Can bladder cancer treatment impact sexual health in women?

Question

Hello doctor,

My mother, who is 68 years old, was recently diagnosed with bladder cancer. While she has been open about some aspects of her condition, she has been hesitant to discuss how this might affect her intimate relationship with my stepfather. She has experienced pain during urination and some vaginal bleeding, which we initially assumed was related to menopause.

Her urologist has recommended surgery, but she is understandably concerned about how treatment might impact her sexual function and overall quality of life. Specifically, she is worried about the potential for increased vaginal dryness or pain during intercourse.

Given these concerns, would it be advisable for her to consult a gynecologist as well to address these issues more comprehensively? I want to support her as best I can, but she feels embarrassed to bring up these sensitive topics even with her doctors. Please help.

Thank you for your guidance.

Answer 1

Hi,

Welcome to icliniq.com.

I understand your concern. It is commendable that you are attentive to her emotional and physical well-being during this challenging period.

The possible contributing factors:

Hormonal changes: Postmenopausal estrogen deficiency can lead to vaginal atrophy (happens when the lining of the vagina and nearby tissues become thin, dry, and irritated because the body has less estrogen), resulting in discomfort during intimacy.
Surgical impact: The location and extent of bladder cancer surgery may affect pelvic tissues, potentially leading to sexual dysfunction.
Psychosocial factors: Concerns about body image and intimacy post-surgery can contribute to emotional distress.

The recommended evaluations:

Gynecological examination: To assess vaginal health and identify any atrophic changes.
Hormonal profiling: Optional tests to determine estrogen levels.
Urodynamic studies: If urinary incontinence (one cannot fully control the bladder, leading to accidental leaks or sudden urges) is suspected, these studies can evaluate bladder function.

The possible differential diagnoses to consider:

Postmenopausal atrophic vaginitis: Thinning and inflammation of vaginal walls due to decreased estrogen.
Radiation-induced vaginal stenosis: Radiation used to treat pelvic cancers (like cervical or uterine) can damage the vaginal lining and muscles. Over time, this leads to scar tissue forming, causing the vagina to become shorter, narrower, and less elastic.
Urinary tract infections or coexisting vulvovaginal conditions: Inflammation of the vagina and vulva that can come from infection, hormones, or irritants is vulvovaginitis. A UTI (urinary tract infection) is an infection in any part of your urinary system, most commonly the bladder or urethra. These can cause discomfort and should be ruled out.

The probable diagnosis:

Sexual dysfunction secondary to bladder cancer surgery, compounded by postmenopausal changes and psychosocial factors.

Proposed management plan:

Gynecological referral: For evaluation of vaginal tissue and consideration of local estrogen therapy, if appropriate.
Use of vaginal lubricants or moisturizers: To alleviate dryness and enhance comfort during intimacy.
Pelvic floor physiotherapy: If indicated, to strengthen pelvic muscles and improve function.
Psychosexual counseling: To address emotional and psychological aspects of sexual health.

Follow-up recommendations:

Reassessment: Evaluate sexual symptoms six to eight weeks post-operation.
Continued therapy: Maintain pelvic floor exercises if initiated.
Emotional health monitoring: Consider follow-up with a mental health professional to support psychological well-being.

Preventive measures:

Preoperative vaginal estrogen therapy: If no contraindications exist, initiating therapy before surgery may improve postoperative tissue health.
Open communication: Encourage dialogue between your mother, her partner, and the healthcare team to address concerns and expectations.
Utilization of survivorship resources: Explore available resources focusing on intimacy and quality of life post-cancer treatment.

Please consult with your mother's healthcare providers to tailor this plan to her specific needs and circumstances.

I hope this helps.

Kindly revert if there is any query.

Thank you.