Young women who are cancer survivors may be at a much higher risk of sexual problems, including loss of libido and discomfort, according to research published by Wettergren et al in the journal Acta Oncologica. The study also suggests that cancer type and intensity of treatment may influence the quality of a patient’s sex life.
The findings are based on nearly 700 women diagnosed with breast cancer and other cancers before the age of 40. They show that women who are cancer survivors may be equally sexually active as those without a history of cancer, but a significantly higher proportion experience difficulty with intimacy.
Forty-five percent of patients showed a lack of interest in sex—the most common issue patients with cancer reported—followed by 34% who reported having problems achieving orgasm and 22% who reported problems with feeling satisfaction with their sex life.
These concerns were also common among women without a cancer diagnosis, but to a lesser extent (32%, 28%, and 19%, respectively).
The study authors—including a team of researchers from Uppsala University and the Karolinska Institutet—urged health-care providers to provide sexual well-being support where appropriate. Hormone-replacement therapy, vaginal moisturizers, and psychosexual counseling were among treatment strategies they suggested.
“This is one of the largest population-based studies of sexual function ever conducted in young women following cancer,” said lead author and principal investigator Lena Wettergren, PhD, RN, a Professor in the Department of Public Health and Caring Sciences at Uppsala University and a Professor in the Department of Women’s and Children’s Health at Karolinska Institutet. “Our results show two out of three women [reported] experiencing sexual dysfunction, and the problems are related to their cancer treatment and emotional distress. These findings underscore the need to routinely assess sexual health in clinical care and follow-up. We recommend development of specific interventions directed to women, in addition to offering counseling and other aids.”
Study Background and Details
Every year, more than 500,000 young adult women are diagnosed with cancer globally. Hormone changes and body image issues are among biological and psychological factors that can undermine their participation in or enjoyment of intimacy.
Yet, the full extent of the link between cancer and sexual dysfunction is unknown. Some studies have suggested that around half of young women with cancer report sexual issues in the first few years after diagnosis. However, patients with breast cancer dominate the research, and few studies have compared patients with cancer to those without a history of cancer.
Data was based on 694 women aged 18 to 39 years old diagnosed with cancer between January 2016 and August 2017 who were identified through official national health registries.
Half of the patients had breast cancer, and the rest had been diagnosed with gynecologic cancers, brain tumors, or lymphoma. A total of 53% of patients had undergone treatments rated “very” or “most” based on the level of intensity or extensiveness.
One-and-a-half years after diagnosis, all of the patients were surveyed about their sex lives during the prior month. Questions were based on eight topics relating to sexual activity, such as satisfaction with sex life, interest in sexual activity, discomfort and pain when engaging in sexual activity, and ability to orgasm. They were also asked to rate their emotional distress.
In addition, patients were asked to give reasons for not having sex with a partner and were questioned about body image—such as whether they found it hard to look at themselves naked.
Results were compared with a random sample of 493 women aged 19 to 40 years old without a cancer diagnosis.
Extent of Reported Issues
Findings showed that 83% of women with cancer and 87% of women without cancer had sex in the last 30 days, either with a partner or through masturbation.
However, 63% of patients with cancer complained of at least one sexual issue, such as vulvar discomfort. Survey participants were also more likely, overall, to report issues relating to any type of sexual activity.
Older women and those with breast or gynecologic cancers were at higher risk of sex-related problems. This was also the case with patients undergoing more intense treatments, including high-dose radiotherapy and chemotherapy.
Emotional distress and a distorted body image following cancer treatment were associated with greater sexual dysfunction.
Vaginal dryness or pain and feeling unattractive were the key factors linked to a lack of sexual activity with a partner among patients with cancer. The study authors highlighted that these problems were all potentially related to cancer treatment.
The limitations of the study include the potential that participants may have been more sexually active and had fewer sex problems than the general population, or vice versa. The results, therefore, may overestimate or underestimate the findings. Of those asked to take part in the study, 72% completed the survey.
Dr. Wettergren and colleagues concluded: “The results of the study underscore the need to routinely assess sexual health in clinical care and follow-up. Based on the results, development of interventions to support women to cope with cancer-related sexual dysfunction is recommended.”
Disclosure: For full disclosures of the study authors, visit tandfonline.com.The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.