women's sexual impairments.

How Does Cancer Treatment Cause Sexual Dysfunction in Females?

Some problems are for a brief time that affects a woman’s sexual health during cancer treatment and improves once treatment is over. Other sexual side effects may be long-term or may begin after cancer treatment. Following are the possible factors related to sexual dysfunction in females;

• Psychological Effects: Specific psychological issues for female cancer patients include fear of recurrence and worry over spouses and children, depending on the children's age at the diagnosis. Additionally, women may suffer from unnecessary self-blaming or feel some past behavior or wrongdoing contributed to their cancer development. Relationship conflict may also exacerbate during cancer care and treatment. Moreover, the effects of antidepressant medications, especially SSRIs (selective serotonin reuptake inhibitors), are well known to suppress sexual desire and inhibit arousal and orgasms.

• Surgery: Surgical procedures such as oophorectomy result in an acute decline in levels of estrogen, testosterone, and progesterone in women. This results in irreversible menopause. These effects give rise to the emergence of menopausal symptoms such as clitoral and vulvovaginal atrophic changes, vaginal thinning, decreased vaginal elasticity, vaginal dryness, and the onset of dyspareunia (pain related to sexual intercourse). In patients undergoing hysterectomy, both long-term and short-term sexual morbidity are there. In the short term, females can experience difficulty related to orgasm, dyspareunia, sexual distress, and dissatisfaction by a reduced vaginal size during sexual intercourse. Long-term effects (can be for two years) tend to impact sexual desire and vaginal lubrication negatively. These morbidities are more recurring with radical hysterectomies. Treatment for other cancers may also cause physical changes that can affect how a woman views her body, such as after a mastectomy (surgical removal of breast tissue).

• Chemotherapy: Cytotoxic chemotherapy in females creates poor self-esteem because of alopecia and generalized weakness. It leads to decreased sexual interest due to side effects such as leukocytopenia (lower white blood cells in the blood), anemia, diarrhea, and fatigue.

• Medications: Antiestrogen therapies, such as Tamoxifen, are most commonly utilized in hormone-positive cancers, especially breast cancer. Tamoxifen affects sexual function leading to physiological consequences such as impaired venous congestion and loss of vaginal lubrication, resulting in sexual arousal and pain while sex issues.

• Hormone Therapy: It is also called endocrine therapy, which may cause lower estrogen levels which can lead to symptoms similar to chemotherapy, such as irregular or no periods, hot flashes, and vaginal dryness.

• Radiation Therapy: It may cause nerve damage and scarring similar to surgery. Vaginal stenosis (narrow, shorter, and loss of elasticity of the vagina) and thinning of the vaginal lining cause pain and discomfort during sexual intercourse. Radiation therapy can cause low estrogen levels and vaginal dryness, especially in the pelvis.

How Is a Sexual Dysfunction in Female Cancer Survivors Managed?

Management of sexual dysfunctions consists of a multifaceted approach, such as proper education, open communication, and pharmacological and device aid.

1) Information: The knowledge that sexual dysfunctions may appear during treatment and screening of it during treatment and follow-up. Regular and routine screening also assists in identifying new or evolving problems regarding sexual dysfunction and may allow addressing and ultimately guide prognosis for recovery.

2)Hormonal Supplements: In some cases, hormone supplementation is strictly contraindicated, depending on the nature of the tumor.

• Testosterone supplementation has libido-enhancing effects in females and is used for females under some circumstances. However, the use of testosterone in women with cancer is not approved by the food and drug administration.

• In some cases, systemic estrogen treatment can help boost estrogen levels. Local estrogen creams, tablets, or rings applied directly on the vaginal mucosa have very little systemic effects and may effectively manage sexual dysfunctions.

3) Prescription Device: The FDA-approved (food and drug administration) device helps female sexual arousal by creating orgasm via gentle suction over the clitoris to improve blood flow and enhance sexual feeling. This device has a promising role in women with oophorectomy and hysterectomy and women treated with radiotherapy who suffer from severe dyspareunia. The use of vaginal dilators and aggressive vaginal rehabilitation with vaginal moisturizers, lubricants, and minimal absorbable local vaginal estrogen products, may help to lengthen or widen the vagina.

4) Counseling: A partner may abandon the initiation of sexual activity, sabotaging the survivor female's confidence. A partner may have difficulty coping with the stress of the partner's disease or overcoming the emotional and physical changes the survivor has gone through. The partner needs to be involved in the counseling, the initial set of expectations, in screening for dysfunction. Also, open communication with a healthcare provider and appropriate therapist may be required in difficult situations.

Conclusion

Despite the prevalence of sexual dysfunction associated with cancer therapy, most female cancer survivors do not receive the necessary information, treatment, or support for these conditions. Thus, a multimodal treatment paradigm is essential for effectively treating this sexual dysfunction in female cancer survivors. Sexual rehabilitation after cancer should encompass physical and psychosocial facets of function that get disrupted due to cancer and its treatment to maximize the possibility for short-term and long-term sexual function recovery. Thus, a multimodal treatment paradigm is essential for effectively treating this sexual dysfunction in female cancer survivors.