Sexual Function After Cancer

This article introduces common unwanted side effects that affect sexual function after cancer and discusses strategies to counteract these symptoms. 

Sexuality can be a big part of who we are as individuals.

Sexual functioning can be defined as “specific physical, physiological, neurological and emotional behaviors expressed by an individual response” (Wood, 1984).

Certain cancers can unfortunately affect our sexual health, including cervical, ovarian, bladder, kidney, colorectal and breast cancer to name a few.

Some cancer treatments can cause unwanted side effects that affect our sexual health such as decreased sexual arousal or desire, vaginal stenosis (narrowing of the vaginal canal), dyspareunia (painful sexual intercourse), and bladder/bowel dysfunction. Issues with sexual function after cancer can affect our relationships with ourselves and with our partners, and reduce quality of life. Hopefully a physical therapist is part of your team to help guide you during this challenging time and minimize these aforementioned side effects. Otherwise, ask for a pelvic floor physical therapist to join your team during your recovery!

Sixty-seven percent of those diagnosed with gynecological cancer suffer from dyspareunia. People diagnosed with other cancers not directly related to genitals can experience side effects to sexual function after cancer. In those diagnosed with breast cancer, 50-75% also have pain with sexual intercourse. Common symptoms after bladder or kidney cancer surgeries include decreased sexual desire, decreased ability to achieve orgasm, decreased lubrication, and dyspareunia. Some kidney surgeries bypass the abdominal surgical approach and attempt to remove kidney or tumor intravaginally, which is a less invasive approach. As you can see, the pelvic floor musculature is a very involved player in promoting healthy bladder and bowel function. More importantly, pelvic floor muscles are crucial in sexual function after cancer.

Radiation, immunotherapies, chemotherapy, antihormonal therapies (usually in breast cancer) and surgery are some of the common cancer treatments. Each type of treatment may increase the likelihood of some type of sexual dysfunction, whether it be pain, decreased sensation, decreased arousal and desire, or vaginal stenosis.

Pelvic organ prolapse, a bulging or sensation of something falling in the vaginal canal, can also occur as a result of a shift in organs and or decrease in integrity of the fascia that helps support pelvic organs, and can also lead to pain with sexual activity. There are strategies to help counteract these symptoms, as well as manual therapy to help improve pelvic floor muscle integrity and thus improve symptoms! A systematic review in 2020 found moderate level evidence supporting the rehabilitation of pelvic floor muscles following gynecological cancer treatments.

Physical therapy sessions would incorporate the following to help improve sexual function after cancer:

• Yoga-based poses
• Gentle, individualized exercises
• Maintaining bladder and bowel healthy habits
• Pelvic floor coordination training to gain the ability to contract and lengthen your pelvic floor muscles
• Manual therapy
• Individualized dilator program (guided by your pelvic floor physical therapist) You can watch a quick video of Heather Jeffcoat talking about her book: Sex Without Pain: A Self-Treatment Guide To The Sex Life You Deserve.

One study found that an intervention program that consisted of education, manual therapy, specific pelvic floor exercises, development of a home exercise program, and incorporation of a dilator program improved patients’ pain level, pelvic floor symptoms, quality of life, and overall sexual functioning. Remember, you are not alone in experiencing these symptoms of sexual function after cancer and there is help. If you have any questions, no matter where you are in your journey, it is not too late to seek help from a pelvic floor physical therapist.

References:

• Arthur SS, Dorfman CS, Massa LA & Shelby RA. Managing female sexual dysfunction. Urologic Oncology. 2021; 1-7. https://doi.org/10.1016/j.urolonc.2021.06.006
• Brennen R, Lin KY, Denehy L & Frawley HC. The Effect of Pelvic Floor Muscle Interventions on Pelvic Floor Dysfunction After Gynecological Cancer Treatment: A Systematic Review. Phys Ther. 2020;100:1357-1371.
• Chang YC, Chang SR, Chiu SC. Sexual Problems of Patients With Breast Cancer After Treatment. A Systematic Review. Cancer Nursing 2019; 42(5): 418-425.
• Cyr MP, Dumoulin C, Bessette P, Pina A et al. Feasibility, acceptability and effects of multimodal pelvic floor physical therapy for gynecological cancer survivors suffering from painful sexual intercoures: A multicenter prospective interventional study. Gynecologic Oncology 159 (2020) 778-784.
• Wood F. Human Sexuality in Health and Illness. 3rd ed. St Louis, MO: C.V. Mosby; 1984.