Sexuality

Abstract

Sexual dysfunction in men and women after treatment for cancer is one of the most common problems of survivorship, yet most survivors experiencing sexual dysfunction do not receive medical help. Left untreated, sexual dysfunction does not resolve, but instead persists over many years. Not all survivors are distressed about sexual dysfunction. Factors associated with distress include young age, being in a relationship, and having enjoyed sexuality before the cancer diagnosis. The most common problem for which men seek help is erectile dysfunction, although loss of desire for sex, difficulty reaching orgasm, and pain during sexual activity also occur after a number of treatments. Pelvic surgery and radiation are common causes of erectile dysfunction, but hypogonadism also sometimes occurs in survivors of intensive chemotherapy. In women, chemotherapy-induced ovarian failure is a major risk factor for vaginal dryness, dyspareunia, and consequent loss of interest in sex. Pelvic radiation therapy, surgery that changes vaginal or vulvar anatomy, or vaginal complications of graft-versus-host disease are also problematic. Oncology clinics should provide basic education, counseling, and referrals. The optimal treatment for sexual dysfunction is multidisciplinary, with a medical specialist and a mental health professional working together to assess the problem and create a treatment plan.