The Onco Fertility Journal

EDITOR«SQ»S CORNER
Year
: 2019  |  Volume : 2  |  Issue : 1  |  Page : 1--2

Sexual health of breast cancer survivors


Nalini Mahajan 
 Department of Reproductive Medicine, Mother and Child Hospital, New Delhi, India

Correspondence Address:
Dr. Nalini Mahajan
Mother and Child Hospital, D-59 Defence Colony, New Delhi - 110 024
India




How to cite this article:
Mahajan N. Sexual health of breast cancer survivors.Onco Fertil J 2019;2:1-2


How to cite this URL:
Mahajan N. Sexual health of breast cancer survivors. Onco Fertil J [serial online] 2019 [cited 2019 Sep 22 ];2:1-2
Available from: http://www.tofjonline.org/text.asp?2019/2/1/1/261250


Full Text



In recent years, there has been a concerted effort to improve the quality of life of cancer survivors. Fertility issues are gaining prominence, and conception posttreatment is not discouraged. Preservation of fertility and pregnancy-associated breast cancer (BC) were reviewed in the first two issues of the journal while this issue includes a review on pregnancy after BC. Regrettably, there has been only a passing mention of the sexual health of BC survivors in these articles.

Sexual and psychological health, a very important aspect of life quality in cancer survivors, is often overlooked by health-care specialists.[1] BC diagnosis in itself provokes an intense emotional reaction, fear related to the terminal nature of the disease, and anxiety over the multiple side effects of treatment. The rising number of cancer survivors globally makes it mandatory that in addition to curative therapy, we look after their emotional needs, to ensure that they are well adjusted in society.

Sexuality and sexual dysfunction – the emotional and physical aspects of sexual behavior, respectively, are invariably disturbed in cancer patients. Sexuality is defined as the patient's attitude toward intimacy, while sexual dysfunction is caused by the physical and hormonal changes that result from cancer treatment.[2] Sexuality contributes to well-being,[2] and understanding the basis of these issues may provide an insight into its management. BC survivors are engulfed in an emotional quagmire – alopecia, mastectomy, and surgical scarring can lead to poor body image and a loss of desirability. Treatment-related amenorrhea causes symptoms of estrogen deprivation and dyspareunia. The fear of intimacy at both an emotional and physical level results in the woman withdrawing emotionally. Many relationships fall apart because of these issues, and addressing them should be an essential part of treatment. It is believed that when the quality of intimate relationship is good, a woman has better self-esteem and sexual satisfaction. If couple communication is poor, women experience higher levels of depression and sexual problems.[3] Aging per se leads to a decrease in sexual activity and may contribute to sexual problems as BC presents at an older age.[4]

Reports on sexual health of BC survivors suggest that treatment is associated with a substantial decrease in desire, arousal, pleasure, and orgasm. This along with a negative body image and loss of femininity leads to psychological distress which impacts a woman long after completion of successful treatment.[5] Survival and not sex is the priority initially, but as time passes, sexual intimacy becomes important. Women are often hesitant to talk about sexual problems leading to a delay in the management of sexual dysfunction.[6]

What are the solutions to this? Survivorship interventions should include management of physical symptoms and emotional well-being. On the surgical front, it has been reported that women who undergo a nipple-sparing mastectomy and those in whom the nipple-areola complex is retained have a better body image.[2] Estrogen deprivation because of premature menopause and/or hormonal suppression leads to genital atrophy which is not responsive to drugs; hence, sexual rehabilitation needs to be discussed with the patient at the start of treatment. Dyspareunia can be reduced with vaginal dilators and sensate focus exercises.[7] Alopecia is one of the most traumatizing side effects of chemotherapy. Apart from loss of femininity, it is a constant reminder of the disease, and patients perceive it as a violation of privacy – an unspoken proclamation of their disease to the world at large. Support groups, sessions with psychologist, family support, and support from spouse improve the patient's ability to cope. Sexual counseling units should be incorporated into the oncology department to look into the sexual health of cancer survivors. Psychological, emotional, and sexual health should be treated as importantly as treatment of the disease.

It is possible to provide a fairly good quality of life to BC survivors given the improvement in oncological care. However, greater efforts need to be made by health providers to improve patients' emotional and sexual needs so that they lead a more fulfilled life.

References

1Scanlon M, Blaes A, Geller M, Majhail NS, Lindgren B, Haddad T, et al. Patient satisfaction with physician discussions of treatment impact on fertility, menopause and sexual health among pre-menopausal women with cancer. J Cancer 2012;3:217-25.
2Ghizzani A, Bruni S, Luisi S. The sex life of women surviving breast cancer. Gynecol Endocrinol 2018;34:821-5.
3Male DA, Fergus KD, Cullen K. Sexual identity after breast cancer: Sexuality, body image, and relationship repercussions. Curr Opin Support Palliat Care 2016;10:66-74.
4Soldera SV, Ennis M, Lohmann AE, Goodwin PJ. Sexual health in long-term breast cancer survivors. Breast Cancer Res Treat 2018;172:159-66.
5Gilbert E, Ussher JM, Perz J. Sexuality after breast cancer: A review. Maturitas 2010;66:397-407.
6McClelland SI, Holland KJ, Griggs JJ. Quality of life and metastatic breast cancer: The role of body image, disease site, and time since diagnosis. Qual Life Res 2015;24:2939-43.
7De Villers L, Turgeon H. The uses and benefits of “sensate focus” exercises. Contemp Sex 2005;39:11.