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| Date Last Modified:
09/2002 |
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Introduction
This patient summary on the sexual side effects from cancer and cancer
treatment is adapted from the summary written for health professionals
by cancer experts. This and other credible information about cancer treatment,
screening, prevention, supportive care, and ongoing clinical trials, is
available from the National Cancer Institute. Better treatment of many
cancers has resulted in more patients experiencing longer periods of disease-free
survival. In addition, the side effects associated with cancer and cancer
treatments have also become more prevalent.
This patient summary addresses the impact cancer and cancer treatment
can have on all aspects of an individual's sexuality, including sexual
desire and physical and psychological sexual dysfunction. |
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The Prevalence and Types of Sexual Dysfunction in People
With Cancer
Sexuality is a complex characteristic that involves the physical, psychological,
interpersonal, and behavioral aspects of a person. Recognizing that "normal"
sexual functioning covers a wide range is important. Ultimately, sexuality
is defined by each patient and his/her partner according to sex, age, personal
attitudes, and religious and cultural values.
Many types of cancer and cancer therapies can cause sexual dysfunction.
Research shows that approximately 50% of women who have been treated for
breast and gynecologic cancers experience long-term sexual dysfunction.
Nearly 70% of men who have been treated for prostate cancer experience
long-term sexual dysfunction.
An individual's sexual response can be affected in many ways. The causes
of sexual dysfunction are often both physical and psychological. The most
common sexual problems for people who have cancer are loss of desire for
sexual activity in both men and women, problems achieving and maintaining
an erection in men, and pain with intercourse in women. Men may also experience
inability to ejaculate, ejaculation going backward into the bladder, or
the inability to reach orgasm. Women may experience a change in genital
sensations due to pain, loss of sensation and numbness, or decreased ability
to reach orgasm. Most often, both men and women are still able to reach
orgasm, however, it may be delayed due to medications and/or anxiety.
Unlike many other physical side effects of cancer treatment, sexual
problems may not resolve within the first year or two of disease-free survival
and
can interfere with the return to a normal life. Patients recovering from
cancer should discuss their concerns about sexual problems with a health
care professional. |
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Factors Affecting Sexual Function in People With Cancer
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. |
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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.
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.
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. |
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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. |
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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. |
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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.
The effects of tamoxifen on the sexuality and mood of women who have
breast cancer are not clearly understood. |
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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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Assessment of Sexual Function in People with Cancer
Sexual function is an important factor that adds to quality of life. Patients
should discuss their problems and concerns about sexual function with their
doctor. Some doctors may not have the appropriate training to discuss sexual
problems. Patients should ask for other information resources or for a
referral to a health care professional who is comfortable with discussing
sexuality issues. |
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General Factors Affecting Sexual Functioning
When a possible sexual problem is identified, the health care professional
will do a detailed interview either with the patient alone or with the
patient and his or her partner. The patient may be asked any of the following
questions about his or her current and past sexual functioning:
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How often do you feel a spontaneous desire to have sex?
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Do you enjoy sex?
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Do you become sexually aroused (for men, are you able to get and keep an
erection, or for women, does your vagina expand and become lubricated)?
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Are you able to reach orgasm during sex? What types of stimulation can
trigger an orgasm (for example, self-touch, use of a vibrator, shower massage,
partner caressing, oral stimulation, or intercourse)?
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Do you have any pain during sex? Where do you feel the pain? What does
the pain feel like? What kinds of sexual activity trigger the pain? Does
this cause pain every time? How long does the pain last?
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When did your sexual problems begin? Was it around the same time that you
were diagnosed with cancer or received treatment for cancer?
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Are you taking any medications? Did you start taking any new medications
or did the doctor change the dose of any medications around the time that
these sexual problems began?
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What was your sexual functioning like before you were diagnosed with cancer?
Did you have any sexual problems before you were diagnosed with cancer?
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Psychosocial Aspects of Sexuality
Patients may also be asked about the significance of sexuality and relationships
whether or not they have a partner. Patients who have a partner may be
asked about the length and stability of the relationship before being diagnosed
with cancer. They may also be asked about their partner's response to the
diagnosis of cancer and if they have any concerns about how their partner
may be affected by their treatment. It is important that patients and their
partners discuss their sexual problems and concerns and fears about their
relationship with a health care professional with whom they feel comfortable. |
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Medical Aspects of Sexuality
Patients may be asked about current and past medical history since many
medical illnesses can affect sexual function. Lifestyle risk factors such
as smoking and high alcohol intake can also affect sexual function as well
as prescribed and over-the-counter medications. Patients may be asked to
fill out questionnaires to help identify sexual problems and may undergo
a variety of physical examinations, blood tests, ultrasound studies, measurement
of nighttime erections, and hormone tests. |
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Treatment of Sexual Problems in People with Cancer
Many patients are fearful or anxious about their first sexual experience
after cancer treatment. Fear and anxiety can cause patients to avoid intimacy,
touch, and sexual activity. The partner may also feel fearful or anxious
about initiating any activity that might be thought of as pressuring to
be intimate or that might cause physical discomfort. Patients and their
partners should discuss concerns with their doctor or other qualified health
professional. Honest communication of feelings, concerns, and preferences
is important.
In general, a wide variety of treatment modalities are available for
patients with sexual dysfunction after cancer. Patients can learn to adapt
to changes in sexual function through reading books, pamphlets, and internet
resources or listening to and watching videos and CD-ROMs. Health professionals
who specialize in sexual dysfunction can provide patients with these resources
as well as information on national organizations that may provide support.
Some patients may need medical intervention such as hormone replacement,
medications, or surgery. Patients who have more serious problems may need
sexual counseling on an individual basis, with his or her partner, or in
a group. Further testing and research is needed to compare the effectiveness
of various treatment programs that combine medical and psychological approaches
for people who have had cancer. |
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Fertility Issues
Radiation therapy and chemotherapy treatments may cause temporary or permanent
infertility. These side effects are related to a number of factors including
the patient's sex, age at time of treatment, the specific type and dose
of radiation therapy and/or chemotherapy, the use of single therapy or
many therapies, and length of time since treatment. |
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Chemotherapy
For patients receiving chemotherapy, age is an important factor and recovery
improves the longer the patient is off chemotherapy. Chemotherapy drugs
that have been shown to affect fertility include: busulfan, melphalan,
cyclophosphamide, cisplatin, chlorambucil, mustine, carmustine, lomustine,
cytarabine, and procarbazine. |
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Radiation
For men and women receiving radiation therapy to the abdomen or pelvis,
the amount of radiation directly to the testes or ovaries is an important
factor. Fertility may be preserved by the use of modern radiation therapy
techniques and the use of lead shields to protect the testes. Women may
undergo surgery to protect the ovaries by moving them out of the field
of radiation. |
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Procreative Alternatives
Patients who are concerned about the effects of cancer treatment on their
ability to have children should discuss this with their doctor before treatment.
The doctor can recommend a counselor or fertility specialist who can discuss
available options and help patients and their partners through the decision-making
process. |
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To Learn More
Call
For more information, U.S. residents may call the National Cancer Institute's
(NCI's) Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237)
Monday through Friday from 9:00 a.m. to 4:30 p.m. Deaf and hard-of-hearing
callers with TTY equipment may call 1-800-332-8615. The call is free and
a trained Cancer Information Specialist is available to answer your questions.
Web sites and Organizations
The NCI's Cancer.gov Web site (http://cancer.gov)
provides online access to information on cancer, clinical trials, and other
Web sites and organizations that offer support and resources for cancer
patients and their families. There are also many other places where people
can get materials and information about cancer treatment and services.
Local hospitals may have information on local and regional agencies that
offer information about finances, getting to and from treatment, receiving
care at home, and dealing with problems associated with cancer treatment.
Publications
The NCI has booklets and other materials for patients, health professionals,
and the public. These publications discuss types of cancer, methods of
cancer treatment, coping with cancer, and clinical trials. Some publications
provide information on tests for cancer, cancer causes and prevention,
cancer statistics, and NCI research activities. NCI materials on these
and other topics may be ordered online or printed directly from the NCI
Publications Locator (http://cissecure.nci.nih.gov/ncipubs).
These materials can also be ordered by telephone from the Cancer Information
Service toll-free at 1-800-4-CANCER (1-800-422-6237), TTY at 1-800-332-8615.
LiveHelp
The NCI's LiveHelp service, a program available on several of the Institute's
Web sites, provides Internet users with the ability to chat online with
an Information Specialist. The service is available from 9:00 a.m. to 10:00
p.m. Eastern time, Monday through Friday. Information Specialists can help
Internet users find information on NCI Web sites and answer questions about
cancer.
Write
For more information from the NCI, please write to this address:
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National Cancer Institute
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Office of Communications
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31 Center Drive, MSC 2580
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Bethesda, MD 20892-2580
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About PDQ
PDQ is a comprehensive cancer database available on Cancer.gov.
PDQ is the National Cancer Institute's (NCI's) comprehensive cancer
information database. Most of the information contained in PDQ is available
online at Cancer.gov (http://cancer.gov),
the NCI's Web site. PDQ is provided as a service of the NCI. The NCI is
part of the National Institutes of Health, the federal government's focal
point for biomedical research.
PDQ contains cancer information summaries.
The PDQ database contains summaries of the latest published information
on cancer prevention, detection, genetics, treatment, supportive care,
and complementary and alternative medicine. Most summaries are available
in two versions. The health professional versions provide detailed information
written in technical language. The patient versions are written in easy-to-understand,
non-technical language. Both versions provide current and accurate cancer
information.
The PDQ cancer information summaries are developed by cancer experts
and reviewed regularly.
Editorial Boards made up of experts in oncology and related specialties
are responsible for writing and maintaining the cancer information summaries.
The summaries are reviewed regularly and changes are made as new information
becomes available. The date on each summary ("Date Last Modified") indicates
the time of the most recent change.
PDQ also contains information on clinical trials.
Some patients have symptoms caused by cancer treatment or by the cancer
itself. Patients who have symptoms related to cancer treatment may want
to take part in a clinical trial. A clinical trial is a study to answer
a scientific question, such as whether one method of treating symptoms
is better than another. Trials are based on past studies and what has been
learned in the laboratory. Each trial answers certain scientific questions
in order to find new and better ways to help cancer patients. During supportive
care clinical trials, information is collected about new treatment methods,
the risks involved, and how well they do or do not work. If a clinical
trial shows that a new treatment is better than one currently being used,
the new treatment may become "standard."
Listings of clinical trials are included in PDQ and are available online
at Cancer.gov (http://cancer.gov/clinical_trials).
Descriptions of the trials are available in health professional and patient
versions. Many cancer doctors who take part in clinical trials are also
listed in PDQ. For more information, call the Cancer Information Service
1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615. |
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